Little Leaguer’s Elbow

With baseball season in full swing we begin to see an increase in upper extremity injuries in young athletes. One of the most common injuries we treat is a throwing injury known as medial apophysitis, or “Little Leaguer’s Elbow.”

This condition occurs when the repetitive stress of frequent throwing places excessive strain on the tendons, ligaments and cartilage of the elbow joint.  In the young player and immature elbow this is particularly concerning because of the damage it can cause to the growth plate.

The two “phases” of throwing which impact the elbow joint include the early acceleration phase (a pulling force on the growth plate of the inner elbow) and the throwing/release phase (strong inward and downward snap of the wrist).  A hinge and pivot joint, the elbow allows a broad range of motion.  The growth plate in the elbow, though, is comprised of growth cartilage – a soft substance that is not as strong as bone.  With repetitive stress, this growth cartilage can weaken, develop small fissures and in more severe cases pull apart from the bone. The repeated pulling can also tear ligaments and tendons away from the bone – possibly pulling tiny bone fragments with it.  In a young player, this could potentially disrupt normal bone growth and result in deformity.

Another less common though more serious throwing injury, known as Osteochondritis Dissecans, can occur in young athletes and involves the loosening and fragmenting of immature bone and cartilage. The pain associated with this condition is usually felt on the outside of the elbow.

Both prevention and early treatment of Little Leaguer’s Elbow are key for young players.

Symptoms of Little Leaguer’s Elbow

The most common symptom associated with Little Leaguer’s Elbow is pain on the inside of the elbow, which may be severe and occur abruptly, or mild – increasing in intensity, gradually over time.  Other symptoms may include swelling, redness and warmth over the inner elbow.  Range of motion may be restricted in some players, with an inability to straighten the elbow.

Diagnosis and Treatment

A physical examination and pain assessment will help diagnose Little Leaguer’s Elbow.  An X-ray or MRI may be indicated to assess irregularities in the elbow joint and growth plate damage.

When diagnosed early, nonsurgical treatment can effectively resolve the problem and may entail rest (refraining from throwing activity), as well as icing to reduce swelling.  Sports rehabilitation specialists may also be able to help young players refine their throwing technique to reduce stress on the elbow joint.

In more severe cases, surgery may be required to reattach a ligament and/or the bone or growth plate  – stabilizing the elbow joint.

Preventing Throwing Injuries in Little League Baseball

Understanding the impact of throwing injuries on the immature elbow is key for coaches, parents and players.  Risk of injury can be reduced by properly warming up and ensuring proper throwing technique.  And adequate rest is as equally important as practice for optimal performance.

The American Academy of Orthopaedic Surgeons (AAOS) recommends that young pitchers play no more than three to four innings each game, to prevent throwing injuries.

Pitch Count Guidelines and Little League Regulations

As competition in youth sports intensify and seasons extend to include tournaments and World Series games, we are seeing an alarming increase in throwing injuries in the young player.  This has prompted the American Sports Medicine Institute, together with USA Baseball, Little League Baseball and Major League Baseball to examine the impact of excessive throwing on the young, skeletally immature athlete.  Their findings have translated into new regulations, pitch count guidelines and educational initiatives in Little League Baseball.

Next month we’ll talk about pitch count guidelines and its role in protecting young baseball players.

 

 

Hand and Wrist Pain in Exercise – Can Make it Hard to Power Through

Hand and wrist pain in exercise can affect men and women, young and mature alike.  From weightlifting and exercise machines to pushups, injuries and conditions can result from the repetitive stress of the activity or the sudden frequent exposure (training in an off season, sudden increase in weights or repetitions, new exercise program, etc.).

Powering Through

Exercise Impact on the Hand & Wrist

The hand and wrist conditions most commonly associated with these types of exercise regimens is tendinitis. Other less common injuries include stress fractures of the wrist.

If not addressed, pain and restricted hand and wrist function could hinder proper form during the activity and cause more serious injury.

Tendinitis – Symptoms and Diagnosis

Tendinitis is the inflammation of the tendon resulting from micro-tears that occur when the “musculotendinous unit” (muscular and tendinous tissue and its ability to be stretched) is severely overloaded with a excessive or sudden tensile force (resistance of a material to a force tending to tear it apart).

It can also be associated with Tendinosis, which is the degeneration of the tendon’s collagen in response to chronic or repetitive overuse.

Symptoms can vary depending on the area affected.  When affecting the fingers, symptoms can be similar to those experienced with trigger finger – catching or locking when bent.

Occurring where a tendon attaches to bone, other symptoms of tendinitis include:

  • Pain and/or tenderness in the hand or wrist when lifting weights
  • Possibly mild swelling

Tendinitis is confirmed upon physical examination and discussion of patient history.  It is generally resolved by resting and refraining temporarily from the activity causing the strain.  If this does not resolve the condition, anti inflammatory medications and hand therapy exercises may be recommended.  Only in extreme cases of tendon damage is surgery considered.

Stress Fractures – Symptoms and Diagnosis

A stress fracture is an overuse injury which occurs when muscles become fatigued – unable to absorb added shock therefore transferring the stress overload to the bone.  This can cause a tiny crack in the bone and is called a stress fracture.  While stress fractures are most commonly seen in the lower extremity, they can occasionally occur in the wrist when subjected to excessive strain or repetitive stress activity such as increasing the amount or intensity of an activity too rapidly.

A stress fracture can sometimes be confirmed on an x-ray, though may not be visible for several weeks despite the pain.  If necessary, a computed topography (CT) scan or magnetic resonance imaging (MRI) may be indicated to confirm the fracture.

Among the most effective treatments for a stress fracture is rest from the activity that caused the fracture for approximately six to eight weeks.  Resumption of activity before proper healing can result in a more serious fracture and potentially chronic problems.

Reducing Risks

There are a number of things that those engaged in weightlifting or related exercise program can do to reduce these types of hand and wrist injuries and conditions.

  • Build up gradually to increased weight and reps
  • Wear wrist guards or protective gloves (minimizing pressure and providing wrist assist)
  • Taking breaks to rest the hands and wrist
  • Using proper technique/form  

Learn more about common hand and wrist injuries and conditions. 

 

 

Handlebar Hazards

Repetitive Stress Hand & Wrist Conditions Affecting Cyclists

As training begins for the upcoming MS150, we thought we’d talk about some of the common overuse, or repetitive stress, hand and wrist conditions affecting cyclists.  By discussing some of these conditions and ways to reduce your risk, hopefully we can ensure pain free cycling and play a hand in many successful rides.

How Repetitive Stress Occurs
Avid cyclists competing year round in weekend rides and races tend to experience various types of overuse strains and stress associated with such a sport – nearly one-third of these

Hyperextended Wrist

affect the hand and upper extremity.  Despite the best equipment and preventive measures, the jarring vibration of a rough terrain, handlebar hand positioning for hours at a time or tense ride into the wind can result in such repetitive stress conditions as carpal tunnel syndrome or handlebar palsy (also known as ulnar neuropathy).  Cold weather also makes tissue more distensible and may slightly increase risk for carpal tunnel syndrome as well.

Carpal Tunnel Syndrome

Hyper Flexion of Wrist

One of the most common tendinopathic conditions associated with overuse activity and repetitive stress in the hand and wrist is Carpal Tunnel Syndrome (CTS).  CTS is the result of irritation and swelling, which causes compression within the narrow carpal tunnel located at the wrist – through which one of the major nerves in the arm, the median nerve, passes. CTS is one of the most common overuse hand and wrist conditions affecting cyclists. When the median nerve becomes irritated in this inflamed and compressed tunnel, numbness, pain, tingling and weakness may result in the thumb, index and middle fingers – causing discomfort and affecting a cyclist’s ability to even shift gears with the affected hand.  Resting periodically and stretching the hands, changing grip to reduce hyperextension and hyper flexion may help during the ride, but ongoing pain may require treatment – which is generally nonsurgical and may entail night bracing and/or injection therapy.  CTS pain remaining unresolved following nonsurgical treatment may require a minimally invasive Endoscopic Carpal Tunnel Release.

Handlebar Palsy (Ulnar Neuropathy)
Handlebar palsy, known medically as ulnar neuropathy, is another common overuse or repetitive stress condition affecting cyclists.  It is the result of direct pressure placed on the ulnar nerve at the hand and wrist – from the grip of a cyclist’s hands on handlebars, causing stretching or hyperextension of the nerve.  The ulnar nerve controls sensation in the ring and little fingers as well as the muscular function of the hand.  Compression of it may result in numbness and tingling in the ring and little fingers and/or hand weakness. Nonsurgical treatment such as rest, stretching exercises, and anti-inflammatory medications can generally resolve this condition.

These overuse, repetitive stress conditions affecting bicyclists also often affect motorcyclists – as the continuous vibration of the motorcycle causes the same type of conditions long rides and regular bicycling can cause.

Reducing Your Risks
Decades of cycling enthusiasts have contributed to an array of preventive cycling gear and recommendations for reducing a fellow cyclist’s risk for such conditions.  These include everything from basic and specialized gel cycling gloves to additional handlebar padding and adjustments in handlebar height and overall bike fit specific to each rider.

Applying less pressure or weight to the handlebars and avoiding hyperextension and hyper flexion, along with frequent adjustments to grip and position on the handlebars, should reduce risk for carpal tunnel syndrome and handlebar palsy.

Figures source:  http://www.hughston.com/hha/a_15_3_2.htm