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Caution About Year Round Pitching

This week we’d like to highlight a recently published clinical study assessing elbow MRI abnormalities in young baseball players. This well conducted study is a three year follow-up to a previously performed MRI study. In the current study the authors found that 58% of the young players had MRI abnormalities on the most recent MRI scans, up from 35% on the initial preseason MRIs at the start of the study.

There is increasing evidence about the risk to the young player’s elbow from year-round baseball participation. The risk is especially high for year-round pitching. This study along with other available evidence suggests that year-round pitching is not only a risk factor for an abnormal MRI but also a risk factor for injury and loss of performance. Most sports medicine physicians recommend that young pitchers follow guidance from MLB’s PitchSmart. We also recommend multisport participation for athletes up until about age 14.

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“Fortnite Shoulder”?

We are now about two weeks away from the start of the 2019 Little League World Series. There will be a lot of baseball, of course, but there’ll also be a lot of Fortnite and other video games being played. With that in mind I thought it would be interesting to take a look at an article published in 2018 showing a strong association between videogame playing and risk of shoulder and elbow injuries in baseball players.

Researchers from the Tohoku University School of Medicine in Japan found that players who spent three or more hours daily on videogames were 5.6 times more likely to have felt elbow or shoulder pain in the prior year than those who played videogames for less than an hour a day.

Could this possibly be real? Do we actually need to add extensive videogame playing to the list of risk factors for shoulder and elbow injuries amongst young baseball players?

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“Tommy John” Surgery Does Not Make You Throw Better Than You Did Before

We now have a solid understanding of the behaviors that place a thrower at risk for elbow injuries, but making inroads in changing that behavior remains a challenge. For example, 40% of youth pitchers report throwing in chronic elbow pain, and 25% of Major League Baseball pitchershad “Tommy John” surgery at some point in their career.

The reality is that surgery to reconstruct a torn ulnar collateral ligament (UCL) does not make the elbow stronger and better than it was before the injury. Many pitchers do successfully compete again after surgery but it’s likely due to extensive rehabilitation to correct underlying functional issues as much as it is to skillful surgery.

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Predicting Baseball Related Arm Injury

It would be great if we could take a young baseball player and be able to accurately predict arm injury risk for that player. If we could identify specific factors we could take steps proactively to prevent injury. A recently published study shows that we are closer to being able to identify cause and effect for elbow injuries in young baseball players but still need quite a bit more data to conclusively show cause and effect for shoulder injuries.

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New Treatment For Elbow Ligament Injury: Possible To Cut Rehab Time In Half

The ulnar collateral ligament in the elbow is a critical stabilizer, and one that gets stressed during the baseball pitch. We’ve seen a substantial increase in tears of the ulnar collateral ligament in all age groups but especially in teenage pitchers. The standard of care for those athletes choosing surgery is a ligament reconstruction commonly known as “The Tommy John” procedure. The traditional surgery has undergone refinements over the years and has a high success rate, but the downside is that return to competitive pitching takes more than a year, often around 16 months (that’s two seasons of sport…). But a new procedure offers the chance to potentially cut the rehab time and return to play time to less than half.

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Help For Elbow Injuries In Pitchers? A Prevention Program Offers Hope.

By Dev Mishra, M.D. President, Sideline Sports Doc Clinical Assistant Professor of Orthopedic Surgery, Stanford University Key Points: Overuse injuries to the elbow are common in young baseball players, and prevention programs are needed to reduce injury risk A recently published scientific study highlighted the potential benefit of a stretching program called the Yokohama Baseball-9,…

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100 Innings
Can 6 Questions Predict Elbow Injury Risk For Young Pitchers?

By Dev K. Mishra, M.D. President, Sideline Sports Doc Clinical Assistant Professor of Orthopedic Surgery, Stanford University Key Points: We are gaining more knowledge about the factors responsible for overuse injuries and catastrophic elbow ligament tears in young pitchers It is far better to monitor and reduce load when appropriate to prevent injury, than to…

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Youth Pitchers
Baseball After “Tommy John” Surgery: High Return To Play Rates

By Dev K. Mishra, M.D. President, Sideline Sports Doc Clinical Assistant Professor of Orthopedic Surgery, Stanford University Key Points: Surgery to reconstruct the torn ulnar collateral ligament in the elbow can result in return to play rates around 90% for high school aged athletes If you’re talented enough to be drafted in MLB, your elbow…

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Pitch Smart Recommendations for Youth Baseball

By Dev K. Mishra, M.D. President, Sideline Sports Doc Clinical Assistant Professor of Orthopedic Surgery, Stanford University Key Points: Young pitchers are at risk for arm injuries due to a number of factors, and pitching while fatigued is perhaps the biggest risk for injury MLB’s Pitch Smart guidelines are designed to reduce injury risk while…

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Pitchers: strengthen your legs and core to improve your pitching

By Dev K. Mishra, M.D. President, Sideline Sports Doc Clinical Assistant Professor of Orthopedic Surgery, Stanford University Key Points: A recently presented study from orthopedic surgeons at Midwest Orthopaedics at Rush sheds further light on the risk factors for injury in elite adolescent pitchers The study strongly supports the idea that fatigue is a contributing…

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