Characteristics of the Pitching-Related Elbow Injuries in Intercollegiate Baseball Pitchers

Abstract

An act of pitching places high stress to the elbow, which leads to a variety of injuries. Collegiate pitchers typically started pitching competitively at a young age. Over the years of pitching, increasing level of competition and body size places increasing stress to the throwing elbow, and many pitchers have sustained significant injuries by the time they pitch in college. PURPOSE: To describe characteristics of elbow injuries in a cohort of collegiate pitchers (age = 18-24 years) using a cross-sectional survey design. Lifetime prevalence of elbow injuries, injury type, and association of injuries with reporting of pitching while experiencing shoulder pain were evaluated. Additionally, lifetime prevalence of elbow injuries were compared between Division I (D-I) pitchers and non-D-I pitchers. METHODS: A total of 1,464 surveys including questions on a history of throwing-related elbow injuries were mailed to pitchers at 96 institutions. Injury was defined as "an injury resulting in 7 or more days lost to pitching". Data from 629 surveys (43% return) were used to calculate descriptive statistics and to analyze association using chi-square statistics. RESULTS: A history of elbow injury was present in 42.8% of the pitchers. Of the 364 reported injuries, 35.3% were muscle/tendon inflammation, 24.8% were ulnar collateral ligament (UCL) injuries, and 15.8% were bone/growth plate fractures. The prevalence of elbow injuries was higher among the pitchers who reported having pitched while experiencing shoulder pain (57.7% vs.49.3%, X2=4.37, p=.037). D-I pitchers tended to have a higher lifetime prevalence of UCL injury relative to the non-D-I pitchers (13.1% vs. 7.9%, X2=3.39, p=.066). CONCLUSIONS: Lifetime prevalence of elbow injury in collegiate pitchers is alarmingly high. Association between the history of elbow injury and pitching while experiencing pain and a trend of higher prevalence of UCL injuries in D-I pitchers suggest that increasing competitiveness may be associated with elbow injuries. An association between elbow injury and pitching while experiencing shoulder pain may indicate that shoulder pain may result in compensatory change in pitching mechanics that leads to development of elbow injuries. Further biomechanical studies are needed to investigate this relationship.