By Dr. Paul D. Protomastro, Coastal Orthopaedics
Baseball and softball season are in full swing! From the exhilaration of hitting a game winning RBI, to the satisfaction of making a double play, to the triumph of striking out the side: baseball and softball are timeless American sports that have captured the hearts of millions for over a century. Our youngsters embrace this sport with a passion and commitment like never before. Travel ball, club and elite teams and the year round nature of modern competition can stress the throwing arms of these young athletes to the point of failure!
Shoulder and elbow pain sideline throwing athletes of all ages and ability levels but child athletes are vulnerable to a unique type of injury commonly known as Little Leaguers Arm. Under age 13 in girls and 15 in boys, children’s bones are still growing. These skeletally immature bones grow in length and width at a specialized area of cartilage within the bone know as the Growth Plate. These cartilage growth centers are softer than the surrounding bone and are thus the “weak link”. As children grow in size, strength and ability the intensity, frequency and force of throwing can actually break their bones through these growth plates. The cumulative repetitive stress of excessive throwing can cause a stress fracture of the growth plate. The humerus (the upper arm bone), is the most commonly injured in young throwers. When the upper growth plate of the humerus becomes fractured the child will experience sharp shoulder pain when throwing. When the lower growth plate becomes fractured, the thrower will get sharp pain on the inside of the elbow. Less commonly, the growth plate on the ulna bone at the back of the elbow can fracture and give the athlete pain on the point of the elbow. Ironically, in children the soft tissue structures (tendons and ligaments) are stronger than their bones. For this reason, ligament tears and tendon ruptures are exceedingly rare in children.
Unlike rotator cuff tendon tears and ligament tears(Tommy John) in adults that do not heal without surgical repair, growth plate fractures of the shoulder and elbow in children almost always heal. The key element to healing is REST! A 3 to 4 week break from sports and gym is usually enough. Surgery is almost never required for the skeletally immature throwing athlete that spontaneously develops arm pain. Rehabilitation is occasionally necessary to return the athlete to throwing after they have healed. Developing Little Leaguers Arm is linked to three key factors: 1. the frequency and intensity of throwing, 2. improper throwing mechanics and 3. inadequate warm-up and strengthening prior to throwing. The best way to treat these arm injuries is to PREVENT them. Limiting children to a maximum number of pitches or throws per day, innings pitched and games per day or weekend is essential. Instruction in proper throwing technique is invaluable. The serious, year round throwers benefit from a home exercise program for arm flexibility and strengthening taught by a physical therapist or athletic trainer to keep their arms ready for the field.
When your throwing athlete complains of shoulder or elbow pain that is sharp, intense and lasting more than a week or two at most, it is time take action. Even if the child denies pain, a reduction in throwing velocity, distance or accuracy are signs of an evolving injury. The simplest and most prudent step is to take the athlete out of all throwing activities for 2 weeks and then gradually return them to play. If this proves unsuccessful or as a parent you want assurances the athlete can “play through” the pain, evaluation by an orthopaedist is recommended. If, upon evaluation, the arm has full motion and strength, no tenderness or instability, and normal x-rays: continuing to play with pain may be safe. Pitchers and catchers are most susceptible, but third basemen, short stops and outfielders are also commonly affected by Little Leaguers Arm. Moving a player with a sore arm to first, second or right field may prevent an early injury from turning into a season ending one. Enrolling child athletes in multiple sports throughout the year has merits. It not only gives their arms time to heal but also develops their balance, endurance, coordination and psychomotor skills which may ultimately make them a better baseball or softball player.