Baseball and other throwing sports put tremendous stress on the shoulder and elbow. As more athletes play more baseball and softball at younger ages, Sports Medicine specialists see more and more elbow and shoulder pitching injuries. The most devastating of these is a torn ulnar collateral ligament of the elbow (also known as the medial collateral ligament). Often this serious injury needs a elbow ligament reconstruction known as a “Tommy John” procedure. Ulnar collateral ligament tears can start slowly as an elbow sprain and progress steadily, or can happen all at once. Ulnar collateral ligament tears result in pain on the inner side of the elbow with throwing, and difficulty controlling the pitch. When the symptoms are mild, rest and medication may take care of the problem. However, if the athlete is unable to pitch due to the pain the “Tommy John” operation is needed.
Throwing sports put tremendous stress on the shoulder and elbows.
Shoulder injuries also plague pitchers and other throwers. The most commonly injured structures are the capsule/ligaments, rotator cuff, and labrum. Often the rotator cuff can be strengthened to compensate for the injury, but sometimes the ligaments are too loose or there is a torn labrum and surgery is necessary.
Throwing athletes often develop pain in their shoulder or elbow. Most often the problem will resolve without surgery. But sometimes surgery is necessary. The key is to determine who has a good chance of getting well without surgery and who does not. Players at different ages will have different issues. A 12 year old with elbow pain is often struggling with growth plate problems while trying to learn breaking pitches (see Little League Elbow Section) while a sixteen year old with similar symptoms may have a torn ulnar collateral ligament. A twelfth-grader will say “This is my senior year and I really want to play” while a sophomore or junior will usually say “I want this fixed now so that I can be ready for my senior year”. Similarly college players worry about eligibility and “red-shirting”. Professional pitchers are worried about their careers and remaining competitive.
When taking care of throwers and their injuries, knowledge of baseball and the mechanics of pitching helps. I have been fortunate to learn from some of the most knowledgeable baseball people in the business, and the coaches, players, and athletic trainers of the Houston Astros have been invaluable friends and teachers. They have taught me much over my ten years as their Team Physician, and combining our expertise has helped us provide quality care to the players in the organization as well as in my private practice.