Baseball Nostalgia and Common Elbow Injuries

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July 12, 2016

By Desi Rotenberg, MS, LAT, ATC

Baseball is woven into the fabric of America’s national consciousness and offers participants from diverse background the opportunity to put aside their differences and play a friendly game of catch. Like many of you, some of my greatest memories as a child were going to the ball park with my dad, throwing, hitting and through it all, learning invaluable life lessons. Whether playing in a competitive environment, or playing a casual game of toss, baseball offers us an opportunity to connect with earlier generations and continue the legacy of American nostalgia and pride.

Elbow Injury Prevalence

Baseball, like any sport, offers its share of injury risk. According to a study by Hootman et al. in Journal of Athletic Training, 45% of all injuries sustained in Major League Baseball (MLB) from 1988-2005 were related to the upper extremity.¹ Furthermore, the highest volume of baseball injuries to the upper extremity (21.7%) were related to the elbow (compared with 17.1% of injuries related to the shoulder).² Concurrently, according to an article by Forbes Magazine, pitchers accounted for 58.6% of MLB injuries in 2015.² These 2 statistics do have relative correlation, as pitchers with elbow injuries seem to make up the majority of the disabled list throughout any given season.

Elbow injuries seem like an inevitable consequence to overhand sports. In a year-long study that followed youth baseball players from the start of the season to the end of the season, Matsuura et al. found 30% of youth baseball players will have elbow pain each year, and nearly 60% of players with elbow pain will show radiographic abnormalities.³

Common Elbow Injuries

Baseball at any level requires high level velocities that place rotational and shearing forces on the joints and ligaments required for those movements. The elbow has 6 degrees of motion: flexion/extension, pronation/supination and valgus/varus. The 3 main mechanisms of elbow injuries are valgus force, posterior translation and posterior-lateral translation.⁴

However in baseball, the most common mechanism of injury is associated with overload. The varus/valgus motion of the elbow can only articulate up to 3-4° before the forces begin to overload the articulating structures and the chronic forces compromise the integrity of the joint.⁴

Andrews reviewed 72 baseball players who underwent arthroscopic or open elbow surgery and found 65% were diagnosed with a posterior olecranon osteophyte and 25% were diagnosed with an ulnar collateral ligament injury.⁵

Statistics

Below is a chart showing frequency of Tommy John Surgery, or ulnar collateral ligament (UCL) reconstruction, from 2000-2014 in Major and Minor League Baseball:

Source: Sporting Charts- Disabled List Data for Major and Minor League (MLB)⁶

1. Hootman, Jennifer M., Randall Dick, and Julie Agel. "Epidemiology of collegiate injuries for 15 sports: summary and recommendations for injury prevention initiatives." Journal of Athletic Training 42.2 (2007): 311.

2. Maury, B “Infographic: 2015 Baseball Injuries, Broken Down By Position And Body Part” http://www.forbes.com/sites/maurybrown/2015/10/16/infographic-breaks-down-where-700-million-in-baseball-injuries-are-at/#4a88e35d5ade; (2015).

3. Matsuura, Tetsuya, et al. "Elbow Injuries in Youth Baseball Players Without Prior Elbow Pain A 1-Year Prospective Study." Orthopaedic journal of sports medicine 1.5 (2013): 2325967113509948.

4. Inagaki, K. (2013). Current concepts of elbow-joint disorders and their treatment. Journal of Orthopaedic Science, 18(1), 1-7.

5. Andrews JR, Timmerman LA. Outcome of elbow surgery in professional baseball players. Am J Sports Med. 1995;23:407–13.

6. http://www.sportingcharts.com/articles/mlb/tommy-john-surgery-statistics.asp

a. http://www.baseballheatmaps.com/disabled-list-data/

About the Author

Desi Rotenberg, originally from Denver, Colorado, graduated with his bachelor's degree in 2012 from the University of Northern Colorado. He has been a BOC Certified Athletic Trainer since 2012 and earned his master's degree in Exercise Physiology from the University of Central Florida in 2014. He currently is a high school teacher, teaching anatomy/physiology and leadership development. Along with being a teacher, he wears many hats, such as basketball coach, curriculum developer and mentor. He has been a contributor to the BOC Blog since the summer of 2015.