Strain on young arms is concern

Increasingly, youngsters with worn-out arms need surgery to repair elbows and shoulders.

By JOHN ZENOR

ASSOCIATED PRESS

MONTGOMERY, Ala. — Battling elbow problems for months, the pitcher finally put his playing career on hold and opted for reconstructive surgery.

An overworked major leaguer? Hardly. Not even a hotshot college hurler.

“He hurt the ligament when he was 13,” said Dr. James Andrews, the noted sports surgeon, “and at 14 he had surgery.”

Make room on sports medicine’s operating tables. Increasingly, youngsters with worn-out arms need surgery to repair elbows and shoulders, derailing or sidetracking careers that haven’t even had a chance to really get started.

It’s a problem that prompted Little League International to impose a pitch limit on its players this season. Other youth leagues are limiting innings pitched to avoid straining young arms.

An especially common injury for youngsters appears to be tears in the ulnar collateral ligament in their elbows. Correcting the problem requires the so-called Tommy John surgery, named for the first major leaguer to have the procedure that typically involves transplanting ligament taken from the forearm, wrist or hamstring.

Many surgeries

For instance, Andrews, a prominent Birmingham orthopedist who frequently operates on high-profile athletes, performed Tommy John surgery 119 times from 1995-98. Only nine of those were for high school-aged patients, less than 8 percent, according to Dr. Glenn Fleisig of Andrews’ Alabama Sports Medicine Institute (ASMI) in Birmingham.

And from 2003-06? The numbers skyrocketed to 619 overall and 148 for high school players, or 24 percent.

“We’re seeing an epidemic of arm injuries, both the shoulder and the elbow, that’s appalling,” Andrews said. “We’ve seen a five- to six-fold increase in elbow ulnar collateral ligament injuries since the year 2000. Some of that’s based on increased referrals. [But] my sports medicine peers around the country are all experiencing the same situation.”

In an effort to determine the cause, ASMI tracked 476 youth baseball players during a spring season, measuring pitches, how many curve balls they threw and which players wound up with elbow or shoulder pain. The study was commissioned by USA Baseball’s Medical & Safety Advisory Committee.

Fleisig, ASMI’s research director, said the curve ball correlated with a “slight” risk increase, while pitch count was “the dominant factor.”

The bottom line, he said: “When someone’s tired, take them out. That’s pretty much the only rule you need. We need more rules because not everyone follows that common-sense rule.”

Last year ASMI and USA Baseball recommended imposing pitch counts on young pitchers. Only Little League has taken them up on it so far, after studying the rule in a pilot program last year.

Little League President Stephen Keener said the rule change has drawn mostly positive reviews, and has helped educate parents and coaches about the risks of overworking a young player.

“There’s only so many throws in an arm, and we’d like to see those throws extended over to the life of that player’s career, as opposed to cutting it short at 15 or 16 years old,” Keener said.

The Little League’s pitch limits are: 105 for 17- to 18-year-olds; 95 (13-16), 85 (11-12), and 75 for 10 and under with mandatory rest periods depending on how many pitches are thrown.

Dixie Youth coach Sheldon Johnson said he keeps a close eye on his team’s pitchers, including 10-year-old son Matt. The Montgomery American League limits pitchers to three innings a game for the first half of the season, instead of the national organization’s limit of six innings a week. Dixie Youth also has a mandatory 40-hour rest period between outings of three or more innings.