Sunday, November 13, 2016

Prevalent Injuries in Baseball Pitchers

In the overhead athlete, there are a vast array of injuries that can happen for a multitude of  reasons. Some are  more severe than others, and require different levels of intervention. In today’s blog, we will discuss one of the most prevalent injuries experienced in overhead throwing athletes, specifically baseball pitchers.
The injury being referred to is the tear of the ulnar collateral ligament (UCL), of the elbow. The UCL is considered one of the most important structures of the elbow in a baseball pitcher. While it is not commonly stressed in everyday activity, it is however placed under a great deal of stress during a baseball pitch.1 As you could imagine, UCL tears are more common in pitchers than any other position in the sport. In addition, it has been found that there has been an increase in occurrence of the UCL tears recently. In a survey done by Conte et al, it was found that 25%, or 1/4th of the pitchers in the MLB had reported having a history of UCL pathology requiring reconstruction. It has also been found that there has been an increase in the number of UCL reconstructions in adolescent athletes from the ages of 15-19.1 So this raises the question, what is causing the increase in the amount of UCL injuries occurring?
There have been no prospective studies to date that have identified the cause for an increase in the number of ulnar collateral ligament reconstruction, however there have been multiple studies done identifying risk factors for the elbow in adolescent athletes. These risk factors include: pitching more than 100 innings per year, pitching while fatigued, pitching year round, pitching with supraspinatus weakness, pitching with GIRD, and pitching with loss of total arc of motion, to name a few.1 Even though there has been no measured outcome on if preventive measures taken decrease the likelihood of injury to the UCL, it is important to address poor biomechanical deficiencies in the athlete.2 As an athletic trainer, coach, or performance specialist, it is important you address underlying factors to try and prevent likelihood of injury, as with anything.
Former Dodgers Pitcher Tommy John
Once considered a career-ending injury, great strides have been made in rehabilitating and repairing the UCL. This started with the famous surgery performed on former Los Angeles Dodgers pitcher, Tommy John, in which his UCL was reconstructed.2 Reconstruction combined with efficient rehabilitation have resulted in better outcomes and pitchers returning with minimal loss in control or velocity.

1Erickson, B. J., Jr, B. R., Bush-Joseph, C. A., Verma, N. N., & Romeo, A. A. (2016). Medial ulnar collateral ligament reconstruction of the elbow in major league baseball players: Where do we stand? WJO World Journal of Orthopedics, 7(6), 355. doi:10.5312/wjo.v7.i6.355

2Redler, L. H., Degen, R. M., Mcdonald, L. S., Altchek, D. W., & Dines, J. S. (2016). Elbow ulnar collateral ligament injuries in athletes: Can we improve our outcomes. WJO World Journal of Orthopedics, 7(4), 229. doi:10.5312/wjo.v7.i4.229

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