Longitudinal study of elbow and shoulder pain in youth baseball pitchers

TLDR

Prior research on young pitchers has mainly described elbow injury frequency and characteristics. This prospective cohort study aimed to determine the frequency of elbow and shoulder complaints among 298 youth pitchers and to identify how pitch type, volume, and other risk factors are associated with these conditions. Participants were surveyed by telephone after each game to report arm complaints, and generalized estimating equations were applied to assess associations between complaints and independent variables. Elbow pain occurred in 26% and shoulder pain in 32% of the pitchers, with elbow pain linked to older age, higher weight, lower height, weight‑lifting, off‑league play, low self‑satisfaction, arm fatigue, and atypical pitch counts (<300 or >600), while shoulder pain was associated with low satisfaction, arm fatigue, >75 pitches per game, and <300 pitches, indicating distinct etiologies and supporting recommendations to limit games to ≤75 pitches, remove fatigued pitchers, and restrict nonleague pitching.

Abstract

Previous studies among young pitchers have focused on the frequency and description of elbow injuries. The purpose of this study was to evaluate the frequency of elbow and shoulder complaints in young pitchers and to identify the associations between pitch types, pitch volume, and other risk factors for these conditions.A prospective cohort study of 298 youth pitchers was conducted over two seasons. Each participant was contacted via telephone after each game pitched to identify arm complaints. Generalized estimating equations were used to assess associations between arm complaints and independent variables.The frequency of elbow pain was 26%; that of shoulder pain, 32%. Risk factors for elbow pain were increased age, increased weight, decreased height, lifting weights during the season, playing baseball outside the league, decreased self-satisfaction, arm fatigue during the game pitched, and throwing fewer than 300 or more than 600 pitches during the season. Risk factors for shoulder pain included decreased satisfaction, arm fatigue during the game pitched, throwing more than 75 pitches in a game, and throwing fewer than 300 pitches during the season.Arm complaints are common, with nearly half of the subjects reporting pain. The factors associated with elbow and shoulder pain were different, suggesting differing etiologies. Developmental factors may be important in both. To lower the risk of pain at both locations, young pitchers probably should not throw more than 75 pitches in a game. Other recommendations are to remove pitchers from a game if they demonstrate arm fatigue and limit pitching in nonleague games.