Examining the rash of UCL tears & how to prevent them: Drs. Neal ElAttrache, Steve Jordan & Luga Podesta

Orthopedic Sports Medicine

Of the 4,000 ulnar collateral ligament reconstruction surgeries that have been performed on Major League Baseball players since the procedures inception in 1974, nearly one-third of them have been performed in the last five years, according to a study in the American Journal of Orthopedics.

Baseball is in the middle of an epidemic. As players get bigger and throw harder, the effects are being seen with an uptick of elbow injuries. It's not just at the professional level either.


Orthopedic surgeons are seeing a younger clientele come into their practices everyday complaining about arm pain. UCL tears are becoming increasingly more common, and surgeons are calling for a renaissance on how America's pastime handles its future ballplayers.

Neal ElAttrache, MD, of the Kerlan-Jobe Orthopaedic Clinic in Los Angeles; Steve Jordan, MD, of the Andrews Institute for Orthopaedics and Sports Medicine in Gulf Breeze, Fla.; and Luga Podesta, MD, director of sports medicine at St. Charles Orthopedics in Port Jefferson, N.Y., shared their thoughts on the injury epidemic, and what they think can curve the problem.


Nationwide guidelines were recently implemented requiring all states to draft pitch count legislation by 2017. The guidelines will limit how often young arms can throw, and will cap pitchers' starts to a certain number of pitches — much like their major league counterparts.


Dr. ElAttrache encourages young athletes to limit their season and avoid specializing in a single sport. Pitching for several consecutive months in a year creates arm fatigue, and doesn't give the muscles time to recover. It also does something far more dangerous: it creates an unhealthy pathology.


Athletes often feel pressure from their teammates and coaches to pitch through discomfort. Dr. ElAttrache said when young athletes are pitching with a sore elbow, they're creating a pathology they'll carry with them for life.


"What you have then is these kids that finally mature into men and now they're able to throw the ball in the 90s instead of the 60s or 70s, and that pathology they built up when they were younger has now created a weakened environment for that ligament," he says. "By preventing early damage, we hope to prevent the surgery later in life."


Dr. ElAttrache said several sports medicine societies are using their prestige and proximity to the game to shape the younger generation of ballplayers. He said when professional pitchers return from injury and their managers use pitch counts and inning limits, he hopes parents and youth coaches will begin to realize "this is really truly the safest way to go for our kids."


Dr. Podesta believes youth showcases and year-round baseball are some of the biggest contributors to the explosion of UCL tears. The argument against single sport specialization has been around for several years now, but today, year round baseball can be incredibly detrimental to a pitcher's arm.


High school and college pitchers, besides pitching for their respective teams, participate in showcases on an almost year-round basis. The "best of the best" are recruited to pitch in talent showcases in front of multiple major league scouts with radar guns. The young talent often participate in several showcases a year, putting extra unnecessary stress and fatigue on an arm.


"Some of these kids throw more than a major leaguer would throw and they're 12-years-old," Dr. Podesta said.


All of this uninterrupted pitching increases the amount of stress on the ligament, and it gets to a point where it can no longer withstand the force.


"What we're really seeing is that combination of throwing too much and being fatigued when you throw, it's really getting this cascade going," he said.


A study from the American Sports Medicine Institute shows when a young pitcher throws for more than eight months in a year, it is five times more likely for an injury to occur, and when fatigue is factored into the occasion it is 36 times more likely for an injury to occur.


Dr. Jordan has seen the effects of fatigue on young arms, far too many times. When looking at elbow injuries, he referenced a joint that previously plagued young arms: the shoulder.


Frank Jobe, MD, besides creating Tommy John surgery, was one of the physicians credited with solving the shoulder epidemic. In the past, shoulder injuries were far too common in the game, but through a mix of therapies and proper weight training, shoulder injuries are becoming less frequent.


"Once (the therapy) came along, we saw those injuries going down," Dr. Jordan says. "Nobody has figured out the elbow part yet."


Dr. Jordan also believes that improved nutrition, exercise and conditioning can play a part in the rash of elbow injuries. With kids being bigger and stronger, they can throw the ball harder than they did, which is putting additional stress on the ligaments.


A recent study in the American Journal of Sports Medicine showed that pitchers with higher fastball velocities see a higher rate of UCL tears.


Velocity is a problem that's making its way to high school. Dr. Jordan wants coaches to do a better job handling each of their individual pitchers, and not just stick to the pitch count.


"So you're 18-years-old and your limit is 108 pitches, if you're tall and you throw really hard, you have to be extra careful," he said. "What we're trying to say is not every kid is the same."


The key to curbing the problem is educating coaches and parents and then communicating with players. To that effect, James Andrews, MD, created the STOP program. It's a website that has resources for parents and coaches to talk to their athletes about injuries and proper rest, "because you ask a kid about risk factors, and they're not aware."


Dr. Jordan said Dr. Andrews "will talk to anyone who will listen" about trying to limit overuse, trying to keep kids away from unnecessary showcases and urging caution with the radar gun.


"We need to teach these things, because getting it to the field, seems to be the problem," Dr. Jordan said.


More news related to sports medicine:
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Med Center Health and WKU announce new sports medicine clinic: 4 takeaways

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