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Baseball Puts Kids' Elbows at Risk, Study Shows

FRIDAY, DEC. 1, 2023 (Healthday News) -- Millions of American kids and teens love to play the game of baseball, but the sport can leave many with elbow pain and injuries, new research finds.

“When we look at the forces that baseball players, even Little League baseball players, deal with during routine practice and games, it becomes apparent why elbow injuries are so common amongst this group,” said study co-author Vandan Patel, a radiology-orthopedics research scholar at Children’s Hospital of Philadelphia (CHOP) in Philadelphia.

Recent estimates show that 20% to 40% of youth baseball players between the ages of 9 and 12 complain of elbow pain at least once during the season, the researchers noted.

“This does not mean that elbow injuries are inevitable in baseball,” Patel noted. “With proper technique and proper rest, these injuries could potentially be avoided.”

What sets these youngsters up for injury in the first place? Throwing a baseball repeatedly stresses the growing bones, joints and muscles of the elbows of players.

“We conducted this study in order to better understand the patterns of injuries that can occur among youth baseball players with elbow pain,” said senior study author Dr. Jie Nguyen, director for the section of musculoskeletal imaging in CHOP's Department of Radiology. “A younger player injures differently than an older player. It is our hope that this data will help us continue to improve and individualize the care of current and future generations of youth baseball players.”

With younger players, their bodies haven't reached skeletal maturity, making them vulnerable to elbow pain and injuries, the researchers explained.

Children have growth plates, made up of flexible cartilage, that allow bones to grow and change as a child grows. Importantly, these growth plates are weaker than the surrounding muscles and bones and are prone to permanent injury. Growth plates finally close at the end of puberty, typically around ages 13 to 15 for girls and ages 15 to 17 for boys.

In the study, the researchers reviewed elbow MRI exams from 130 youth players (18 and younger) being evaluated for elbow pain. The average age of patients was 13.9 years, with 115 boys and 15 girls included. The frequency with which the patients played baseball varied from daily to recreationally.

The MRIs were reviewed by two different radiologists, to assess skeletal maturity and the findings of each scan of a patient’s elbow. They found 85 patients were skeletally mature, while 45 patients were skeletally immature.

With skeletally immature players, the most common findings included fluid build-up around the joint, stress injuries near the growth plate, fractures, and osteochondritis dissecans (OCD) lesions, where a piece of bone and the overlying cartilage is injured and can detach. That condition reduces range of motion and raises the risk for premature osteoarthritis.

In skeletally mature players, the injury pattern shifted from the growth plates to the soft tissue. These players most often had triceps tendinosis -- a condition in which the tendon connecting the triceps muscle to the elbow bone becomes strained, irritated or torn -- and fluid build-up in the bony area of the elbow where the ulnar collateral ligament attaches. The ulnar collateral ligament runs on the inner side of the elbow and helps stabilize it.

Injuries that required surgery included intra-articular bodies (small fragments inside the joint), and unstable OCD.

“In terms of the skeletally immature children, 9 patients (11%) had intra-articular bodies, and 19 patients (22%) had OCD lesions,” Patel said.

The findings were to be presented Thursday at the Radiological Society of North America (RSNA) annual meeting in Chicago. Such research is considered preliminary until published in a peer-reviewed journal.

“This information is critically important not only to physicians, but also to parents and team coaches, all of whom provide crucial support for these children, reducing injury and preventing permanent damage on and off the field,” study co-author Dr. Theodore Ganley, director of CHOP's Sports Medicine and Performance Center, said in a meeting news release. “As parents, caregivers and coaches, it is important to be aware of these findings in order to ensure that symptoms of pain are not overlooked during the baseball season.”

More information

Visit Stanford Medicine for more on sports injuries among kids.

SOURCE: Radiological Society of North America, news release, Nov. 30, 2023

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