Child Elbow & Shoulder Injuries – Pt 1 Video

Call us at 281-633-8600 for an appointment. This article is from a presentation to the Sugar Land Toros Baseball Organization from Dr. J. Michael Bennett. This section and later sections cover preventing and treating shoulder and elbow injuries in youth baseball athletes. Doctor Bennett specializes in treating issues of the shoulders, elbows, knees, certain hand and wrist injuries like carpal tunnel syndrome from his clinics in Sugar Land and in Houston, near the Houston Galleria.

This video is the first of three sections of a talk given by Dr. J. Michael Bennett to the parents, coaches and players of the Toros Baseball organization of Sugar Land, TX. The talk was hosted by Bases Loaded in Houston, TX.

Dr. J. Michael Bennett is a Board Certified Orthopedic Surgeon with a Certificate of Added Qualification (CAQ) in Sports Medicine. Doctor Bennett also completed a Sports Medicine fellowship at the University of Miami and served as assistant team physician for the Tampa Bay Buccaneers and the University of Miami Hurricanes. He’s also served as a team physician consultant for the Houston Livestock Show and Rodeo and as a team doctor for the Houston Independent School District. An athlete himself, Dr. Bennett was captain of the varsity lacrosse team at the University of Texas.

Here’s a transcription of the video:

A lot of this information is very important because most of the elbow and shoulder injuries I see in these cases are preventable. If you start early enough, you can prevent them from happening long term.

A little bit about my background. I am a sports medicine specialist and I work with shoulders, elbows and knees primarily but I treat all sorts of sports injuries such as ankle sprains and back pain as well. I did my residency at Baylor College of Medicine here in Houston and then did a sports medicine fellowship at the University of Miami. I worked with the Hurricanes in Miami and also with the Tampa Bay Buccaneers for awhile so I’ve dealt with baseball and football basically all of my adult life.

And this is a very important talk because I’ve been practicing now for seven to eight years and I’ve seen substantially a large increase in the number of elbow and shoulder injuries in kids. Hopefully you guys will get some general information in what to look for, in what we look for, and what you can do to prevent some of these things from happening.

So just to go back to the epidemiology behind things, you’ve got three million kids per year that are seen in the emergency room for sports injuries, and there’s an estimated five million additionally that are seen directly by their physicians. And these figures are from 1997 so this has obviously changed a lot. It’s probably doubled or tripled by now. Basically, there’s a lot more elbow and shoulder injuries occurring now.

As far as the shoulder and elbow injury types we’re seeing, we have:

Macrotrauma. These are fractures and dislocations and it’s pretty obvious when you have them.
Repetitive Microtrauma. These are usually overuse injuries, repetition of the shoulder and elbow, constant movements.
Repetitive load and stress. Basically what happens is the body just can’t keep up or can’t keep up with the injury that’s occurring. So usually the injury occurs, the body starts to heal but what happens with repetitive loading and stressing is it’s not giving the body time to heal and it keeps on injuring itself. It becomes kind of a cycle. So the ability of the tissue to repair itself is outpaced by the repetition of the insult.

This article here is about a 14-year-old pitcher (and we’re seeing more and more of this) who has had both of his elbows operated on. I’ve got 40 to 50-year-old guys that don’t have scars on their elbows like this kid. And this isn’t even a Tommy John procedure; this is the lateral side, which is the outside of the elbow, which is more of an outside lateral ligament kind of injury where you get a tennis elbow type of issue. But this is unfortunately becoming more common these days.

Just to show you how much it’s increasing – and I apologize for this data of this slide, it’s outdated – back in 1988-94 we had an 8 percent number of cases for Tommy John procedures. It went up to 13 percent in 1995-2003. Shoulder surgery went from 3 percent to 12 percent. So either sports are getting more competitive, kids aren’t training right, kids are just overloading their joints too early, or the surgeons are being more aggressive, or perhaps it’s a combination of all of these things. But no matter what, these numbers are going up.

Of the upper extremity injury risks, which are some of the most common injuries we see, baseball is always at the top. And we also get a lot of tennis, swimming, weight lifting, and gymnastics as well.

Here are the risk factors for overuse injury:

Training errors. “Too much too soon.”
Muscle-tendon imbalance problems. As the individual grows there’s decreased flexibility and increased strength, and that causes an imbalance in your muscles and that leads to injury.
Vitamin D deficiency. And I’m seeing a lot more of this these days, which is kind of interesting. A lot of doctors are just missing this. I saw a kid that was just walking around with his parents and he came in with a fractured toe. I said, “What did you do? Did you fall? Did you get injured? Did something fall on your foot?” He said he had just been walking. So you’ve got a stress fracture in this young kid. I sent off some labs to check for Vitamin D deficiency and it was very low. The previous doctor had just been putting him in a boot, a cast, and nobody looked at the reason why this fracture had happened. Lots of these concern Vitamin D deficiency. There can be a number of reasons for this. Many kids are doing more things indoors these days and a lot of times they’re drinking a lot of sodas and that can actually leach calcium from the bones and cause weakness. So if you’ve got a young kid with a fracture and you don’t have a history of any injury you probably want your doctor to look at Vitamin D deficiency.
Deconditioning. This is also a big problem. The less conditioned an individual is prior to getting involved in a sport, the more likely he or she is to get an injury. So I’m a big advocate for cross training. You love baseball, go play baseball. But it’s important to also play other sports to train all these other muscles, to maintain them so you don’t overload the joints in certain areas because of repetitive motion. Cross training is good and we certainly encourage it.

So why are we seeing these types of injuries?

Immature skeletal structure. The bones aren’t all calcium at these ages, half of the bone is all cartilage and these cartilage areas have a growth plate where these injuries are occurring.
An actively changing skeletal structure. As they grow, these areas of the bones calcify; it makes them at a higher risk for injury. These growth plates are in areas where they can have a fracture.
Poor mechanics and skills. That’s why you guys are here. We learn the proper mechanics, the proper skills, that’s key. Because there’s a lot of kids out there that aren’t involved in these programs and they keep on working through it the wrong way and are thereby setting themselves up for injury.
Delayed coordination of kinetic chain. This just means that muscles are not firing properly, they don’t have a good muscle balance, and they don’t have the ideal strength needed for some of these movements.

Just to show you here a picture of this, what we look for in bone, this is the growth plate right here, this is bone here, this is cartilage up here, all these cells here are replicated. In a young child that’s growing, their growth is occurring at this level right here, and it’s called the epiphysis or the growth plate, and that’s what’s being injured. So this just shows you what the skeletal structure is doing, and what ages it closes at. They close at different ages. Where the growth plate closes at the top of the shoulders, for instance, it’s usually at 18 to 21 years. At the elbow it’s around 15 to 18 years. So you’ve got a lot of time here with these growth plates so there’s definitely some risk involved with that so you also have to pay attention to that.

If you have questions about any aspect of this information about elbow and shoulder injuries in young athletes, please contact our office at 281-633-8600 to make an appointment with Dr. Bennett.

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