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Pediatric throwing injuries about the elbow
Abstract
Pediatric elbow injuries that result from repetitive throwing-type activities are common. These injuries differ from those seen in adults, because of anatomic differences. The purpose of this paper is twofold: first, to review the anatomy of the elbow and the mechanics of the throwing motion about the elbow, and second, to discuss the diagnosis, treatment, rehabilitation, and prevention of pediatric throwing injuries of the elbow.
... This group, however, did not include or identify a subgroup of throwing athletes, and the authors did note a trend toward an increase in the presence of mild ulnar nerve symptoms in the pseudoarthrotic group [33]. If conservative management is indicated, the authors of this article advocate immobilization at 90° flexion in a long-arm posterior splint with the forearm in moderate pronation for up to 2 to 3 weeks [3,19,38]. A hinged elbow orthosis is applied as soon as the patient's symptoms allow, and is used for up to 6 weeks to achieve optimal range of motion with active-assist range-ofmotion exercises. ...
... Medial epicondylar apophysitis results from repetitive tensile stress on the medial epicondyle, caused by the flexor-pronator muscle mass and the medial collateral ligament. These valgus stresses result in repetitive microtrauma and ultimately lead to stress fracture failure of the medial epicondylar apophysis [1,38]. Medial epicondylar apophysitis frequently presents with an insidious onset of progressively worsening medial elbow pain that occurs with throwing activities. ...
... The acceleration phase of throwing in the overhead athlete subjects the olecranon to repetitive forceful contraction of the triceps, which may result in olecranon apophyseal injury [19,31,38,47]. These repetitive forceful triceps contractions required for powerful overhead throwing are thought to place a distraction force across the epiphysis, and Gore et al hypothesized that the etiology of olecranon apophyseal injury is a traction apophysitis similar to that which occurs at the medial epicondyle [48]. ...
Elbow injuries in skeletally immature athletes continue to increase as juvenile and adolescent athletes participate in organized athletics at earlier ages and with greater intensity. Specialization in specific sports at younger ages has led to an increase in injuries related to repetitive microtrauma. As a result, the spectrum of injuries commonly seen in skeletally immature athletes has increased at a time when long-term outcomes and less invasive interventions with biologic principles are gaining greater attention. Optimal treatment of these injuries requires a knowledge of the complex developmental and radiographic anatomy, the pathophysiology and natural history, and the indications and expected outcomes for conservative and operative management.
... Injuries to the elbow in both adult and youth baseball pitchers are quite common. 4,10,11,27,28,30,41 Pitching biomechanics, in particular the ballistic movements of the arm while throwing, have been blamed for many of these injuries. 36 Because of the likely relationship between pitching biomechanics and the loads experienced by the elbow, the biomechanics of the throwing elbow in adults have been well described. ...
... In fact, the elbow is one of the most common sites of overuse injuries in youth baseball players. 11,22,23,27,30,32 More than one quarter of youth baseball pitchers, observed over two baseball seasons, reported elbow pain in one study. 31 Given the high incidence of such problems, it is surprising that the biomechanics of youth baseball pitchers have not been studied as extensively as those of adults. ...
During the pitching motion, velocity is generated by the upper extremity kinetic chain on internal rotation of the shoulder and trunk translational/rotational motion. This generation of power places significant forces and torques on the elbow and shoulder. Elbow valgus torque and shoulder rotational torque are theoretically linked to elbow injury.
Pitchers experiencing higher levels of elbow valgus torque and shoulder external rotation torque throughout the pitching motion are more likely to suffer elbow injury than pitchers with lower levels of torque.
Cohort study; Level of evidence, 3.
With an established biomechanical analysis model, 23 professional baseball pitchers were videotaped during spring training games and followed prospectively for the next 3 seasons for elbow injury. A mixed statistical model using differences of least squares means and analysis of variance was used to analyze the association between elbow injury and torque levels throughout the pitching motion as well as at each major event within the pitching motion.
There were overall statistical trends relating elbow injury with both higher elbow valgus torque (P = .0547) and higher shoulder external rotation torque (P = .0548) throughout the entire pitching motion. More importantly, there was an individual significant correlation of elbow injury with both higher elbow valgus torque (P = .0130) and higher shoulder external rotation torque (P = .0018) at the late cocking phase (pitching event of maximum external rotation of the shoulder).
This study provides information that supports existing theories about how and why certain injuries occur during the throwing motion in baseball. The late cocking phase appears to be the critical point in the pitching motion, where higher levels of torque at the shoulder and elbow can result in increased risk of injury. Manipulation of pitching mechanics to alter these torque levels or using these measures to identify pitchers at risk may help decrease injury rates.
... Injuries to the elbow in both adult and youth baseball pitchers are quite common. 4,10,11,27,28,30,41 Pitching biomechanics, in particular the ballistic movements of the arm while throwing, have been blamed for many of these injuries. 36 Because of the likely relationship between pitching biomechanics and the loads experienced by the elbow, the biomechanics of the throwing elbow in adults have been well described. ...
... In fact, the elbow is one of the most common sites of overuse injuries in youth baseball players. 11,22,23,27,30,32 More than one quarter of youth baseball pitchers, observed over two baseball seasons, reported elbow pain in one study. 31 Given the high incidence of such problems, it is surprising that the biomechanics of youth baseball pitchers have not been studied as extensively as those of adults. ...
The purpose of this study was to determine the biomechanical and anthropometric factors contributing to elbow valgus torque during pitching. Video data of 14 youth pitchers throwing fastballs were used to calculate shoulder and elbow kinematics and kinetics. Peak elbow valgus torque averaged 18 Nm and occurred just before maximal shoulder external rotation. The magnitude of valgus torque was most closely correlated with the thrower's weight. When subject weight and height were controlled for, maximum shoulder abduction torque and maximum shoulder internal rotation torque were most strongly associated with elbow valgus torque, accounting for 85% of its variance (P <.001). When only kinematic variables were considered, maximum shoulder external rotation accounted for 33% of the variance in valgus torque. Given that the biomechanical variables correlated with peak valgus torque are not easily modifiable, limiting the number of innings pitched is likely the best way to reduce elbow injury in youth pitchers.
... Takve su vjeaebe i testiranja uËinkoviti i bezopasni upravo zbog moguÊnosti velikih miπiÊnih optereÊenja uz vrlo malo optereÊenje samog zgloba (25)(26)(27)(28)(29). IzokinetiËko vjeaebanje danas u nas i svijetu ima jednu od vodeÊih uloga u lijeËenju ozljeda i oπteÊenja koljenskog zgloba buduÊi da skraÊuje trajanje rehabilitacijskog postupka za 50%. Osim toga izokinetiËkim Slika 2 Vjeaeba jaËanja muskulature natkoljenica: A -koncentriËna vjeaeba, B -ekscentriËna vjeaeba se treningom usporedo radi na snazi antagonistiËke muskulature koja rezultira proporcionalnim optereÊenjem tretiranoga zglobnog sklopa, koji je tada manje podloaean razvoju novih ozljeda i oπteÊenja (25)(26)(27)(28)(29)(30)(31). ...
As a rule, the treatment of the overuse syndrome in the locomotorÕs system is non-surgical, and surgical treatment is needed on rare occasions. Non-surgical treatment should start as soon as possible. The first step is to halt or modify sports activities. The treatment includes administration of non-steroidal anti-inflammatory drugs, physical therapy, stretching exercises, and the strengthening of affected muscles. The programme should be adapted to the patient, taking into account the localization and the degree of the injury, as well as his/her sport or work-related activities. The RICE therapeutic programme is important in the treatment of overuse syndromes, especially within the first 72 hours from the occurrence of first symptoms, as it shortens the duration of convalescence for as much as 50%-70%. Beside stabilisation of the joint with optimal loading of antagonistic muscles, stretching exercises have the leading position in prevention and treatment of overuse injuries. During rehabilitation, it is necessary to change activity, its duration and intensity. When a person successfully resumes its sports activities with full load, the rehabilitation is considered completed. No surgical or non-surgical method can warrant a hundred percent recovery for any localization of overuse injury. Prevention, education, and close co-operation between the physician, athlete, and the coach is therefore crucial and is receiving increasing attention.
... 1,14,22,23,37 Little Leaguer's shoulder, Little Leaguer's elbow, and other physeal injuries constitute the most common injury pattern in the skeletally immature thrower; these physeal injuries are thought to be caused by the repetitive microtrauma of throwing and, particularly, pitching. 3,4,13,17 The primary contributor to injuries is thought to be overuse, which affects young pitchers and catchers 1,15,[24][25][26]28 more commonly than it does other position players. This overuse occurs throughout the course of a single game, season, or year in the developing baseball player, with all aspects of overuse contributing to increased risk. ...
Increased pitch counts have been linked to increased complaints of shoulder and elbow pain in youth baseball pitchers. Improper pitching mechanics have not been shown to adversely affect the upper extremity in youth pitchers.
The correct performance of 5 biomechanical pitching parameters correlates with lower humeral internal rotation torque and elbow valgus load, as well as higher pitching efficiency, in youth and adolescent pitchers.
Descriptive laboratory study.
In sum, 169 baseball pitchers (aged 9-18) were analyzed using a quantitative motion analysis system and a high-speed video while throwing fastballs. The correct performance of 5 common pitching parameters was compared with each pitcher's age, humeral internal rotation torque, elbow valgus load, and calculated pitching efficiency.
Motion analysis correlated with video analysis for all 5 parameters (P < .05). Youth pitchers (aged 9-13) performing 3 or more parameters correctly showed lower humeral internal rotation torque, lower elbow valgus load, and higher pitching efficiency (P < .05).
Youth pitchers with better pitching mechanics generate lower humeral internal rotation torque, lower elbow valgus load, and more efficiency than do those with improper mechanics. Proper pitching mechanics may help prevent shoulder and elbow injuries in youth pitchers.
The parameters described in this study may be used to improve the pitching mechanics of youth pitchers and possibly reduce shoulder and elbow pain in youth baseball pitchers.
... Due to repetitive valgus stress or axial loading, especially in pitchers and gymnasts, subchondral infarction occurs, followed by chondral lesions and dehiscence of bony fragments (Fig. 2). A variant of osteochondral lesion is Panner's disease, which can be considered a self-limiting osteochondrosis in the under- 10-years age group due to avascularity of the capitellum rather than a posttraumatic disorder [7, 17]. MRI findings include high signal intensity of the subcortical bone on T2-W images, fragmentation with defects in both subchondral bone and overlying cartilage and loose fragments, which can sometimes best be depicted on CT arthrography if MRI is inconclusive. ...
With an increasing number of paediatric and adolescent athletes presenting with injuries due to overuse, a greater demand is put on clinicians and radiologists to assess the specific type of injury. Repetitive forces applied to the immature skeleton cause a different type of injury than those seen in adults due to the differences in vulnerability of the musculoskeletal system, especially at the site of the growth cartilage. Intrinsic and extrinsic risk factors all play a role in the development of overuse injuries. MRI plays a key role in imaging overuse injuries due to its high potential for depicting cartilaginous and soft-tissue structures. Sport-specific biomechanics are described, since this knowledge is essential for adequate MRI assessment. An overview of several sport-related injuries is presented, based on anatomical location.
... Although shoulder and elbow injuries due to baseball throwing have been well documented, [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44] there are no known studies that have reported shoulder and elbow injuries specifically due to throwing a football. Hence, research is needed in this area. ...
The purpose of this review is to determine how throwing overweight and underweight baseballs affects baseball throwing velocity and accuracy. Two studies examined how a warm-up with overweight baseballs affected throwing velocity and accuracy of 5 oz regulation baseballs. One of these studies showed significant increases in throwing velocity and accuracy, while the other study found no significant differences. Three training studies (6 to 12 weeks in duration) using overweight baseballs were conducted to determine how they affected ball accuracy while throwing regulation baseballs. No significant differences were found in any study. From these data it is concluded that warming up or training with overweight baseballs does not improve ball accuracy. Seven overweight and 4 underweight training studies (6 to 12 weeks in duration) were conducted to determine how throwing velocity of regulation baseballs was affected due to training with these overweight and underweight baseballs. The overweight baseballs ranged in weight from 5.25 to 17 oz, while the underweight baseballs were between 4 and 4.75 oz. Data from these training studies strongly support the practice of training with overweight and underweight baseballs to increase throwing velocity of regulation baseballs. Since no injuries were reported throughout the training studies, throwing overweight and underweight baseballs may not be more stressful to the throwing arm compared to throwing regulation baseballs. However, since currently there are no injury data related to throwing overweight and underweight baseballs, this should be the focus of subsequent studies. In addition, research should be initiated to determine whether throwing kinematics and kinetics are different between throwing regulation baseballs and throwing overweight and underweight baseballs.
... Takve su vjeaebe i testiranja uËinkoviti i bezopasni upravo zbog moguÊnosti velikih miπiÊnih optereÊenja uz vrlo malo optereÊenje samog zgloba (25)(26)(27)(28)(29). IzokinetiËko vjeaebanje danas u nas i svijetu ima jednu od vodeÊih uloga u lijeËenju ozljeda i oπteÊenja koljenskog zgloba buduÊi da skraÊuje trajanje rehabilitacijskog postupka za 50%. Osim toga izokinetiËkim Slika 2 Vjeaeba jaËanja muskulature natkoljenica: A -koncentriËna vjeaeba, B -ekscentriËna vjeaeba se treningom usporedo radi na snazi antagonistiËke muskulature koja rezultira proporcionalnim optereÊenjem tretiranoga zglobnog sklopa, koji je tada manje podloaean razvoju novih ozljeda i oπteÊenja (25)(26)(27)(28)(29)(30)(31). ...
As a rule, the treatment of the overuse syndrome in the locomotor's system is non-surgical, and surgical treatment is needed on rare occasions. Non-surgical treatment should start as soon as possible. The first step is to half or modify sports activities. The treatment includes administration of non-steroidal anti-inflammatory drugs, physical therapy, stretching exercises, and the strengthening of affected muscles. The programme should be adapted to the patient, taking into account the localization and the degree of the injury, as well as his/her sport or work-related activities. The RICE therapeutic programme is important in the treatment of overuse syndromes, especially within the first 72 hours from the occurrence of first symptoms, as it shortens the duration of convalescence for as much as 50%-70%. Beside stabilisation of the joint with optimal loading of antagonistic muscles, stretching exercises have the leading position in prevention and treatment of overuse injuries. During rehabilitation, it is necessary to change activity, its duration and intensity. When a person successfully resumes its sports activities with full load, the rehabilitation is considered completed. No surgical or non-surgical method can warrant a hundred percent recovery for any localization of overuse injury. Prevention, education, and close co-operation between the physician, athlete, and the coach is therefore crucial and is receiving increasing attention.
... Although disordered endochondral ossification is associated with blood dyscrasia, endocrine abnormalities, and genetic factors, most investigators believe that abnormal valgus compressive forces exerted across the radiocapitellar joint during a period of vulnerability are the principle factors in the development of Panner's disease. 15,16,[18][19][20][21][22] In 1959, Haraldsson 23 studied the vascular anatomy of the distal humerus and noted that the ossific nucleus of the capitellum is supplied primarily by posterior vessels functioning as end arteries in the skeletally immature individual. Figure 2 incorporates Haraldsson's conclusions into a schematic proposed by Yamaguchi et al 24 after their investigation of the vascular anatomy of the skeletally mature elbow. ...
Lateral compression injuries of the elbow typically occur in throwing athletes and gymnasts. In the preadolescent and adolescent patient, these injuries predominantly include Panner's disease and osteochondritis dissecans. Panner's disease, an osteochondrosis of the capitellum, is a rare disorder that usually affects the dominant extremity in individuals younger than age 10 years. Symptomatic management of Panner's disease consisting of reduction of stressful activities of the elbow is usually sufficient to allow resolution. Although a prolonged period is required for healing, most patients demonstrate excellent long-term results. Osteochondritis dissecans of the capitellum typically occurs in adolescents and is associated with loose body formation. Panner's disease and osteochondritis dissecans likely represent a continuum of disordered endochondral ossification with presentation and prognosis dependent primarily on age at onset.
Recognition, evaluation, and management of foot and ankle stress fractures are key, especially in an athletic population as it can cause long absences from performance. These can present in all bones of the human body, but they appear to be more common in the lower limb, especially over foot and ankle.Therefore, a high index of suspicion without delay in further investigation is mandatory in the athlete. Additionally, treatment consists mostly of activity modification and relative rest.Surgery can be indicated in case of a “high-risk” fracture pattern that is potentially prone to diastasis and/or displacement.This chapter focuses on the specific foot and ankle stress fractures in athletes and presents the evidence-based clinical examination pearls and best management for an early and safe return to play.KeywordsStress fracturesFoot and ankleTrack and fieldAthlete risk factorsReturn-to-play
To perform satisfactory examinations of pediatric elbow lesions, it is essential to have a thorough knowledge of the anatomy of the pediatric elbow joint. This should include an understanding of the bony anatomy with particular attention to the ossification centers of the distal humerus, and proximal radius and ulna. The anatomy of the capsule and of the medial and lateral collateral ligaments along with all other soft tissues around the joint should be all understood. It is also important to carefully examine patients’ history—particularly, assessing the presence of congenital deformities like primary or secondary aspect that can influence the symptoms. Assessment of the trauma mechanism is also important to better understand the lesions. In pediatric elbow disorders, symptoms are most frequently reported by patients as pain associated with local tenderness, reduced elbow movement, and intermittent swelling and locking. Alternatively, patients may report symptoms related to elbow instability. Sometimes, a combination of all symptoms mentioned above will be described.KeywordsElbow jointOssification centersSupracondylar fractureLateral condylarFractureMedial epicondyle fracturesProximal radius fractureOlecranon fractureElbow fracture-dislocations
The ankle sprain incidence in sports has been reported between 0.324 and 9 per 1000 h of activity [1, 2], with a variability that is most likely due to different definitions of injury and population. In football for example, increased ankle sprain rates have been reported in older players, dominant leg, during competition, and at the end of each half of a game [3]. Historically, the ankle used to be the most common location of injury in professional football players (around 30% of total injuries). However, more recent studies suggest a lower ankle injury rate, accounting for 10–15% of all injuries [4–6]. Approximately 60% of ankle sprains occur as a result of player contact [7, 8] and the overall ankle sprain recurrence rate is between 4% and 29% [3, 7, 8].KeywordsSyndesmosisHigh ankle sprainInstabilityClinical assessmentAnkle injuryAthlete
This is a 5-year-old boy who fell off a trampoline and injured his left elbow. Radiographs, including stress views, were negative for fracture or effusion (not shown).
The pediatric musculoskeletal system has many distinct differences from the adult musculoskeletal system. Because of the anatomic and physiologic differences and the differences in sports training methods and sports participation between children and adults, the spectrum of injuries incurred by the pediatric athlete is unique. This chapter focuses on those injuries that are peculiar to the pediatric musculoskeletal system but includes “adult” injuries where they have particular relevance to pediatric patients.
The purpose of this study was to determine the biome-chanical and anthropometric factors contributing to elbow valgus torque during pitching. Video data of 14 youth pitchers throwing fastballs were used to calculate shoulder and elbow kinematics and kinetics. Peak elbow valgus torque averaged 18 Nm and occurred just before maximal shoulder external rotation. The magnitude of valgus torque was most closely correlated with the thrower's weight. When subject weight and height were controlled for, maximum shoulder abduction torque and maximum shoulder internal rotation torque were most strongly associated with elbow val-gus torque, accounting for 85% of its variance (P < .007). When only kinematic variables were considered, maximum shoulder external rotation accounted for 33% of the variance in valgus torque. Given that the biomechanical variables correlated with peak val-gus torque are not easily modifiable, limiting the number of innings pitched is likely the best way to reduce elbow injury in youth pitchers.
Objective
To design interval throwing programs for baseball players other than pitchers from 13 years of age to the college level.
Design
The authors recorded throws to base, distance of throws, and perceived effort of throws at 4 levels of play. For catchers they also recorded number of throws to the pitcher, number of sprints to first or third base, and time in the squat stance. From these data they designed throwing programs specific to outfielders, infielders, and catchers.
Results
No significant difference was found between the number of throws and distance of throws for infielders and catchers across all age groups. The mean distance of throws differed significantly between 13-year-olds and all other levels of play.
Conclusion
The authors devised 1 program for infielders and catchers of all age groups, 1 program for 13-year-old outfielders, and 1 for all other levels.
This chapter first discusses the timing of ossification of the apophyses and epiphyses at the elbow, as an understanding of the appearance of the normal elbow is essential to correct interpretation of the pediatric elbow radiograph. It then discusses fractures that are common in younger children, such as supracondylar, lateral condylar, and medial condylar fractures. It presents radial neck and olecranon fractures, generally encountered in the adolescent period. The many injuries that result from valgus stress are then discussed, including osteochondritis dissecans of the capitellum and medial epicondylar apophysitis. The chapter concludes with a presentation of osteochondrosis of the capitellum (Panner disease).
objective: To describe and discuss the assessment and conservative management of traumatic osteochondrosis of the olecranon apophysis in an adolescent baseball pitcher. clinical features: A 17-year-old, male high school baseball pitcher was evaluated for insidious onset of right elbow pain of three months duration. Diagnosis of triceps tendonitis with prescribed rest and NSAIDs by the patient's primary care provider resulted in temporary relief Further clinical and radiographic investigation revealed traumatic osteochondrosis of the olecranon apophysis in his dominant elbow. intervention and outcome: Activity restrictions were recommended. He was given instructions to perform a series of rehabilitation exercises and an interval-throwing program. Complete clinical recovery was achieved, which corroborated with the findings of follow up radiographs. conclusion: The significance of this case is to show the importance of diagnosing an uncommon presentation of posterior elbow pain. This retrospective case report demonstrates that chiropractic physicians can effectively manage non-articular osteochondroses and facilitate a complete and long lasting recovery.
In recent years, injuries that are characteristic of specific sports have received much attention. Baseball is one of the most popular sports in the world, so injuries and the mechanisms of injury that are peculiar to baseball are of great concern. Baseball pitching consists of rapid movements of the upper extremities, and overuse of the throwing arm by professional, semiprofessional, and Little League pitchers causes typical sports injuries of the shoulder and upper arm. Sports injuries are diagnosed on the basis of clinical history, symptoms, physical examination, arthroscopy, and imaging findings. Imaging is valuable for the early detection of sport injuries, evaluation of their severity and prognosis, and monitoring of the recovery process. This article reviews sports injuries of the shoulder and upper arm in baseball pitchers and describes the appropriate imaging modalities for making the diagnosis.
Elbow injuries in the young throwing athlete are common and encompass a wide variety of pathologic problems from acute traumatic failure to repetitive overuse. The unique features of the still developing bony anatomy of the young throwers' elbow result in distinct injury patterns often involving the physis or apophysis. Medial elbow injuries such as medial epicondylar apophysitis, medial epicondyle avulsion and ulnar collateral ligament tear result from excessive tensile forces. Lateral elbow injuries such as Panner's disease and osteochondritis dissecans are the result of compressive forces. When evaluating the young thrower's elbow a specific diagnosis should be made based on the mechanism of injury, clinical symptoms, physical examination, and appropriate imaging studies. The term Little Leaguer's Elbow is a wastebasket term that, in light of improved understanding of those conditions affecting the young thrower's elbow, should be avoided in favor of a specific diagnosis.
Because youth athletes are smaller and weaker than their adult counterparts, smaller equipment and fields are often used in
youth sports. Previous research has shown that youth baseball pitchers use similar motions to older pitchers, but generate
lower kinetics and angular velocities at the shoulder and elbow. The purpose of this study was to determine potential biomechanical
benefits for youth pitchers to use lighter baseballs. Thirty-four youth (11.1 ± 0.7 years) pitchers pitched both standard
[5 ounce (142 g)] and lightweight [4 ounce(113 g)] baseballs in a laboratory setting. Kinematic and kinetic parameters were
measured with a six-camera high-speed motion analysis system. Three repeated measures MANOVAs were used to compare (p > 0.05) position, velocity, and kinetic parameters between the standard and lightweight baseballs. Subjective data were also
collected. Pitching the lightweight ball produced no difference in arm position, but greater shoulder, elbow, and ball velocities.
With the lightweight ball, pitchers produced decreased kinetics.Post-hoc analysis of the kinetic data revealed significant decreases in elbow varus torque and shoulder internal rotation torque.
The data suggest that playing with lightweight baseballs may reduce the risk of overuse injury in the youth pitcher and also
help develop arm speed. However, before introducing lightweight baseballs into the youth game, the effect of lighter, faster
pitched balls for the batters and fielders should also be considered.
The primary objective of this study was to investigate the influence of segmental mass and body composition on the upper extremity biomechanics of overweight youth participating in baseball activities. The study used a regression framework to investigate the relationship between whole body, throwing arm segmental mass and body composition measures to kinetic variables about the shoulder and elbow. The multivariate regression results indicated a strong positive significant relationship between each of the mass variables to that of the moment variables about the shoulder and elbow. Participants who had a greater percentage of fat mass produced greater injury correlated moments about the shoulder and elbow.
With increasing youth participation in organized sports, more injuries in this age group are being treated by primary care and sports medicine physicians. Overuse injuries are much more common now than in past decades, with Little League shoulder, Little League elbow, and gymnast wrist being particular concerns. Rotator cuff tears and glenoid labral injuries, once thought to be rare in this age group, are also more common now. Osteochondritis dissecans of the elbow is relatively common and typically fares poorly without surgery. Wrist abnormalities that occur nowadays include triangular fibrocartilage tears. Tendonitis, which is now observed frequently in clinical practice in this age group, rarely requires imaging.
Throwing injuries of the elbow in the pediatric population are common. These can occur as lateral compression osteochondral injuries such as osteochondritis dissecans or medial tension overload such as so-called Little League elbow. Extension overload injuries may present in teens as stress injuries of the olecranon process. We review the imaging findings of each of these common injuries, with an emphasis on their magnetic resonance imaging appearance.
The sport of baseball is played by millions of children across America and around the world. Although generally considered a safe activity, it is estimated that there are over 100,000 acute baseball injuries yearly in the 5- to 14-year age range in the United States, many of which present to the emergency department. Acute injuries often involve ball impact to the face and hands; baseball is the leading cause of sport-related eye injury. Ball impact particularly to the chest results in a small but steady number of fatalities each year, many of which are widely publicized events. In addition to acute injury, many young baseball players are affected by chronic and acute conditions of the elbow. In this article, we review the history, epidemiology, and common injury patterns that are specific to baseball. Case reports are included, as well as a section on the physical examination of the elbow.
The aim of this study was to determine long term changes in shoulder and elbow joints of former elite javelin throwers. Twenty-one elite javelin throwers were examined at an average of 19 years after the end of their high performance phase. Mean age at examination was 50 years. Functional assessment of both shoulders was determined by the Constant-score. The shoulder of the throwing arm was examined by magnetic resonance imaging. Both elbow joints were examined clinically and radiographically. Five athletes complained about transient shoulder pain in their throwing arm affecting activities of daily living, fourteen athletes had a deficit of internal rotation of at least ten degrees. Constant-scores of throwing arms were six points lower than those of non-throwing arms (P < 0.05). Complete ruptures and partial tears of the rotator cuff were frequent. Three athletes complained about transient elbow pain in their throwing arm affecting activities of daily living; ten athletes had a deficit of extension of more than five degrees. All dominant elbows had advanced arthrotic alterations (osteophytes, sclerosis) compared to the non-dominant side. Athletes who trained with weights of more than 3 kg had a significantly higher risk of degenerative changes than athletes who did not (P < 0.01). We therefore recommend to avoid throwing training with weights of more than 3 kg.
This article reviews basic concepts in fundamental elbow biomechanics, particularly how they relate to the skeletally immature elbow in throwing athletes. Adult phases of throwing and the forces generated in each phase are compared with the developmental phases of throwing in children. The impact of elevated forces, poor mechanics, and poor coordination are emphasized as they relate to potential areas of injury in the skeletally immature. Finally, concepts in prevention focused on biomechanics are offered.
Sports-related injuries about the elbow occur commonly and are often managed by a wide variety of health care providers. It is particularly important that a surgeon well versed in arthroscopy, reconstructive trauma, and peripheral nerve techniques evaluates potentially complex injuries. It is equally imperative that the preoperative care regimen and postoperative management be conducted by an experienced therapist who understands elbow biomechanics and function. Acute pathology, such as fracture or severe ligamentous and tendinous injury, usually warrants operative treatment. A thorough understanding of the anatomy and biomechanics of the elbow is crucial since the expected recovery in the nonathlete will not suffice for the competitive athlete. Demanding activities, such as the overhead-throwing motion cycle, require a much more complete recovery than simple return to activities of daily living. Chronic elbow problems in the athlete can often be managed with appropriate therapy and modification to the training protocol. Poor response to conservative means should lead to a more thorough evaluation by an experienced elbow surgeon as these injuries can often be career ending. The spectrum of commonly seen lesions in the athlete's elbow is described here, as are conservative care measures, operative treatments, and postoperative management.
The elbow is a common site of orthopaedic injury in the paediatric population. The number of these injuries continues to rise following increased levels of participation in paediatric recreational and competitive sport. Injuries to the paediatric elbow can be classified as either overuse or acute. Delineating injury patterns to the elbow in children can be challenging, given the cartilaginous composition of the distal humerus and the multiple secondary ossification centres that appear and unite with the epiphysis at defined ages. Pitching in baseball, serving in tennis, spiking in volleyball, passing in American football and launching in javelin-throwing can all produce elbow pathology by forceful valgus stress, with medial stretching, lateral compression and posterior impingement.
In children and adolescents, the epiphyseal plate is weaker than the surrounding ligaments, predisposing them to epiphyseal plate injuries. On the other hand, post-pubescent or skeletally mature athletes are more prone to tendinous or ligamentous injury. Injuries may cause significant impact on the athlete, parents and healthcare system. With the exception of baseball, there are few prospective cohort studies on the epidemiological trends of childhood elbow injuries in other sports.
This paper aims to describe the epidemiological trends in paediatric elbow injuries related to sports, suggests prevention strategies and discusses the scope for further research.
A web-based search of existing articles pertaining to paediatric elbow injuries in sports was performed.
The implications of acute and overuse injuries and the possibility of permanent damage should be understood by parents, coaches and the athletes. Proper understanding of the intrinsic and extrinsic risk factors that could lead to elbow injuries is thus required. Measures to prevent elbow injuries should include proper coaching, warm-up, officiation, legislation, medical expertise and protective gear. There are still many opportunities for prospective studies and other research projects among young athletes in various sports. Current studies will serve as a baseline for future research to assess the success of specific interventions in reducing the incidence of elbow injury in the paediatric athlete. Further epidemiological studies in various sports will help expand our knowledge and prevent potential disability and deformity in the paediatric elbow.
The field of pediatric sports medicine has grown dramatically with
the widespread participation of children in physical fitness and club
sports activities in the United States. The use of three-dimensional
(3-D) automated motion analysis in pediatric sports has become a focus
of increased interest and research potential. This work addresses an
overview of the activities and frequent injury patterns seen in the
pediatric sports population. The objective of the article is to identify
common pediatric sports activities that have the potential for study
with motion analysis techniques
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