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Overuse injuries caused by repetition

By Doug Haltom, M.D.

Sports requiring repetitive overhead motion, such as baseball, can lead to shoulder and elbow overuse injuries, especially in children and adolescents.

Unique to children and adolescents are their developing physes, or growth plates. These areas are inherently weak and are therefore susceptible to overuse injuries.

Growth plates are the areas of bone that contribute to the growth of that particular bone.These areas are weaker than the tendons and ligaments that attach to them, making them more susceptible to overuse

injuries. The proximal (upper) part of the humerus at the shoulder and the medial (inside) part of the elbow are the most common areas for these types of injuries in adolescents.
Little League shoulder is the term used for this type of injury to the growth plate in the shoulder. This occurs from repetitive microtrauma from overhead activities, such as throwing. Patients complain of shoulder pain, made worse with throwing.

A recent increase in the amount of throwing often precedes the symptoms. Patients usually have tenderness of the shoulder and weakness of the shoulder muscles. X-rays often show widening of the growth plate. (See image, inside.)

Likewise, Little League elbow is a term used to describe an overuse injury to the inside part of the elbow’s growth plate and its surrounding structures. This area does see significant tension during a portion of the throwing motion. (See picture, below.)

Patients complain of elbow pain, decreased throwing velocity, and decreased throwing distance. X-rays can be normal or can show several distinctive growth plate abnormalities around that part of the growth plate. Treatment for both of these conditions is rest. The initial period of rest and avoidance of throwing is usually four to eight weeks, followed by stretching, strengthening and a throwing progression. Athletes usually return to their pre-injury level of play, and long-term consequences are rare. Proper throwing mechanics and careful attention to pitch counts (specific for age) are very important in preventing these overuse injuries.

Prevention tips

Overuse injuries, especially those related to the shoulder and ulnar collateral ligament in the elbow, are preventable.

Here are some tips to keep you healthy and in the game…

• Warm up properly with stretching, running and easy, gradual throwing.
• Rotate playing other positions besides pitcher.
• Concentrate on age-appropriate pitching. Master the fastball first and the change-up second, before considering breaking pitches. (See box, top right.)
• Adhere to pitch count guidelines.
• Don’t pitch with elbow or shoulder pain; see a doctor if the pain persists.
• Don’t pitch on consecutive days.
• Don’t play year-round.
• Never use a radar gun.
• Communicate regularly about how your arm is feeling and if there is pain.
• Avoid pitching on multiple teams with overlapping seasons.
• Emphasize control, accuracy and good mechanics.
• Speak with a sports medicine professional or athletic trainer if you have concerns about baseball injuries or injury prevention strategies.

These sports tips provide general information only and are not a substitute for your own good judgment or consultation with a physician. Information is provided through the website, www.STOPSportsinjuries.org.