Evaluation of elbow and shoulder problems in professional baseball pitchers (SS-98)

Abstract

Background: Shoulder and elbow problems in the professional pitcher are common injuries seen as result of the throwing motion. Few studies have evaluated the frequency of shoulder and elbow problems in the professional baseball pitchers and none have evaluated the possible relationship between such injuries. Hypothesis: The null hypothesis is that an injury of the shoulder or elbow does not make injury in the other joint more likely. Purpose: The purpose of this study was to establish a database that could be followed prospectively to determine whether injury to one joint was more likely to result in a problem with the other joint. Study Design: This study is a retrospective review of prospectively collected data. Methods: A survey was administered to all the pitchers of the White Sox Professional Baseball Association to collect data about shoulder and elbow problems during their career. Information from this survey has been analyzed for trends or correlations. Results: This study evaluated eighty four baseball pitchers, with a total of 737 seasons of baseball experience and a total of 52 index injuries resulting in days lost. Elbow problems were more frequent than shoulder problems in this group. Right-handed pitchers had both more shoulder and elbow problems than left-handed pitchers. Twenty seven of the 52 injured players were treated surgically: four index shoulder surgeries and 23 index elbow surgeries. Of these, there were 12 ulnar collateral ligament reconstructions (55%). Twelve injuries followed the index injury or surgery of 27 players who had surgery. Ten experienced a subsequent injury whereas 2 of 25 players without surgery had another injury; four of these were elbow injuries and 8 were shoulder injuries. Six shoulder surgeries followed elbow surgery; five of these followed UCL reconstruction. With an index surgery, there was a 4.6 greater relative risk of having later injury than for those who had no surgery. More surgically treated players reported shoulder injury than elbow injury at sometime after their index surgery. Of the players having UCL reconstruction, 42% sustained a shoulder injury sometime after their reconstruction. In contrast, none of the players with rotator cuff surgery sustained subsequent elbow or shoulder injury. Conclusions: With this study, there were significantly more upper extremity injuries with right-hand dominant throwers. The occurrence of elbow injury was more likely to result in shoulder problems, and specifically shoulder problems followed UCL reconstruction. In addition, more than half of the procedures done for elbow problems were UCL reconstruction. Players who required surgery were almost 5 times more likely to have a later injury or surgery than players who did not require surgery. It appears the null hypothesis has been disproved and there is a relationship between elbow injury and the occurrence of shoulder problems both injury and surgery. It may be constraining the elbow either as a result of injury or surgery with resultant tightening of the medial side or as result of elbow flexion contracture. There are greater forces applied to the shoulder.