Shoulder & Elbow Overuse Injuries

Overuse injuries in young athletes are usually caused by repetitive motion and excessive practice. Orthopedic surgeons and athletic trainers are increasingly concerned that overuse syndrome is causing injuries to the developing musculoskeletal structure of young athletes. Some of the conditions that can result from advanced overuse of the shoulder or elbow in young athletes include: tendinitis, shoulder instability, labrum injuries called SLAP tears, shoulder impingement syndrome and ulnar collateral ligament (UCL) tears. All athletes who train too much are more prone to overuse syndrome. Athletes who compete in overhead sports, such as baseball, softball, tennis, lacrosse, volleyball, gymnastics and swimming are more at risk of wear and tear of the shoulder or elbow.

Experts believe that year-round specialized training for young athletes is contributing to the overuse epidemic. Without periods of rest or cross-training, young players continue to strain the same muscles over and over again. Other potential factors can be starting the sport at a very early age, poor mechanics, poor practice or conditioning and genetics. Those factors, coupled with a developing skeleton that isn’t strong enough and underdeveloped growth plates, can lead to injuries. These athletes continue to strain the same muscles over and over again.

Symptoms of overuse injuries can vary depending on the person and the sport but typically include such things as: pain during sporting activity and after, swelling and stiffness in the extremity, weakness and instability, and inability to raise the arm above the shoulder. Throwing athletes may also describe decreased velocity with pitching or throwing.  

According to the CDC, more than five million children under the age of 18 suffer a sports-related injury each year, with approximately half of these due to overuse. The American Journal of Sports Medicine recently published a study which showed that seventy-five percent of baseball players under 18 years of age have arm pain and many fail to report it. A Safe Kids survey indicates that one in three children who plays team sports suffers injuries severe enough to require medical treatment. The same survey showed that nine out of ten parents underestimate how long children should refrain from playing any one sport in order to protect them from overuse, overtraining and burnout. Ninety-two percent of parents said they rely on coaches to keep their children safe while playing sports, but nearly half of all coaches said they have felt pressure to play an injured child in a game. Moreover, three out of ten children think a good player should keep playing even when he or she is hurt, unless a coach or other adult makes them stop.  

How does a surgeon treat overuse symptoms? Treatment sometimes is as simple as reducing the intensity, duration or frequency of the movement causing pain. In most cases, orthopedic surgeons and athletic trainers recommend the athlete refrain from play in order to rest the stressed tissues. Ice and over-the-counter inflammatory medications will help reduce inflammation and pain. If the injury is severe enough, our physicians may recommend shoulder surgery.  For instance, Tommy John surgery, named after the former Los Angeles Dodgers pitcher, is often a method of treatment for UCL tears in athletes, especially in baseball. More formally known as ulnar collateral ligament (UCL) reconstruction, the surgeon takes a tendon from the forearm and uses it to repair the injured ligament and stabilize the joint. Unfortunately, it may be 12 to 18 months before the athlete can return to his or her sport. However, this surgery can have excellent results and many times the athlete can return to sport with no limitations.  

There are many current studies that have shown professional pitchers can return to the same level prior to the injury. Labrum injuries often require arthroscopic surgery, where the orthopedic surgeon will place sutures to repair the labrum back to the bone. This allows the labrum to heal and improve pain, but also improves the function of the shoulder joint.

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