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Daily Bulletin

Children Who Play Baseball Risk Elbow Injury

Friday, Dec. 01, 2023


Awareness of injury potential may help parents, caregivers and coaches protect young athletes

Youth baseball players are prone to elbow pain and injuries, including repetitive overuse changes and fractures, based on the maturity of their bones, according to a new study presented at RSNA 2023.

The repetitive motion and force of throwing a baseball places a large amount of stress on the growing bones, joints and muscles of the elbows of baseball players. Youth baseball players who have not yet reached skeletal maturity might be especially vulnerable to elbow pain and injuries.

"When we look at the forces that baseball players, even Little League baseball players, deal with during routine practice and games, it becomes apparent why elbow injuries are so common amongst this group," said study co-author Vandan Patel, BS, a radiology-orthopedics research scholar at Children's Hospital of Philadelphia (CHOP).



Most recent estimates show that 20% to 40% of youth baseball players between the ages of nine and 12 complain of elbow pain at least once during the season.

In this retrospective study, the researchers reviewed elbow MRI exams from 130 youth players (18 years of age and younger) being evaluated for elbow pain.

"We conducted this study in order to better understand the patterns of injuries that can occur among youth baseball players with elbow pain," said senior author Jie C. Nguyen, MD, MS, director for the Section of Musculoskeletal Imaging in the Department of Radiology at CHOP. "Tissue vulnerability and, thus, sites at risk for injury, change with growth and maturation. A younger player injures differently than an older player. It is our hope that this data will help us continue to improve and individualize the care of current and future generations of youth baseball players."

Proper Technique, Proper Rest Can Help Avoid Injury

The average age of this study group of patients was 13.9 years, with 115 boys and 15 girls included. The frequency with which the patients played baseball varied from daily to recreationally.



Two radiologists independently reviewed the MRI exams to categorize the skeletal maturity and different findings of each patient's elbow. They classified 85 patients as skeletally mature and 45 patients as skeletally immature.

The most common MRI findings in skeletally immature players included fluid build-up around the joint, stress injuries near the growth plate, fractures, and osteochondritis dissecans (OCD) lesions, where a piece of bone and the overlying cartilage is injured and can detach, leading to reduced range of motion and risk for premature osteoarthritis in adulthood.

Conversely, in skeletally mature players, the injury pattern shifts from the growth plates to the soft tissue. These players most often had triceps tendinosis, and fluid build-up in the bony area of the elbow where the ulnar collateral ligament attaches.

Injuries that required surgery included intra-articular bodies and unstable OCD.

"In terms of the skeletally immature children, 9 patients (11%) had intra-articular bodies, and 19 patients (22%) had OCD lesions," Patel said.

The researchers hope that the results of this study will help to identify elbow injuries in children who play baseball and to individualize treatment based on skeletal maturity.

Elbow images. In image on the left (10-year-old boy), growth plate has not yet fused. On the right (15-year-old boy), growth plate has fused. (Courtesy of Radiology)

"This information is critically important not only to physicians, but also to parents and team coaches, all of whom provide crucial support for these children, reducing injury and preventing permanent damage on and off the field," said co-author Theodore J. Ganley, MD, director of Sports Medicine and Performance Center in the Division of Orthopaedics at CHOP. "As parents, caregivers and coaches, it is important to be aware of these findings in order to ensure that symptoms of pain are not overlooked during the baseball season."

Although they did find that prevalence of injury was linked to prolonged play, the researchers said further studies are needed to identify exactly which injuries are more time dependent compared to others.

"This does not mean that elbow injuries are inevitable in baseball," Patel said. "With proper technique and proper rest, these injuries could potentially be avoided."

Access the presentation, "MRI Findings in the Elbow Among Pediatric Baseball Players Based on Skeletal Maturity," (R6-SSMK12-6) on demand at