Arms at Risk: Elbow Abnormalities Common Among Little Leaguers

Here we are in the heart of Little League season, with an estimated 2.5 million kids out there playing. However, the rate of arm injuries in the 10- to 13-year-old population of baseball players has increased in the last two decades, despite the implementation of pitching guidelines.

In the May 4, 2016 edition of The Journal, Pennock et al. report findings from a prospective study of 26 Little League players whose elbows were physically examined and evaluated with MRI before the start of the season. Here are some salient results:

• Nine players (35%) had 12 positive MRI findings, including seven instances of edema of the medial epicondyle apophysis.
• Surprisingly, the prevalence of positive MRI findings and a history of arm pain were not greater in pitchers and catchers when compared to other position players.
• Those with a positive MRI finding had greater reduction in shoulder internal rotation compared with the nondominant arm.
• Year-round play (i.e., playing ≥8 months per year) and working with a private coach were associated with positive MRI findings and a history of elbow pain.

Noting that 27% of the players in this study used a private coach, Pennock et al. concluded that “ultimately, a balance must be found between teaching proper throwing mechanics and excessive throwing.” The authors also suggest that guidelines be revisited to address year-round play.