Batter Up! Elbow Out?

3 min read  |  September 07, 2017  | 

People tend to take elbows for granted: they move and bend to help with a variety of daily activities. But they’re critical to athletes for motions including throwing, catching, and swinging a baseball bat. Unfortunately, in baseball as in other sports, overuse and repetitive motion may lead to elbow problems. An increasing trend among youth athletes has brought new concerns.

Tommy John surgeries on the rise

According to a 2014 study in the American Journal of Sports Medicine, 15- to 19-year-olds accounted for 57 percent of Tommy John surgeries in the United States from 2007-2011. The surgery is formally known as ulnar collateral ligament reconstruction (UCL). It involves replacing a ligament in the elbow with a tendon from another part of the body. The surgery was named for pitcher Tommy John, the first person to have the procedure in 1974, and whose career included pitching for five Major League Baseball teams.

Are young people playing harder than ever?

“That’s part of it, but there’s more to it,” says Dr. Lee Kaplan, Director of the Sports Medicine Institute at the University of Miami Health System. “We find that they have been playing too hard, too often, and even learning adult pitches that their bodies are not yet ready for. Awareness of the procedure also has grown, which leads to some of the increase.”

Kaplan says that along with following age-appropriate pitch count recommendations, research by Major League Baseball has identified other risk factors. These include fastball usage, number of pitch types, rest between outings, release points, weight, height, age, peak velocity, average velocity and even mound height.

Other elbow injuries

According to Dr. Kaplan, young baseball players are susceptible to other common elbow injuries like medial epicondylitis (also known as baseball elbow), flexor tendonitis and valgus extension overload (VEO).

Treatment varies depending on the condition and its severity. For example, while surgery may be required for each, medial epicondylitis may require medication, physical therapy, a brace and rest. Time and rest may also help with flexor tendonitis. Players suffering VEO could be helped by rest, ice, and physical therapy. Newer approaches include platelet-rich plasma (PRP) therapy, which initiates the healing of connective tissue in some cases.

“Start out with the tried-and-true RICE protocol: Rest, Ice, Compression, and Elevation,” Kaplan says. “If it’s a minor problem, this may be enough. If the pain is severe, if there’s a lot of swelling, or if it’s not getting better, seek professional medical attention.”

Safety: the best approach

The best treatment, of course, is prevention. It’s essential for everyone – parents, coaches, athletic trainers, and the athletes – to be cautious. That includes time to rest during the season and between seasons, monitoring techniques to minimize risk, and following medical and professional guidelines.

An example of these guidelines is Pitch Smart, a program from USA Baseball and Major League Baseball. The program offers information and age-specific recommendations for pitchers, such as no more than 105 pitches in a game thrown by 17- and 18-year-olds. Variations on the numbers are offered for situations based on rest between games and games per week, too.

For more information, or to arrange an appointment, call the UHealth Sports Medicine Institute at 305-243-3000, or visit us online at

Tags: baseball, elbow injury, sports injuries, sports medicine, surgery, Tommy John

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