I Wish I Knew Then What I Know Now

Abstract

We have all probably felt that way at some point in our lives, whether in our personal matters, in business, or in our medical profession. This statement seems to apply to the story of Sandy Koufax, one of the best all-time pitchers in the history of professional baseball. Sandy Koufax was forced to retire in 1966 during the peak of his career due to severe elbow pain. He has reportedly said that his elbow hurt every time he pitched. He suffered from a suspected UCL injury. His career record was 165-87 with a career ERA of 2.76, and he was the youngest player ever inducted into the Baseball Hall of Fame. In 1974, Dr Frank Jobe performed the first UCL reconstruction on pitcher Tommy John, and the procedure became known as the “Tommy John procedure.” Tommy pitched for 14 more years after the surgery, winning more games after the surgery than before (164 compared to 124 games). As the story goes,4 Sandy Koufax had asked Dr Jobe in later years, “Why didn’t you do that on me?” Dr Jobe had responded, “We simply didn’t know what to do for them back then.” But today we do know what to do. Injuries in baseball players continue to increase and at all ages. In Major League Baseball pitchers, 67% of all injuries occur to the upper extremity, with 26% occurring to the elbow joint.7 Conte et al2 reported an elbow injury rate of 22% in major league players. Pitchers injure their elbow at a higher rate than positional players (26% compared to 16%). Youth baseball players, especially pitchers, injure their elbow at an alarming rate. Since 1998 we have seen a 2.5-times increase in elbow surgery rate in youth baseball players at our center. Not only do baseball players injure their elbow, but football players and other collision athletes sustain these injuries, too. Carlisle et al,1 examining elbow, forearm, and wrist/hand injuries in the NFL, noted that 40% of those injuries occurred to the elbow joint. Sprains of the elbow were the most frequent (21%) with offensive and defensive linemen sustaining the most elbow sprains. Kenter et al5 reported an average of 18 elbow injuries per year in the NFL, with sprains being the most frequent. The authors noted that there appears to be an increasing trend of elbow injuries in the NFL. Overuse injuries occur at the elbow joint, with tendinitis being the most frequently seen and often most difficult to treat. In tennis players, approximately 40% have reported current or previous complaints of overuse tendinitis. Patients above the age of 50 years described their pain as severe and disabling.3 Tennis elbow is common, especially in individuals over 40 years of age, where there is a 4-times increase among men and a 2-times increase among women. These lesions are often challenging to treat. The elbow joint is an “unforgiving joint,” as stated by Dr Morrey in his classic elbow joint textbook.6 This is due to the high incidence of joint stiffness, loss of motion complications following fractures, dislocations, and other injuries. In this special issue of Sports Health, we have compiled some of the experts in the area of recognition and treatment of elbow disorders in sports. With elbow injuries in youth baseball players being so common, there is an article discussing factors to reduce the elbow injury rate. We hope that the knowledge and expertise shared by these authors will help us all to better treat the elbow joint today and reduce the frequency of us saying, “I wish I knew then what I know now.”