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Throwing Injuries

Throwing injuries are common among athletes in sports that involve throwing motions, including softball and baseball. These injuries typically cause damage to the upper extremities, including the elbows and even the hands. Most are the result of overuse rather than an acute injury, meaning the damage occurs over a length of time.

  • Types

    • Flexor tendinitis
    • Medial apophysitis
    • Olecranon stress fracture
    • Osteochondritis dissecans
    • Ulnar collateral ligament (UCL) injury
    • Ulnar neuritis
    • Valgus extension overload
  • Symptoms

    • Decreased throwing velocity
    • Limited ability to throw
    • Numbness and tingling in the elbow, forearm or hand
    • Pain during or after throwing
  • Prevention

    • Your best defense against throwing injuries is to properly condition for the sport you’re participating in, warm up prior to activity and cool down after activity.
    • It’s also important to ensure proper technique is used at all times, so mastering form at the beginning of sports participation is a good first step. • Because throwing injuries are commonly the result of overuse among young athletes, be certain to follow recommended guidelines about how much throwing should be done at specific ages. This is typically 75 pitches per week for those ages 8–10, 100 pitches per week for those ages 11–12, and 125 pitches per week for those ages 13–14.
    • For best results and prevention of overuse-related throwing injuries, cross-train and participate in multiple sports.
  • Risk factors

    • Participation in sports or other activities requiring throwing
    • Overuse of the joints, muscles and tendons in the elbows
  • Diagnosis

    • Medical history and symptom review. If a throwing injury is suspected, your medical provider will review your overall health and symptoms, along with details about when and how symptoms first began appearing.
    • Physical examination. Discussion of your symptoms will be followed by a physical examination in which your provider will check your range of motion, strength and the stability of structures in the upper extremities, including the elbows and hands. This will often involve comparing the injured side of the body with the unaffected side, along with a valgus stress test, which applies pressure to the side of the elbow to check for pain and instability.
    • Additional tests. To determine whether the source of your discomfort is related to the bones, joints or tendons, your medical provider may also order imaging tests, including X-rays, MRI scans and occasionally CT scans, if bone issues are suspected.
  • Treatment

    • For minor throwing injuries, and as a first phase of treatment for all throwing injuries, your provider will likely recommend resting the affected area for a period of time.
    • If rest doesn’t fully rehabilitate the throwing injury, over-the-counter and prescription pain medications or anti-inflammatory medications may be recommended.
    • Because throwing injuries are commonly the result of overuse, physical therapy may be needed to help restore function and to help you develop better mechanics, particularly for the throwing motion.
      For severe cases that aren’t alleviated using conservative treatment options, your provider may recommend surgical intervention. The specific type of surgery will vary depending on your exact diagnosis and the extent of your injury.
      Options may include:
      • Arthroscopy is used to remove bone spurs and other loose fragments of bone or cartilage in the elbow.
      • UCL reconstruction rebuilds the ulnar collateral ligament in cases where it has been torn or is unstable. This procedure is commonly referenced as “Tommy John” surgery.
      • Ulnar nerve anterior transposition is used to alleviate discomfort and instability caused by ulnar neuritis.
  • Follow-up care

    • If your throwing injury was treated using conservative treatment, you can usually resume throwing activity after two or three months.
    • If you undergo surgical treatment for a throwing injury, recovery time will vary depending on the extent of your injury and the nature of the surgical procedure. It’s important to adhere to all recommendations from your medical provider, including guidelines on using the elbow and rest.
    • After a surgical procedure, physical therapy and occupational therapy will usually be necessary to restore abilities. The length of time therapy will be required and its intensity will vary depending on the injury.