A Clinical and Ultrasonographic Study of Risk Factors for Elbow Injury in Young Baseball Players

Background: Elbow injuries are exceedingly common in baseball players. Previous studies have identified that upper extremity strength and range of motion deficits pose a risk for these injuries, but few studies have examined the effect of lower extremity deficits. Given the role of the lower extremity in the kinetic chain of the baseball throwing motion, lower body deficits may affect the kinematics of the upper extremity and play a role in the elbow injury of baseball players. Purpose: To systematically review the current literature investigating the association of trunk and lower extremity deficits with elbow pain or injury in baseball players. Study Design: Systematic review. Methods: A systematic review of the literature was performed according to the PRISMA (Preferred Reporting Items for Systematic Meta-Analyses) guidelines to identify and analyze all previous studies focused on the association of elbow pain and/or injury with functional deficits of the trunk and lower extremities. Results: A total of 14 studies met inclusion criteria, examining a range of baseball players extending from youth to professional athletes. One of the 14 studies examined other types of overhead throwing athletes alongside baseball players. Lower extremity–related risk factors for elbow pain and injury in these athletes were found and stratified per level of play. Factors included specific hip range of motion, lower extremity injury or pain, balance, and foot arch posture. Associations were also found with lower extremity injury and noncompliance with primary prevention programs. Conclusion: Specific lower extremity deficits were found to be independent risk factors for elbow pain and injury in throwing athletes at certain levels of play. Additionally, prevention programs designed to correct deficits in identified risk factors were effective in reducing the incidence of elbow injury in youth athletes. These results highlight the potential of screening and subsequent intervention to reduce the incidence of elbow injury in certain subsets of baseball players.

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Risk Factors for Baseball-Related Arm Injuries: A Systematic Review

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119825557 ◽

2019 ◽

Vol 7 (2) ◽

pp. 232596711982555 ◽

Cited By ~ 9

Author(s):

Cristine E. Agresta ◽

Kevin Krieg ◽

Michael T. Freehill

Keyword(s):

Risk Factors ◽

Cohort Studies ◽

Prospective Cohort ◽

Injury Risk ◽

Significant Risk ◽

Baseball Players ◽

Elbow Injury ◽

Prospective Cohort Studies ◽

Shoulder Range Of Motion ◽

Arm Injuries

Background: Contributing factors for arm injuries among baseball players have been described. However, no review has systematically identified risk factors with findings from prospective cohort studies. Purpose: To systematically review prospective cohort studies that investigated risk factors for arm injury among baseball players. Study Design: Systematic review; Level of evidence, 3. Methods: Electronic databases were searched for relevant English-language studies. Titles, abstracts, and full-text articles were screened by 2 blinded reviewers to identify only prospective cohort studies and randomized controlled trials. Two independent investigators screened each article for appropriate criteria. Results: Fourteen prospective articles were selected for this review. Youth, high school, and professional baseball players (N = 2426) were pooled, and 43 risk factors were assessed in relation to general arm, shoulder, and elbow injuries. All studies evaluated players for at least 1 season. Deficits in preseason shoulder range of motion and strength were significant risk factors for general arm or shoulder injury among high school and professional players. Elbow and shoulder varus torque at peak external shoulder rotation during pitching, high pitch velocity, and shoulder rotational and flexion deficits were risk factors for elbow injuries among professional pitchers. Pitching >100 innings in 1 year, being aged 9 to 11 years, being a pitcher or catcher, training >16 hours per week, and having a history of elbow pain were significant risk factors for elbow injury among youth players. Conclusion: History of elbow pain and age had a high risk of associated elbow injury among youth players. Training or pitching load also increased elbow injury risk for youth athletes. Loss of shoulder range of motion appears to increase risk for elbow injury among professional athletes. Single time-point data collections per season, studies with the same sample population, and studies with self-reported injury and risk factor data may limit the interpretation of these findings. Health care professionals should use caution when assessing injury risk during evaluation and making decisions about the training workload and playing time of baseball players.

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Physical Risk Factors for a Medial Elbow Injury in Junior Baseball Players: A Prospective Cohort Study of 353 Players

The American Journal of Sports Medicine ◽

10.1177/0363546516663931 ◽

2016 ◽

Vol 45 (1) ◽

pp. 135-143 ◽

Cited By ~ 27

Author(s):

Jun Sakata ◽

Emi Nakamura ◽

Makoto Suzukawa ◽

Atsushi Akaike ◽

Kuniaki Shimizu

Keyword(s):

Risk Factors ◽

Physical Function ◽

Thoracic Kyphosis ◽

Elbow Extension ◽

Kyphosis Angle ◽

Extension Deficit ◽

Baseball Players ◽

Elbow Injury ◽

Physical Risk ◽

Physical Risk Factors

Background: The physical risk factors for a medial elbow injury in junior baseball players are unknown. Purpose: To identify the risk factors for an initial medial elbow injury in junior baseball players. Study Design: Case-control study; Level of evidence, 3. Methods: Junior baseball players (aged 6-12 years) without a history of elbow pain underwent a clinical assessment, ultrasonography, and physical function measurements before the baseball season started. Bilateral passive range of motion (ROM) of elbow extension and flexion, external rotation (ER) and internal rotation (IR) of the shoulder, and ER and IR of the hip were measured. IR and ER strength of the shoulder and scapular muscles were measured on both sides. The thoracic kyphosis angle was measured with participants in a relaxed standing position. Before these examinations, every participant completed a questionnaire regarding his or her age, sex, total years of baseball played, position in baseball, number of balls thrown, and episodes of pain during throwing. After the initial test session, each participant was followed up for 12 months to assess for the occurrence of a new injury. Multiple regression analysis was used to identify the risk factors for a medial elbow injury. Results: Seventy-eight players (22.1%) sustained a medial elbow injury. Age ≥9 years (odds ratio [OR], 2.708; 95% CI, 1.224-5.990), pitcher position (OR, 2.620; 95% CI, 1.389-4.941), >100 throws per day (OR, 1.936; 95% CI, 1.072-3.497), thoracic kyphosis angle ≥30° (OR, 2.501; 95% CI, 1.381-4.531), and elbow extension deficit ≥5° (OR, 1.973; 95% CI, 1.022-3.809) were significantly associated with a medial elbow injury. Conclusion: The incidence of an initial medial elbow injury was 22.1%. Age, number of throws per day, thoracic kyphosis angle, and elbow extension deficit are newly discovered risk factors related to physical function. Improvement of the posture and early detection of a silent elbow extension deficit may prevent a medial elbow injury.

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Asymptomatic Medial Elbow Ultrasound Abnormality in Youth Baseball Players Is an Independent Risk Factor for Elbow Injury: A Prospective Cohort Study

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120986791 ◽

2021 ◽

Vol 9 (4) ◽

pp. 232596712098679

Author(s):

Hitoshi Shitara ◽

Tsuyoshi Tajika ◽

Takuro Kuboi ◽

Tsuyoshi Ichinose ◽

Tsuyoshi Sasaki ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Cohort Study ◽

External Rotation ◽

Medial Epicondyle ◽

Baseball Players ◽

Elbow Pain ◽

Elbow Injury ◽

Youth Baseball ◽

Elbow Injuries

Background: Youth baseball players who experience elbow pain during the season frequently exhibit radiographic elbow abnormalities. However, it is unknown whether asymptomatic elbow abnormalities are risk factors for in-season elbow injuries. Purpose: To determine whether the preseason presence of asymptomatic medial epicondyle apophysitis is a risk factor for in-season elbow injuries in youth baseball players. Study Design: Cohort study; Level of evidence, 2. Methods: Youth baseball players (N = 210; age range, 7-12 years) with no pain or history of injury in their throwing arms underwent preseason evaluations that included shoulder and elbow range of motion measurements, shoulder muscle strength testing, and ultrasound elbow scans with a multifrequency 13-MHz linear array transducer. Over 1 year of play, the players and their parents maintained daily elbow pain diaries. Elbow injuries were defined as medial elbow symptoms that prevented ball throwing for ≥8 days. Results: The preseason ultrasound evaluation revealed medial epicondyle apophysitis in 59 players. In the year following, elbow injuries occurred in 17 (28.8%) players with preseason medial epicondyle apophysitis and 18 (11.9%) players without apophysitis. Independent predictors of elbow injuries were preseason medial epicondyle apophysitis (odds ratio [OR], 2.488; 95% confidence interval [CI], 1.152-5.376; P = .02) and deficits of abduction (ABD) and external rotation of the dominant shoulder (OR, 0.963; 95% CI, 0.936-0.992; P = .012). Conclusion: Asymptomatic medial epicondyle apophysitis and ABD and external rotation deficits in the dominant shoulder were risk factors for elbow injuries in 7- to 12-year-old youth baseball players. These findings may aid in the design of programs to prevent elbow injuries in this population.

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A Preseason Checklist for Predicting Elbow Injury in Little League Baseball Players

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967114566788 ◽

2015 ◽

Vol 3 (1) ◽

pp. 232596711456678 ◽

Cited By ~ 6

Author(s):

Taiki Yukutake ◽

Masumi Kuwata ◽

Minoru Yamada ◽

Tomoki Aoyama

Keyword(s):

Baseball Players ◽

Elbow Injury ◽

Little League

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Increased pitch velocity and workload are common risk factors for ulnar collateral ligament injury in baseball players: a systematic review

Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine ◽

10.1136/jisakos-2018-000226 ◽

2018 ◽

Vol 4 (1) ◽

pp. 41-47

Author(s):

Ryan P Coughlin ◽

Yung Lee ◽

Nolan S Horner ◽

Nicole Simunovic ◽

Edwin R Cadet ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Injury Prevention ◽

Ulnar Collateral Ligament ◽

Quality Data ◽

Sufficient Evidence ◽

Collateral Ligament ◽

Level Of Evidence ◽

Baseball Players ◽

The Impact

ImportanceUlnar collateral ligament (UCL) injuries commonly occur in baseball players. Strategies for injury prevention have long been accepted without clinical data informing which risk factors lead to serious injury.ObjectiveThe objective of this study was to systematically review the impact of various pitching-related risk factors for UCL injury in baseball players from all levels of play.Evidence reviewThe electronic databases MEDLINE, EMBASE and PubMed were systematically searched until 4 March 2018, and pertinent data were abstracted by two independent reviewers. Search terms included ‘ulnar collateral ligament’, ‘medial ulnar collateral ligament’, ‘Tommy John’, ‘risk’ and ‘association’. Inclusion criteria were English-language studies, level of evidence I–IV and studies reporting risk factors for UCL injury of the elbow in baseball players. Study quality was assessed using the methodological index for non-randomised studies (MINORS) criteria. The results are presented in a narrative summary.FindingsPitching practices (workload and pitch characteristics) were reported in 9/15 studies. Specifically, three of four studies (n=1810) reported increased pitch workload as a risk factor for native UCL injury (p<0.001 to 0.02). The most common pitch characteristic reported was pitch velocity with four of five studies showing increased velocity being significantly associated with native UCL injury (p<0.01 to 0.02). Biomechanical risk factors reported were increased humeral retrotorsion (two studies; n=324), poor lower extremity and trunk balance (one study; n=42) and loss of total arc of shoulder motion (two studies; n=118), all significantly associated with UCL injury (p<0.0001 to 0.05). One of three studies assessing pitch workload as a risk factor for re-rupture of UCL reconstruction found a significant association (p<0.01).Conclusions and relevancePitching practices, reflected by increased pitch workload and velocity, were most commonly associated with UCL injury; however, the definition of workload (number of pitches per game, inning or season) was inconsistently reported. Biomechanical risk factors were less commonly reported and lack sufficient evidence to recommend preventative strategies. More quality data is needed to refine the current recommendations for injury prevention in baseball players.Level of evidenceIII.

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Increasing Burden of Youth Baseball Elbow Injuries in US Emergency Departments

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119845636 ◽

2019 ◽

Vol 7 (5) ◽

pp. 232596711984563 ◽

Cited By ~ 5

Author(s):

David P. Trofa ◽

Kyle K. Obana ◽

Hasani W. Swindell ◽

Brian Shiu ◽

Manish S. Noticewala ◽

...

Keyword(s):

Linear Regression Analysis ◽

Shoulder Injuries ◽

Injury Surveillance System ◽

Baseball Players ◽

Elbow Injury ◽

Youth Athletes ◽

Increased Risk ◽

Youth Baseball ◽

Elbow Injuries ◽

Over Time

Background: Youth athletes are starting sports earlier and training harder. Intense, year-round demands are encouraging early sports specialization under the perception that it will improve the odds of future elite performance. Unfortunately, there is growing evidence that early specialization is associated with increased risk of injury and burnout. This is especially true of pediatric and adolescent baseball players. Purpose/Hypothesis: The purpose of this investigation was to analyze national injury trends of youth baseball players. We hypothesized that while the total number of baseball injuries diagnosed over the past decade would decrease, there would be an increase in adolescent elbow injuries seen nationally. A further hypothesis was that this trend would be significantly greater than other injuries to the upper extremity and major joints. Study Design: Descriptive epidemiology study. Methods: Injury data from the National Electronic Injury Surveillance System, a United States Consumer Product Safety Commission database, were analyzed between January 1, 2006, and December 31, 2016, for baseball players aged ≤18 years. Data were collected on the location of injury, diagnosis, and mechanism of injury. Results: Between 2006 and 2016, an estimated 665,133 baseball injuries occurred nationally. The mean age of the injured players was 11.5 years. The most common injuries diagnosed included contusions (26.8%), fractures (23.6%), and strains and sprains (18.7%). Among major joints, the ankle (25.6%) was most commonly injured, followed by the knee (21.3%), wrist (19.2%), elbow (17.7%), and shoulder (16.2%). The incidence of the ankle, knee, wrist, and shoulder injuries decreased over time, while only the incidence of elbow injuries increased. A linear regression analysis demonstrated that the increasing incidence of elbow injuries was statistically significant against the decreasing trend for all baseball injury diagnoses, as well as ankle, knee, wrist, hand, and finger injuries ( P < .05). Additionally, the only elbow injury mechanism that increased substantially over time was throwing. Conclusion: The current investigation found that while the incidence of baseball injuries sustained by youth players is decreasing, elbow pathology is becoming more prevalent and is more commonly being caused by throwing. Given that the majority of elbow injuries among adolescent baseball players are overuse injuries, these findings underscore the importance of developing strategies to continue to ensure the safety of these youth athletes.

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Comparison of Cardiovascular and Metabolic Risk Factors in Professional Baseball Players Versus Professional Football Players

The American Journal of Cardiology ◽

10.1016/j.amjcard.2010.04.022 ◽

2010 ◽

Vol 106 (5) ◽

pp. 664-667 ◽

Cited By ~ 11

Author(s):

John H. Helzberg ◽

Joseph F. Waeckerle ◽

Joel Camilo ◽

Michael A. Selden ◽

Fengming Tang ◽

...

Keyword(s):

Risk Factors ◽

Metabolic Risk Factors ◽

Professional Baseball ◽

Football Players ◽

Metabolic Risk ◽

Professional Football ◽

Baseball Players

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Shoulder Range of Motion Deficits in Baseball Players With an Ulnar Collateral Ligament Tear

The American Journal of Sports Medicine ◽

10.1177/0363546512459175 ◽

2012 ◽

Vol 40 (11) ◽

pp. 2597-2603 ◽

Cited By ~ 56

Author(s):

J. Craig Garrison ◽

Mollie A. Cole ◽

John E. Conway ◽

Michael J. Macko ◽

Charles Thigpen ◽

...

Keyword(s):

Range Of Motion ◽

Internal Rotation ◽

Ulnar Collateral Ligament ◽

Control Group ◽

Elbow Extension ◽

Collateral Ligament ◽

Baseball Players ◽

Elbow Injury ◽

Shoulder Range Of Motion ◽

Shoulder Range

Background: Shoulder range of motion (ROM) deficits are associated with elbow injury in baseball players. Purpose: To compare the ROM characteristics of baseball players with a diagnosed ulnar collateral ligament (UCL) tear with those of a group of age-, activity-, and position-matched healthy controls. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Sixty male competitive high school and collegiate baseball players participated. Thirty athletes (age [mean ± standard deviation], 18.20 ± 1.56 years) with a diagnosed UCL tear were compared with 30 (age, 18.57 ± 0.86 years) age-, activity-, and position-matched players without a UCL injury. Of the 60 participants, there were 44 pitchers, 4 catchers, 5 infielders, and 7 outfielders. Participants were measured for shoulder internal rotation (IR), external rotation (ER), and horizontal adduction (HA) at 90° of shoulder elevation. Participants were also measured for elbow extension in a seated position. Group comparisons were made between participants with and without a UCL injury using independent t tests with an α level set at P < .05. All measurements were taken bilaterally, and the differences (involved to uninvolved) were used to calculate means for all variables, including glenohumeral internal rotation deficit (GIRD), total rotational motion (TRM), HA, and elbow extension. Results: Baseball players with a UCL tear (UCLInj) exhibited significantly greater deficits in TRM compared with the control group of healthy baseball players (NUCLInj) (UCLInj = −6.67° ± 11.82°, NUCLInj = 0.93° ± 9.91°; P = .009). No group differences were present for GIRD (UCLInj = −12.53° ± 5.98°, NUCLInj = −13.63° ± 5.90°; P = .476), HA (UCLInj = −3.00° ± 5.01°, NUCLInj = −3.23° ± 5.15°; P = .860), or elbow extension (UCLInj = −2.63° ± 7.86°, NUCLInj = −1.17° ± 2.76°; P = .339). Pitchers with a UCL tear had significantly greater deficits in TRM (UCLInjPitch = −6.96° ± 11.20°, NUCLInjPitch = 1.29° ± 8.33°; P = .0087) and dominant shoulder ER (UCLInjPitch = 112.04° ± 14.35°, NUCLInjPitch = 121.85° ± 9.46°; P = .011) than pitchers without a UCL tear. Conclusion: A deficit in TRM is associated with a UCL tear in baseball players. Although GIRD may be prevalent in throwers, it may not be associated with a UCL injury. When examining ROM in baseball players, it is important to assess both TRM and GIRD.

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