In this week?s installment of Ask the Expert, Dr. Joshua Dines, Orthopedic Surgeon, answers questions on Little League injuries, including those found in the shoulder and elbow.
Shoulder and elbow injuries are common in young athletes.?This is due to the nature of many overhand sports, such as baseball, which subject the shoulder and elbow to repetitive motion over extended periods of time.?Athletes who play these sports often develop chronic and overuse injuries. It is important to have a good understanding of the major anatomic structures at risk, so that it can be discussed how they get injured and what to do to get them better.
Common Shoulder Injuries
Shoulder injuries can be divided into those that occur more acutely versus those that are more chronic in nature. Little Leaguer?s Shoulder is one of the most common injuries in young kids who play overhand sports. Repetitive forces lead to inflammation in the growth plate or physis. As athletes get older and the growth plates close, tendons become the weaker link during the throwing motion. Symptoms include pain when throwing, decreased velocity, pain with overhead activities. Rotator cuff tears are usually encountered in older patients, but occasionally these do occur in teenagers.
The diagnosis of these injuries begins with evaluation by a physician who will perform a history and physical exam. Diagnosis is confirmed by x-rays and/or MRI. Conservative treatment is the mainstay for overuse-type shoulder (and elbow) injuries in young athletes. This involves rest from the offending activity and, often, a period of structured physical therapy. Therapists will focus on decreasing inflammation then increasing joint range of motion and strength. Anti-inflammatories and icing of the injured body part can help speed up the recovery.
Common Elbow Injuries
Three of the most common elbow injuries in young athletes include Little Leaguer?s Elbow, osteochondritis dissecans, and ulnar collateral ligament injury. Little Leaguer?s Elbow, as the name implies, typically affects throwing athletes. The throwing motion puts significant stress on the elbow in three places: medially on the medial epicondyle and ulnar collateral ligament; laterally on the radial head and capitellum; and posteriorly on the olecranon. Repetitive throwing can cause inflammation in the growth plate of the medial epicondyle or even fractures of the epicondyle. Fracture due to overuse often follows a prodrome of pain in the area without treatment. For this reason, any young athlete with medial-sided elbow pain should refrain from throwing until asymptomatic. In these cases, physical therapy and anti-inflammatory medications can help speed up the recovery.
Ulnar collateral ligament tears can also cause medial sided elbow pain, though these injuries more commonly affect older athletes. While a detailed history and physical exam can diagnose such an injury, MRI is used to confirm the diagnosis. Particularly in young athletes, a trial of conservative treatment should be attempted prior to considering surgery. If conservative treatment fails, ulnar collateral ligament reconstruction (i.e. Tommy John Surgery) can provide excellent outcomes. However, a long recovery, up to a year after surgery, is required.
On the lateral side of the elbow, compression of the radial head into the capitellum during the throwing motion commonly causes osteochondrosis of the capitellum (Panner?s Disease) or osteochondritis dissecans (OCD) of the capitellum. Panner?s disease preferentially affects young children under the age of 13 and presents with activity related pain. This is a self-limiting condition that typically resolves over time with rest. In contrast, OCD of the capitellum is seen in teenagers. It is a localized injury to the cartilage and underlying subchondral bone in the capitellum. In addition to being painful, swelling and decreased range of motion are common symptoms. In some cases, the lesion will break off resulting in a loose body in the joint. Younger patients with more mild lesions respond well to rest; whereas older patients with more severe lesions may require surgery.
Injury Prevention & Recovery
Strength training can increase muscle strength and endurance, which can help athletes perform better and prevent injury. While some experts suggest that it is okay to start strength training at about 7 or 8 years old, the key is waiting until your child has appropriate balance and posture control. Strength training, which involves the use of weights, tubing or even body-weight resistance exercises to increase strength, differs from body-building or weightlifting where the goal is get bigger.
The keys to strength training in young athletes are focusing on form and safety. Proper technique should be emphasized. Lifting weights that are too heavy can put too much stress on developing tendons, ligaments and growth plates. Young children are much better off doing one set of 10-12 repetitions at a lighter weight focusing on perfect form. Make sure to supervise young children when they are working out. And, make sure the kids are having fun!
To all young athletes, check out the following infographic on preventing baseball injuries brought to you by the Sports Medicine and Shoulder Service:
Dr. Joshua Dines?is an orthopedic surgeon and a member of the Sports Medicine and Shoulder Service at Hospital for Special Surgery. He was the team doctor for the U.S. Davis cup tennis team, and currently serves as an assistant team physician for the New York Mets and a sports medicine orthopedic consultant for the NY Rangers.