Paper 16: What Happens to Youth Baseball Players Diagnosed with Little League Shoulder and Little League Elbow?

Abstract

Objectives: Little League elbow (LLE) and Little League shoulder (LLS) are frequent diagnoses encountered in youth baseball players. To date, limited data exists as to how these athletes fare as they progress in their baseball careers. The purpose of the current study was to evaluate the career progression and patient reported outcomes in a series of youth baseball players 5 years after being diagnosed with LLE and LLS. Methods: The electronic medical record from a single pediatric hospital was searched for all patients receiving a diagnosis of LLE or LLS sustained from playing baseball between 2014 and 2018. Baseline data at the time of diagnosis was documented including age, primary position, months played per year, duration of symptoms, and treatment. Patients were then interviewed with a standardized questionnaire including several validated outcomes tools and baseball specific questions at a minimum of 3 years post-diagnosis. Suboptimal outcome was defined as symptom recurrence or a SANE score less than previously published patient acceptable symptom state (PASS) of 75.5. Statistical analysis was then performed to compare outcome groups. Results: In total, 61 athletes were contacted (17 LLS, 44 LLE). All patients were male and the mean age at diagnosis was 13±2 years. While 95% returned to baseball post-diagnosis, at 4.8±1.5 years follow-up, 48% of the cohort was still playing with 18% attributing persistent arm pain as a reason for quitting. Symptom recurrence was present in 25% occurring at an average of 9 months post-diagnosis. Players changing position was not uncommon (26%). In the elbow group, no patient went on to require a UCL reconstruction, whereas one patient in the shoulder group ultimately underwent surgery. The mean QuickDASH, ASES, and Kerlan Jobe scores were 2±5, 96±10, and 90±11, respectively. There were no differences between LLE and LLS groups with respect to these scores (p>0.05). No differences were observed between groups in terms of demographics or play characteristics, however those with recurrence were less likely to be still playing ball and had lower outcome scores (<0.05). Conclusions: While arm pain is frequently encountered in youth baseball players, receiving a diagnosis of LLE or LLS appears to have a good prognosis for these athletes with many patients continuing to remain active in competitive baseball even up to 5 years post-diagnosis. Rates of future arm pain requiring surgical intervention were negligible. This data is important for counseling patients about the long-term prognosis of their arm injuries.