The Nurse Practitioner • Vol. 33, No. 4
Big League Injuries
Samantha G. Lee, RN, MS, PNP
In the United States,approximately 16 million children play some
form of organized baseball. Of those, 7% to 18% will suffer an in-
jury.1,2Baseball players,especially pitchers,are guilty of the one-sport trend
and playing year round on multiple teams.As a result, these youth athletes are
developing surgery-requiring injuries typically seen in older athletes. The most
common injury patterns to baseball pitchers include Little League elbow (LLE) and
Little League shoulder (LLS). The term LLE was created in 1960 to describe a medial
epicondyle fracture that was frequently seen in adolescent pitchers,but now refers to me-
dial epicondylar apophysitis.3,4LLS is a less common injury and is also referred to as proxi-
mal humeral epiphysitis.
Overuse injuries arise from repetitive microtrauma and can occur in tendons,muscles,
or bones that are not given adequate time to heal.5These musculoskeletal injuries tend to
be sport-specific due to the individual stresses each sport places on the body.5Even if a
child plays a different sport each season,participating in baseball,volleyball,and swim-
ming places extreme stress on the upper extremities just as much as if that child
played one sport all year round.
Physiologic and physical differences between youth and mature adult
athletes make children more vulnerable to injury. Children tend to be
less coordinated, have decreased tendon flexibility and muscle
strength,and lack mature motor skills.6Furthermore,youth
athletes are most vulnerable to overuse injuries dur-
ing growth spurts. During a growth
Little League Arm Injuries
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epiphysis in boy baseball pitchers.Calif Med. 1996;105:22-25.
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and elbow injuries in adolescent baseball pitchers. Am J Sports Med. 2006;
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cle strength in baseball players with physical signs of glenohumeral joint sta-
bility.Br J Sports Med. 2003; 37(5): 430-432.
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der. Skeletal Radiol. 2004; 33:352-354.
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overuse injuries.Am Fam Physician. 2006:73:1015-1022.
17. Lowery WD, Kurzweil, PR, Forman SK, Morrison DS. Persistence of the ole-
cranon physis: a cause of ‘little league elbow’. J Shoulder Elbow Surg.
18. Lyman S, Fleisig GS, Andrews JR, Osinski ED. Effect of pitch type, pitch
count, and pitching mechanics on risk of elbow and shoulder pain in youth
baseball pitchers.Am J Sports Med. 2002;30(4):463-468.
19. Hoppenfeld S. Physical examination of the spine extremities. In Appleton &
Lange, eds. Physical examination of the elbow. Norwalk,CT: 1976; 35-58.
20. Lyman S, Fleisig GS,Waterbor JW, Funkhouser EM, Pulley L,Andrews JR et
al. Longitudinal study of elbow and shoulder pain in youth baseball pitch-
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Sports Med. 1998;26:575-580.
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atric athlete.Sports Med. 2000:30:117-135.
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youth baseball injuries,2004 May.Available at:http://graphics.fansonly.com/
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Opin Pediatr. 2002;14:719-722.
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32. Gorman, C.“To an athlete, aching young,” Time Magazine. September 18,
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ABOUT THE AUTHOR
Samantha G.Lee is a Pediatric Nurse Practitioner, Columbia University School
of Nursing, New York, NY.
The Nurse Practitioner • April 2008
Little Arms, Big League Injuries
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