Increasing Number of Shoulder and Elbow Injuries Among Adolescent Baseball Players Seen in US Emergency Rooms 

Purpose: To analyze national injury trends of youth baseball players.

Hypotheses: 1) While the total number of baseball injuries diagnosed over the past decade would decrease, there would be an increase in adolescent elbow injuries seen nationally. 2) The increase in elbow injuries would be significantly greater than other injuries to the upper extremity and major joints.

Methods: Injury data from the National Electronic Injury Surveillance System, a United States Consumer Product Safety Commission database, were analyzed between January 1, 2006, and December 31, 2016, for baseball players aged ≤18 years. Data were collected on the location of injury, diagnosis, and mechanism of injury.

Results:

• Between January 1, 2006, and December 31, 2016, the total number of baseball injuries diagnosed in 100 emergency departments in the NEISS database was 15,389

• These data were used to estimated that there were 665,133 baseball injuries in US emergency departments between 2006 and 2016

• Mean age of the injured players was 11.5 years

• The most common injuries diagnosed were:

  • Contusions (26.8%)

  • Fractures (23.6%)

  • Strains and sprains (18.7%)

• The most often injured joints were:

  • Ankle (25.6%)

  • Knee (21.3%)

  • Wrist (19.2%)

  • Elbow (17.7%)

  • Shoulder (16.2%)

  • Shoulder and elbow (33.9%)

• The incidence of the ankle, knee, wrist, and shoulder injuries decreased over time

• The incidence of elbow injuries increased significantly over time

• Throwing was the only elbow injury mechanism that increased substantially over time

Conclusions:

• Young baseball players are increasingly susceptible to elbow injuries

• These injuries are caused by throwing and the result of overuse

• The increase is occurring despite increased public awareness and national efforts at lowering injuries in throwers

• If the current trend continues, the elbow will soon become the most commonly diagnosed upper extremity injury

• This is not surprising, as elbow pain is becoming increasingly diagnosed among youth throwers

• Studies indicate that elbow pain is common in:

  • 20%-30% of 8- to 12-year-olds

  • 45% of 13- to 14-year-olds

  • >50% of high school and college baseball players

Recommendations:

• New initiatives must continue to be developed to limit early sports specialization, prevent overuse injuries and keep players healthy

• Modifiable risk factors that can be addressed to help reduce the risk of injury include, but are not limited to:

  • High-velocity pitching (>85 miles per hour)

  • Participation in showcases

  • Pitching on more than one team

  • High pitch counts

  • Pitching while fatigued

  • Pitching for more than 8 months per year

  • Poor pitching mechanics

  • Pitching more than 80 combined innings in any 12-month period

  • Pitching in multiple games on the same day

  • Not observing Pitch Smart Guidelines²

• Analysis of these efforts through large-scale prospective investigations will be necessary to appropriately evaluate the effect of these protective measures on injury rates

References

1. Trofa, D. P., et. al. Increasing Burden of Youth Baseball Elbow Injuries in US Emergency Departments. Orthop J Sports Med.2019 May; 7(5): 2325967119845636. Published online 2019 May 14. doi: 1177/2325967119845636

2. http://baseballstrength.org/pitch-smart-risk-factors-and-guidelines/