STRIKE!

Looking behind the baseball at UCL injuries … and the role former Los Angeles Dodgers pitcher Tommy John plays

 

The goal of every great baseball pitcher is to strike out the batter.  To do this requires not only talent but extreme power every…single…pitch.

Few other athletes are required to throw with this kind of power as frequently as a pitcher.

Over the course of a baseball career, particularly if begun at a young age and played competitively, this high speed force repeatedly placed on the elbow can take a toll.

Often beginning with Little Leaguer’s Elbow, a condition affecting young pitchers who do not allow adequate rest between pitches, a baseball player’s elbow joint absorbs a tremendous amount of repetitive stress over the seasons.  The impact of this type of overhead throwing irritates the tendons and ligaments supporting the elbow joint, predisposing pitchers to more serious problems.  One such injury is an Ulnar Collateral Ligament (UCL) injury.

Once seen primarily in adult athletes, the dramatic increase in more serious overuse injuries like UCL damage, Flexor Tendinitis and Valgus Extension Overload (VEO) in young players prompted the American Sports Medicine Institute (ASMI) and the USA Baseball, Little League Baseball and Major League Baseball organizations to establish Pitch Count Guidelines.

While these changes and educational efforts are expected to reduce the number of overuse injuries seen in young players, competitive league players remain at risk.

Ulnar Collateral Ligament (UCL) Injury

Elbow Anatomy and UCL Injury

The Elbow Joint and location of the Ulnar Collateral Ligament

The ulnar collateral ligament (UCL) is among the most commonly injured ligament in throwing athletes.  To accommodate the high speed throwing motions, the ligament stretches and lengthens until it can no longer hold the elbow bones tightly enough. Severity of the injury can range from a sprain with minor damage and inflammation to a complete tear.

Symptoms Include:

baseball bullet

Pain on the inside of the elbow

baseball bulletA feeling of instability in the elbow

baseball bulletLoss of strength in throwing

baseball bulletIrritation of the ulnar nerve (funny bone) causing numbness in the small and ring fingers

Diagnosis and Treatment

A UCL injury is diagnosed based on the results of a physical examination, X-ray and MRI.  Depending on the severity of the damage, rest and refrain from play along with rehabilitative exercises and anti inflammatory medication may be indicated. Work with an athletic trainer may also be helpful, to assess throwing mechanics and improve body positioning which can reduce excessive stress on the elbow.

If there is a complete tear of the ligament and patients fail to improve with conservative treatment, surgery may be indicated.

The UCL reconstruction procedure, which was performed on former Los Angeles Dodgers pitcher Tommy John and is more commonly known as Tommy John surgery today, has dramatically changed the outcome for athletes.  In fact, his results were so impressive, it is reported that young players not actually suffering from a UCL injury have sought Tommy John surgery in hope that it would improve their performance [1]!  The procedure, though, is performed only when necessary to repair a severely torn UCL.

Tommy John surgery is a surgical graft procedure in which the injured UCL is replaced with a tendon graft taken from the forearm or the hamstring tendons.  This procedure is followed by an intense rehabilitation program that lasts from six months to a year, depending on the position an athlete plays.  Throwing exercises can begin in about 16 weeks.

The Role Tommy John Continues to Play

In the medical community, Tommy John remains credited with the shift in how athletes view UCL injuries. Once career ending, today UCL reconstruction has become a common procedure – returning most athletes to their sport at a pre injury level of play.

In the sports world, Tommy John is still revered for the excellent athlete he was, choosing baseball as his sport of choice and playing in all three of the Yankees vs Dodgers World Series in his era (1977, 1978 and 1981).

Undergoing the procedure in 1974 and spending his entire 1975 season in recovery, he learned to pitch in a way that relieved the stress he was placing on his arm and leg.  He returned to the Dodgers in 1976. His 10-10 record that year was considered “miraculous.”  But, he went on to pitch until 1989 winning 164 games after his surgery – just one game shy of baseball great Sandy Koufax.

The recognition he received for his unexpected success following the procedure now donning his name became the launching pad for other endeavors benefiting young baseball players.

His “Let’s Do It” foundation, which umbrellas the Tommy John Pitching Academy, is today dedicated to research in preventing such injuries and teaching pitching techniques that minimize the physical impact. The foundation also supports the efforts of the American Orthopedic Society for Sports Medicine (AOSSM) and its collaborators’ STOP Sports Injuries Campaign as well as the American Foundation of Suicide Prevention (AFSP).  AFSP and its outreach effort is an important component in the foundation’s efforts in memory of his son.

 References

  1. Longman, Jere. Fit young pitchers see elbow repair as cure-all. 2007 Jul.

 

 

Basal Joint Arthritis (Arthritis of the Thumb)

Basal joint arthritis (also known as Basilar Joint arthritis) affects the base of the thumb, known as the basal joint or carpometacarpal (CMC) joint.  It is, in fact, the range of motion permitted by this joint that most distinctly separates the hand movement of humans within the animal kingdom – as it’s function and wide range of motion is unlike any other.

Bones which comprise the basal joint of the thumb.

The basal joint, or the CMC joint, is an interesting joint consisting of the small bone of thewrist known as the trapezium and the first (metacarpal) bone of the thumb.  This joint allows the thumb to reach a unique range of motion – permitting not only up and down movement but also the ability to span across the palm and achieve a “pinching” position.

This type of arthritis of the thumb results when the cartilage, which cushions the meeting point of the bones comprising the joint, deteriorates.  In the absence of sufficient cartilage, the bones are allowed to rub together during movement – causing pain at the base of the thumb and in severe cases deformity as the thumb collapses into the palm.

Pain may hinder many daily activities when the basal joint is irritated during such activities as turning knobs, opening lids, and writing.

It is one of the most common forms of arthritis of the hand, and it is thought that those suffering from a previous fracture or dislocation which affected the joint may be at higher risk for developing basal joint arthritis. Those suffering from osteoarthritis may also suffer from this type of arthritis.

Diagnosing Basal Joint Arthritis

The first steps in diagnosing this type of arthritis may include a physical examination, a discussion of patient history, and review of the pain and limitations experienced. A grind test and an X-ray may also be used to help confirm the diagnosis.

Treating Basal Joint Arthritis

There are a number of nonsurgical treatments for less severe cases of basilar joint arthritis, including:

  • Hand Therapy, which includes: therapeutic hand splints to support the thumb and wrist during rest; posture modification exercises to reduce joint irritation during certain activities; and massage, heat and ice therapy.
  • Non steroidal anti inflammatory medications (NSAIDS) – ibuprofen, aspirin, naprosyn.
  • Injection therapy – such as steroid, viscosupplementation, etc.

More severe cases of basal joint arthritis may require joint reconstruction or other surgical intervention to restore joint stability.

Learn more about this type of arthritis and other conditions affecting the hand, wrist and elbow.