ELBOW INJURIES IN YOUTH BASEBALL by cuiliqing

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									2006 Spring Coaches Clinic
    “Sports Medicine”
        Sponsored by:

 Heritage
 Family
  Care
                  Guest Speakers:



Dr. Scott Konopka                    Dr. Mark Galland
Heritage Family Care                 Orthopaedic Specialists of
                                     North Carolina
Dr. Konopka is a board-certified
family practitioner with a special   Dr. Galland is an Orthopedic
interest in sports medicine. Dr.     Surgeon with a special interest in
Konopka received his medical         sports medicine. Dr. Galland
degree at East Carolina University   received his medical degree at
School of Medicine and completed     Tulane University and completed
his internship and residency at      his internship and residency at
Wake Forest University, Bowman-      Tulane as well.
Gray School of Medicine at Baptist
Hospital.
Prevention of Injuries in
    Youth Baseball
      Scott E. Konopka, M.D.
       Heritage Family Care
             570-3090
     Benefits of Regular Exercise
   Youth athletic programs provide
    opportunities to:
    – Improve self esteem
    – Acquire leadership skills and self-discipline
    – Develop general fitness and motor skills
    – Engage in peer socialization

    However; participation is not without injury risk
        Kids’ Activities Intensify
 More than 35 million youths between the
  age 6-21 participate in sports
 Baseball is one of the most popular sports
  for children
    – Each year more than 500,000 baseball injuries
    – Recent study shows 40% injury incidence
      among 9-12 y/o pitchers over 1 year
    – Upwards of 50% of all injuries in sports are
      due to overuse injuries
      Common Types of Injuries
   Acute Injuries
    – Occur suddenly and are usually related to trauma
    – Usually involve minor bruises, sprains and strains
    – More severe acute injuries
        Eye injuries – scratched retinas, etc
        Broken bones or ligament injuries
        Brain injuries – concussions, etc


       Normally due to inadequate equipment
         for example sliding into immobile bases
                     Avoid Injuries
   Wear protective gear
    – Protective eyewear – especially
      important for all functionally one-eyed
      individuals and for athletes with prior
      eye surgery or trauma
    – Properly fitted helmets (sports specific)
         AAOS – wear helmet at bat, when
          waiting a turn at bat, and running the
          bases
    – Properly fitted footwear
    – Hats and sunscreen to prevent
      sunburn
    – Sports specific pads
         Catchers should wear helmet, face
          mask, throat guard, long model chest
          protector, shin guards
              Avoid Injuries II
   Maintenance and Appropriateness of
    playing surfaces
    – Check to be sure playing fields are not full of
      holes and ruts or foreign objects
    – Break away bases
     Common types of Injuries II
   Overuse Injuries
    – Occur from repetitive actions that put too
      much stress on bones and muscles
    – Problematic in children as they may effect
      bone growth
    – The more time spent in sports, the more likely
      to occur
Common Types of Overuse Injuries
   Anterior Knee pain
    – Front of knee under knee cap
    – Caused by muscle tightness of hamstrings
      and quadriceps
   Little league elbow
    – Medial elbow pain
    – Repetitive throwing
   Shin splints
     Factors contributing to Overuse
                  Injury
   Intrinsic
    –   Growth
    –   Prior injury
    –   Inadequate conditioning
    –   Anatomic malalignment
    –   psychological
   Extrinsic
    – Too-rapid training progression/ inadequate rest
    – Inadequate equipment
    – Adult or peer pressure
Little league Elbow
           Injury Mechanism
 Overhand throwing
  subjects the elbow to
  forces of tension,
  compression, shear,
  and torsion
 Two main stages are
  acceleration, and
  follow through
Common Stages of Injury
Physis changes
    Elbow Injuries in Young throwing
                Athletes
   Anterior Compartment
     –   Anterior capsular stretching
     –   Bicipital tendonitis
     –   Biceps weakness
     –   Osteochondritis dissecans
   Lateral Compartment
     –   Supinator muscle strain
     –   Lateral apophysitis
     –   Anconeus muscle stain
     –   Suprachondral fracture
   Posterior compartment
     –   Olecranon tip impingement
     –   Olecranon apophysitis
     –   Triceps tendonitis
   Medial Compartment
     –   Ulnar collateral ligament strain
     –   Flexor muscle strain
     –   Medial apophysitis
     –   Ulner nerve neuritis
            Typical history
 Medial elbow and proximal forearm pain
  occurring a few days after throwing to first
  base from third or shortstop or after
  pitching.
 Pain abates with rest but returns with
  throwing
 Usually best “skill” player
         Preventing Overuse
 Must have healthy participant –
  preparticipation physicals
 Daily stretching and conditioning
 Distance running and sprinting included
 Age appropriate strength training
 Coaches should teach the proper
  mechanics of pitching and throwing
 Youth league regulations limit the innings
  pitched per week
                      Pitch Count
   9-10 year olds
    – 50 pitches per game
    – 75/ week
    – 1000/ season and 2000/ year
   11-12 year olds
    – 75 / game
    – 100/ week
    – 1000/ season and 3000/ year
   13-14 year olds
    – 75 / game
    – 125/ week
    – 1000/ season and 3000 / year
    Preventing Overuse Injuries
 No breaking pitches in competition until
  bones are mature = 13 y/o (curveball,
  slider)
 Do not pitch for more than 1 team in a
  given season
 Pitch for only 9 months out of the year
          Heat and Hydration
 Children perspire less than adults
 Can be fatal
 Heat related illnesses include:
    – Dehydration
    – Heat exhaustion
    – Heat stroke
         Playing safe in the heat
   Recognize the dangers
   Respond quickly if injury occurs
   Schedule regular fluid breaks during practice and games
   Drinking water is the best choice, others include fruit
    juices and sports drinks
   Kids need to drink 8 oz of fluid every 20 minutes
   Make player substitutions more frequently in the heat
   Wear light colored clothing, hats
   Use misting body sprays on the body to keep cool
    How to prevent sports injuries
   Be in proper physical condition to play the sport
   Know and abide by the rules of the sport
   Wear appropriate protective gear
   Know how to use athletic equipment
   Always warm up before playing
   Avoid playing when very tired or in pain
   Get a preseason physical
   Make sure there is adequate water or other
    liquids to maintain proper hydration
Mark W. Galland, MD
Orthopaedic Specialists of NC
    ORTHOPAEDIC CONSULTANT

        CAROLINA MUDCATS



        RALEIGH REBELS



        LOUISBURG COLLEGE
ELBOW INJURIES IN
 YOUTH BASEBALL
ELBOW ANATOMY
         MCL/UCL



         “TOMMY JOHN”



         30 DEGREES FLEX
SKELETALLY IMMATURE ELBOW
PITCHING SEQUENCE
        PLAYERS MOST AT RISK
   PITCHERS



 3RD   BASEMAN



   SHORTSTOP
              INJURY TYPES
   FRACTURES

   STRAINS

   INFLAMMATION

   NERVE INJURY
  “LITTLE LEAGUER’S ELBOW”

                       SWELLING
MEDIAL EPICONDYLE
APOPHYSITIS            PAIN

                       LOSS OF MOTION
           TYPICAL HISTORY

   “FATIGUE”         “TIGHT”



   PAIN              THROWING ONLY



   CONTROL           VELOCITY
           TREATMENT
   REST



 REST




REST
             TREATMENT

   NSAIDS

   ICE

   REHAB
LOSS OF SEASON
SURGICAL TREATMENT
    INTERVAL THOWING PROGRAM


   “LONG TOSS”

   BULLPEN

   FULL EFFORT
          RETURN TO PLAY

   GOOD CONTROL

   PAIN FREE

   FULL VELOCITY
      PREVENTION


FREQUENCY   OF PLAY


TRAVEL   TEAMS
         PREVENTION


PITCH   COUNT

THROW    COUNT
       PITCH/THROW COUNTS


   50-75 PER GAME

   2-3 DAYS REST (PITCHERS)
               PREVENTION

   VELOCITY

   THROWING MECHANICS

   AGE
  THE “BREAKING BALL”


NEVER
BEFORE
AGE 13
                        CHANGE UP




   “HITTING IS TIMING. PITCHING IS UPSETTING TIMING”
                  --WARREN SPAHN
        INJURY PREVENTION


   RESPONSIBILITY OF ALL INVOLVED IN
    YOUTH BASEBALL
Tom Shipman
President, GWFABC
USA Baseball Medical & Safety Advisory
    Committee recommendations
          Baseball Pitch Count                                 Baseball Pitch Types
  Age Max Pitches Per Game    Max Games Per Week               Age          Type
  8-10         50                     2                         8          Fastbll
 11-12         65                     2                         10      Change-Up
 13-14         75                     2                         14       Curveball
 15-16         90                     2                         16         Slider
 17-18         105                    2                         16        Forkball
                                                                16        Splitter
                                                                17       Screwball




                             Minimum Rest After Pitches
                              Age    1 Day   2 Days   3 Days   4 Days
                              8-10     20      35       45       50
                             11-12     25      35       55       60
                             13-14     30      35       55       70
                             15-16     30      40       60       80
                             17-18     30      40       60       90

								
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