scholarly journals Are the Current Little League Pitching Guidelines Adequate? A Single-Season Prospective MRI Study

2017 ◽  
Vol 5 (5) ◽  
pp. 232596711770485 ◽  
Author(s):  
Andrew V. Pytiak ◽  
Phillip Stearns ◽  
Tracey P. Bastrom ◽  
Jerry Dwek ◽  
Peter Kruk ◽  
...  
Keyword(s):  
Physical Examination ◽  
Significant Loss ◽  
Mri Findings ◽  
Level Of Evidence ◽  
Baseball Players ◽  
Guideline Compliance ◽  
Arm Pain ◽  
Little League ◽  
Significant Difference ◽  
Youth Baseball

Background: Little League throwing guidelines have recently been implemented in an attempt to lessen the growing number of elbow injuries occurring in youth baseball players. Hypothesis/Purpose: The purpose of this study was to examine pre- and postseason changes seen on magnetic resonance imaging (MRI) in youth baseball players’ elbows in an attempt to identify risk factors for pain and MRI abnormalities, with a particular focus on the current Little League guidelines. We hypothesized that MRI abnormalities would be common in pitchers with high pitch counts and poor guideline compliance. Study Design: Cohort study; Level of evidence, 2. Methods: A prospective study of Little League players aged 10 to 13 years was performed. Players were recruited prior to the start of the season and underwent bilateral elbow MRI as well as a physical examination and completed a questionnaire addressing their playing history and arm pain. At the end of the season, a repeat MRI and physical examination were performed. MRIs were read by blinded radiologists. During the season, player statistics including innings played, pitch counts, and guideline compliance were recorded. Physical examination findings and player statistics were compared between subjects with and without MRI changes utilizing chi-square and analysis of variance techniques. Results: Twenty-six players were enrolled. Despite 100% compliance with pitching guidelines, 12 players (48%) had abnormal MRI findings, and 28% experienced pain during the season. There was a significant difference in distal humeral physeal width measured pre- to postseason (1.54 vs 2.31 mm, P < .001). There was a significant loss of shoulder internal rotation during the season, averaging 11°. While pitch counts, player position, and throwing curveballs/sliders were not significantly associated with changes seen on MRI, year-round play was associated with abnormalities ( P < .05). Much lower compliance (<50%) was observed with nonenforced guidelines, including avoidance of single-sport specialization, year-round play, and throwing curveballs/sliders. Conclusion: Arm pain and MRI abnormalities of the medial elbow are common in Little League baseball players who comply with the Little League throwing guidelines, especially those playing year-round.

scholarly journals Shoulder MRI Abnormalities in Asymptomatic Little League Baseball Players

2018 ◽  
Vol 6 (2) ◽  
pp. 232596711875682 ◽  
Author(s):  
Andrew T. Pennock ◽  
Jerry Dwek ◽  
Emily Levy ◽  
Philip Stearns ◽  
John Manning ◽  
...  
Keyword(s):  
Risk Factors ◽  
Physical Examination ◽  
Shoulder Pain ◽  
The United States ◽  
Mri Findings ◽  
Chi Square ◽  
Level Of Evidence ◽  
Baseball Players ◽  
Little League ◽  
Chi Square Test

Background: Youth baseball is extremely popular in the United States, but it has been associated with shoulder pain and injury. The incidence of shoulder abnormalities in this athletic population has yet to be defined. Purpose: To examine abnormalities noted on magnetic resonance imaging (MRI) in the shoulders of asymptomatic Little League baseball players and to correlate these findings with the players’ throwing history and physical examinations. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 23 Little League baseball players aged 10 to 12 years were recruited. All players underwent a comprehensive physical examination and responded to a questionnaire addressing their playing history and any arm or shoulder pain. Bilateral shoulder MRIs were performed and read in a blinded manner by 2 radiologists. Responses on the questionnaire and physical examination findings were compared between participants with and without positive MRI findings through use of chi-square test and analysis of variance. Results: The dominant arm was 8.5 times more likely to have an abnormality on MRI compared with the nondominant arm. In all, 12 players (52%) had 17 positive MRI findings in their throwing shoulder that were not present in their nondominant shoulder. These findings included edema or widening of the proximal humeral physis (n = 5), labral tear (n = 4), partial rotator thickness tear (n = 4), acromioclavicular joint abnormality (n = 2), subacromial bursitis (n = 1), and cystic change of the greater tuberosity (n = 1). Two primary risk factors were associated with an abnormal MRI: year-round play and single-sport athletes focusing solely on baseball ( P < .05). Players with no risk factors, 1 risk factor, and both risk factors had a 25%, 71%, and 100% chance, respectively, of having an abnormal MRI. A majority of players (61%) had previously experienced shoulder pain, especially pitchers throwing curveballs and sliders ( P < .05), but this was not associated with an abnormal MRI. Conclusion: Abnormalities seen on MRI involving the shoulder are common in Little League baseball players, especially those who are single-sport athletes playing year-round.

scholarly journals PROGRESSIVE ELBOW MRI ABNORMALITIES IN LITTLE LEAGUE BASEBALL PLAYERS ARE COMMON: A 3-YEAR LONGITUDINAL EVALUATION

2019 ◽  
Vol 7 (3_suppl) ◽  
pp. 2325967119S0006
Author(s):  
Joshua Holt ◽  
Philip Stearns ◽  
Tracey Bastrom ◽  
Morgan Dennis ◽  
Jerry Dwek ◽  
...  
Keyword(s):  
Internal Rotation ◽  
External Rotation ◽  
Mri Findings ◽  
Baseball Players ◽  
Longitudinal Evaluation ◽  
Elbow Injury ◽  
Arm Pain ◽  
Little League ◽  
Elbow Pathology

Background Significant effort has been made by multiple organizations including Little League Baseball, USA Baseball, Major League Baseball, and the American Academy of Orthopaedic Surgeons to minimize the rate of shoulder and elbow injury among Little League Baseball players. Despite this effort, recent MRI studies have shown high rates of elbow pathology in this athletic population. The purpose of the current study was to track a cohort of Little League baseball players over three years with serial examinations and MRI to determine the natural history, progression, and risk factors of previously identified elbow pathology. Methods A prospective study of Little League players who were 12 to 15 years of age was performed. All players had preseason and postseason elbow MRI performed three years prior to the current study. Players underwent repeat bilateral elbow MRI, physical examination of bilateral shoulders and elbows, a detailed assessment of throwing history, and completed a questionnaire addressing playing history and current playing status, and any arm pain. The MRI scans were read by a blinded musculoskeletal radiologist and subsequently compared to players’ prior MRI to assess for progression or resolution of previously identified pathology. Identified MRI pathology was categorized as persistent/mild, progressive/severe, or improved/resolved (Figure 1). Results All 26 players who participated in the previous single season study returned for a 3-year longitudinal assessment, representing a 100% follow-up rate. Fifteen players (58%) had dominant arm MRI pathology. 80% of MRI findings (12/15 players) were determined to be new or progressive lesions. Players with post-season MRI pathology were significantly more likely to have MRI pathology at 3-years follow-up (p<0.05). Six of the 14 players (43%) with previously normal MRI had new pathology. Year-round play was a significant predictor of tenderness to elbow palpation (p=0.027) and positive MRI findings at 3-years (p=0.047). Moderate/persistent and severe/progressive MRI findings were more often seen in players who continued to play baseball, play pitcher or catcher, and play year-round baseball (Figure 2). Dominant shoulder internal rotation was significantly less than non-dominant shoulder internal rotation amongst all players (60.3° compared with 71.2°, p=0.002). Dominant shoulder external rotation was significantly increased in players who continued to play baseball when compared with those no longer playing (109.1° versus 99.3°, p=0.012), in players playing pitcher or catcher when compared with non-pitchers/catchers (111.4° versus 100.3°, p=0.005), and in players who played year-round baseball when compared to those playing < 8 months per year (109.0° versus 100.2°, p=0.026). Conclusion/Significance Dominant elbow MRI abnormalities are common in asymptomatic Little League baseball players. Three-year longitudinal evaluation suggests that these MRI findings commonly progress, especially amongst players who continue to play baseball. Year-round play appears to impart the most notable risk to young players, with results of the current study showing increased rates of physical exam abnormalities and progressive MRI pathology. Further guidelines addressing year-round play in Little League Baseball should be established.

scholarly journals Prevalence and Consequences of Sport Specialization Among Little League Baseball Players

2021 ◽  
pp. 194173812097095
Author(s):  
Eric G. Post ◽  
Michael D. Rosenthal ◽  
Andrew T. Pennock ◽  
Mitchell J. Rauh
Keyword(s):  
Cross Sectional Study ◽  
Patient Reported Outcome ◽  
Online Questionnaire ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Baseball Players ◽  
Little League ◽  
Patient Reported ◽  
Youth Baseball ◽  
Level 3

Background: Baseball is one of the most popular boy’s youth sports, and there has been a rise in the rates of certain overuse injuries among players. Specialization has been identified as a risk factor for overuse injury in high school athlete populations, but there is little understanding of the prevalence or consequences of sport specialization in Little League baseball players. Hypothesis: Sport specialization will be highly prevalent among Little League baseball players and specialization will be associated with worse throwing arm health. Study Design: Cross-sectional study. Level of Evidence: Level 3. Methods: A total of 246 Little League baseball players (male; N = 241; age, 9.5 ± 1.6 years) between 7 and 12 years old completed an anonymous, online questionnaire with their parent’s assistance. The questionnaire consisted of participant demographics and baseball participation information, including sport specialization status and the Youth Throwing Score (YTS), a valid and reliable patient-reported outcome measure for youth baseball players. Results: Only 29 (11.8%) players met the criteria for high specialization. Approximately one-third of all players (n = 77; 31.3%) reported participating in baseball year-round or receiving private coaching outside of their league (n = 81; 32.9%). Highly specialized athletes demonstrated worse scores on the YTS on average compared with low-specialization athletes (mean [SE]: 56.9 [1.6] vs 61.1 [1.2]; P = 0.01). Similarly, pitching in the previous year ( P < 0.01) or traveling overnight regularly for showcases ( P = 0.01) were associated with a worse score on the YTS. Conclusion: While the prevalence of high sport specialization was low among Little League baseball players, other behaviors associated with specialization such as year-round play and the receiving of private coaching were more common. Highly specialized Little League players demonstrated worse throwing arm health compared with low-specialization players. Clinical Relevance: Little League players and their parents may represent a potential target audience for dissemination campaigns regarding sport specialization.

Progressive Elbow Magnetic Resonance Imaging Abnormalities in Little League Baseball Players Are Common: A 3-Year Longitudinal Evaluation

2019 ◽  
Vol 48 (2) ◽  
pp. 466-472
Author(s):  
Joshua B. Holt ◽  
Jason M. Pedowitz ◽  
Philip H. Stearns ◽  
Tracey P. Bastrom ◽  
M. Morgan Dennis ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Natural History ◽  
Physical Examination ◽  
Resonance Imaging ◽  
Mri Findings ◽  
Baseball Players ◽  
Little League ◽  
History Of

Background: Prior studies have revealed magnetic resonance imaging (MRI) evidence of elbow pathology in single-season evaluation of competitive youth baseball players. The natural history of these findings and risk factors for progression have not been reported. Purpose: To characterize the natural history of bilateral elbow MRI findings in a 3-year longitudinal study and to correlate abnormalities with prior MRI findings, throwing history, playing status, and physical examination. Study Design: Cohort study; Level of evidence, 2. Methods: A prospective study of Little League players aged 12 to 15 years was performed. All players had preseason and postseason bilateral elbow MRI performed 3 years before this study. Players underwent repeat bilateral elbow MRI, physical examination, and detailed assessment of throwing history, playing status, and arm pain. Imaging was read by a blinded musculoskeletal radiologist and compared with prior MR images to assess for progression or resolution of previously identified pathology. Results: All 26 players who participated in the previous single-season study returned for a 3-year assessment. At the completion of the study, 15 players (58%) had dominant arm MRI pathology. Eighty percent (12/15 players) of MRI findings were new or progressive lesions. Players with postseason MRI pathology at the beginning of the study were more likely to have MRI pathology at the 3-year follow-up than players with previously normal postseason MRI ( P < .05), although 6 of the 14 players (43%) with previously normal MRI developed new pathology. Year-round play was a significant predictor of tenderness to elbow palpation ( P = .027) and positive MRI findings at 3 years ( P = .047). At the 3-year follow-up, 7 players (27%) reported having throwing elbow pain and 3 had required casting. Additionally, differences were noted in the dominant arm’s internal and external rotation in those that continued to play baseball ( P < .05). Conclusion: Dominant elbow MRI abnormalities are common in competitive Little League Baseball players. Year-round play imparts significant risk for progression of MRI pathology and physical examination abnormalities.

Effect of Younger Starting Pitching Age on Humeral Retrotorsion in Baseball Pitchers With an Ulnar Collateral Ligament Injury

2021 ◽  
pp. 036354652199080
Author(s):  
Sean M. Kennedy ◽  
Joseph P. Hannon ◽  
John E. Conway ◽  
Kalyssa Creed ◽  
J. Craig Garrison
Keyword(s):  
Ulnar Collateral Ligament ◽  
Ligament Injury ◽  
Collateral Ligament ◽  
Level Of Evidence ◽  
Baseball Players ◽  
Significant Difference ◽  
Ulnar Collateral Ligament Injury ◽  
Baseball Pitchers ◽  
Group 2 ◽  
Group 1

Background: Increased humeral retrotorsion (HRT) has been found to be a risk factor for ulnar collateral ligament (UCL) tears in baseball players. Recent work has demonstrated the age of 11 years as a potential watershed age for HRT development. Hypothesis: In a group of baseball pitchers with UCL injuries, athletes who started pitching before the age of 10 years will demonstrate significantly more dominant limb humeral retrotorsion (DHRT) when compared with a group of baseball pitchers who reported starting pitching at 10 years or older. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 84 baseball pitchers with a diagnosed UCL injury were divided into 2 groups based upon the age at which participants began pitching: 33 players reporting a starting pitching age of 10 years or older (group 1) were compared with 51 baseball pitchers reporting a starting pitching age under 10 years (group 2). Participants’ DHRT and nondominant limb humeral retrotorsion (NDHRT) were measured using diagnostic ultrasound. Independent t tests were run to compare mean group differences of all patient data, starting pitching age, age at time of injury, DHRT, NDHRT, and humeral retrotorsion difference (HRTdiff). Results: There were no significant differences between groups with regard to age at time of injury, height, weight, or playing years’ experience. There was a statistically significant difference in the participant-reported starting pitching age. Significant differences between groups were noted for DHRT (group 1: 20.0°± 9.4°, group 2: 14.5°± 10.3°, P = .015) and for NDHRT (group 1: 38.6°± 8.8°, group 2: 32.9°± 9.5°, P = .007). No significant differences between groups were found for HRTdiff ( P = .940). Conclusion: Baseball pitchers with a UCL injury who reported a starting pitching age younger than 10 years demonstrated significantly greater DHRT and NDHRT when compared with UCL-injured baseball pitchers who reported a starting pitching age at 10 years or later. The results of this study demonstrate that a younger starting pitching age results in increased HRT in players with UCL injuries.

Internal- and External-Rotation Peak Torque in Little League Baseball Players With Subacromial Impingement Syndrome: Improved by Closed Kinetic Chain Shoulder Training

2016 ◽  
Vol 25 (3) ◽  
pp. 263-265 ◽  
Author(s):  
Dong-Rour Lee ◽  
Laurentius Jongsoon Kim
Keyword(s):  
Angular Velocity ◽  
External Rotation ◽  
Peak Torque ◽  
Subacromial Impingement Syndrome ◽  
Subacromial Impingement ◽  
Kinetic Chain ◽  
Baseball Players ◽  
Little League ◽  
Youth Baseball ◽  
Closed Kinetic Chain

Context:Many studies have explored closed kinetic chain (CKC) shoulder exercises (SEs) with a sling because they are safer and more effective than open-chain exercises, especially in early stages of treatment. However, the application of CKC SE in youth baseball players has rarely been attempted, although teenage baseball players also experience shoulder pain.Objective:To investigate the effects of CKC SE on the peak torque of shoulder internal rotation (IR) and external rotation (ER) in youth baseball players.Design:Single-group pretest, posttest.Setting:Biomechanics laboratory.Participants:23 Little League Baseball players with subacromial impingement syndrome.Interventions:The CKC SE with a sling was CKC shoulder-flexion exercise, extension exercise, IR exercise, and ER exercise. This exercise regimen was conducted 2 or 3 times/wk for 8 wk.Main Outcome Measures:The peak torque of shoulder IR and ER was measured using an isokinetic dynamometer. Concentric shoulder rotation was performed, with 5 repetitions at an angular velocity of 60°/s and 15 at 180°/s.Results:The IR and ER peak torque significantly increased at each angular velocity after the exercise program. In particular, the increase in IR and ER peak torque values was statistically significant at an angular velocity of 180°/s.Conclusions:CKC SE was effective in increasing shoulder IR and ER strength, demonstrating its potential benefits in the prevention and treatment of shoulder injury. In addition, increased IR peak torque appears to improve throwing velocity in baseball players.

scholarly journals Impact of physical functions on location of arm pain in youth baseball players

2019 ◽  
Vol 8 (4) ◽  
pp. 159-164
Author(s):  
Emi Nakamura ◽  
Mutsuaki Edama ◽  
Takanori Kikumoto ◽  
Wataru Ito ◽  
Ryo Hirabayashi ◽  
...  
Keyword(s):  
Baseball Players ◽  
Arm Pain ◽  
Youth Baseball ◽  
Physical Functions

The Influence of Pitch Velocity on Medial Elbow Pain and Medial Epicondyle Abnormality Among Youth Baseball Players

2020 ◽  
Vol 48 (7) ◽  
pp. 1601-1607 ◽  
Author(s):  
Daisuke Kurokawa ◽  
Takayuki Muraki ◽  
Hiroaki Ishikawa ◽  
Kiyotsugu Shinagawa ◽  
Hideaki Nagamoto ◽  
...  
Keyword(s):  
Medial Epicondyle ◽  
Level Of Evidence ◽  
Baseball Players ◽  
Elbow Pain ◽  
The Past ◽  
Youth Baseball ◽  
Elbow Injuries ◽  
Internal Rotation Angle ◽  
Straight Leg Raise ◽  
The Relationship

Background: Pitch velocity is associated with elbow injuries among skillful baseball players. However, the relationship between pitch velocity and throwing elbow injuries among youth players has not yet been clarified. Purpose: To investigate the influence of pitch velocity on medial elbow pain and medial epicondyle abnormality among youth baseball players. Study Design: Cohort study; Level of evidence, 3. Methods: The participants consisted of 256 elementary school players (mean age, 11 ± 1 years; range, 9-12 years). The medial aspect of the elbow was evaluated using ultrasound imaging. A questionnaire was used to investigate past or present pain in the elbow, background of the players (age, height, body mass index, and years of baseball experience), and playing environment (number of days of practice in a week, experience as a pitcher, and cryotherapy of the shoulder and elbow after practice). Positioning of the scapula, range of motion in shoulder internal/external rotations and hip internal rotation, angle of the straight-leg raise, and heel-to-buttock distance were measured. The pitch velocity was recorded using a pitch velocity radar gun. The relationship between these variables and the presence of medial epicondyle abnormality, as well as past or present elbow pain, were statistically analyzed. Results: A medial epicondyle abnormality was observed in 130 players (51%), elbow pain in the past in 65 players (25%), and elbow pain during the examination in 14 players (5%). Sixty-nine players (27%) experienced elbow pain either in the past or during examination. Abnormality of the medial epicondyle had a relationship with the pitch velocity (odds ratio [OR], 1.1 for increase of 1 km/h; 95% CI, 1.1-1.2; P < .0001) and the number of practice days in a week (OR, 1.8 for increase of the practice days; 95% CI, 1.4-2.5; P < .0001). Pitch velocity was also significantly related with past pain, present pain, and past and/or present pain of the elbow (OR [km/h], 1.1, 1.1, 1.1; 95% CI, 1.0-1.1, 1.0-1.2, 1.1-1.2; P < .0001, P = .002, P < .0001, respectively). Conclusion: Pitch velocity was significantly associated with abnormality of the medial epicondyle and elbow pain. A 10-km/h increase in pitch velocity would increase the risk of medial epicondyle abnormality and medial elbow pain by 3 times.

Arm Pain in Youth Baseball Players

2014 ◽  
Vol 43 (1) ◽  
pp. 41-46 ◽  
Author(s):  
Eric C. Makhni ◽  
Zachary S. Morrow ◽  
Timothy J. Luchetti ◽  
Pallavi S. Mishra-Kalyani ◽  
Anthony P. Gualtieri ◽  
...  
Keyword(s):  
Baseball Players ◽  
Arm Pain ◽  
Youth Baseball

scholarly journals Muscle Strains in the Lower Extremity of Japanese Professional Baseball Players

2020 ◽  
Vol 8 (10) ◽  
pp. 232596712095656
Author(s):  
Takeshi Kokubu ◽  
Yutaka Mifune ◽  
Noriyuki Kanzaki ◽  
Yuichi Hoshino ◽  
Kenichiro Kakutani ◽  
...  
Keyword(s):  
Lower Extremity ◽  
High Intensity ◽  
Case Series ◽  
Return To Play ◽  
Professional Baseball ◽  
Mri Findings ◽  
Level Of Evidence ◽  
Baseball Players ◽  
Musculotendinous Junction ◽  
Lower Extremity Muscle

Background: Predicting when athletes can return to play after muscle strains is not always simple because of difficulties in evaluating the severity of such injuries. Purpose/Hypothesis: The purpose of this study was to evaluate the use of magnetic resonance imaging (MRI) to classify lower extremity muscle strains in Japanese professional baseball players. The hypothesis was that MRI grading can be used to diagnose the severity of muscle strains in the lower extremity and predict return to play in athletes. Study Design: Case series; Level of evidence, 4. Methods: A total of 55 muscle strains occurred in the lower extremity of players on a professional baseball team between the 2006 and 2015 seasons; all players had undergone MRI examination. Age, player position, location of injury, cause of injury, and duration until return to play (in days) were extracted from the medical records. MRI scans were classified using the following system: grade 0, no abnormal findings; grade 1a, T2-weighted high intensity only between muscles; grade 1b, T2-weighted high intensity between muscles and in muscle belly; grade 2, injury of musculotendinous junction; and grade 3, rupture of tendon insertion. Results: The sites of injuries were distributed as follows: hamstrings (n = 33), quadriceps (n = 6), hip adductors (n = 6), and calves (n = 10). MRI findings revealed 9 muscle strains (16%), 19 grade 1a (34%), 19 grade 1b (34%), and 8 grade 2 muscle strains (16%). The length of time until return to training and competition, respectively, was 15 and 26 days for grade 1a injuries, 19 and 36 days for grade 1b injuries, and 55 and 69 days for grade 2 injuries. Conclusion: Players with grade 1 injuries took 4 to 5 weeks to return to play, whereas players with grade 2 injuries took 10 weeks to return. MRI can be useful for diagnosing lower extremity muscle strains and predicting the time to return to play.

Sign in / Sign up

Export Citation Format

Share Document