Factors Related to Injury in Youth and Adolescent Baseball Pitching, with an Eye Toward Prevention

By Chris Vendilli
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13 Apr, 2018
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The baseball and medical communities have recognized injuries of the upper extremity associated with the overhead throwing motion and have examined manners in which to reduce risk.

The baseball and medical communities have recognized injuries of the upper extremity associated with the overhead throwing motion and have examined manners in which to reduce risk. The authors examine special features of the adolescent pitcher as compared with skeletally mature pitchers and characteristics of pitch mechanics, type, velocity, fatigue, and overuse.

A summary is presented on previously identified risk factors as they relate to pitching injuries. Development, use, and compliance with the most current pitching guidelines in youth baseball, based on the available evidence, will be presented and examined. In an increasingly competitive environment, identifying known risk factors and potential signs of pathology as well as implementing the current best evidence in a consistent manner are important steps in decreasing injury risk of youth baseball pitchers.

More research is needed to evaluate the effectiveness of pitching guidelines in the short and long term and to focus on manners in which to increase compliance with best practice procedures throughout youth baseball organizations.

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Isolated Deltoid Atrophy

By Chris Vendilli • 13 Apr, 2018

A 35-yr-old right-handed male dishwasher was referred to the authors’ electrodiagnostic laboratory for evaluation of left shoulder weakness and atrophy. The patient reported the insidious onset of a sharp, “stinging” pain of his left shoulder region 6 mos before evaluation. This pain lasted approximately 10 days and gradually subsided after initiation of ibuprofen prescribed 1 wk after onset. He denied any preceding systemic illness or trauma, associated neck or radicular pain, and no weakness or numbness/tingling. A few weeks after resolution of the shoulder pain, he noted progressive weakness and decreasing muscle bulk of his left shoulder. His medical history was otherwise unremarkable, and he was taking no medications.

Upper extremity inspection revealed significant atrophy of the entire left deltoid with otherwise normal upper extremity muscle bulk. The findings from the neurologic examination were normal except for slightly weak shoulder abduction and flexion on the left with diminished sensation of a small area overlying the left deltoid.

Magnetic resonance arthrogram of the left shoulder showed significant atrophy and edema of the left deltoid muscle as well as a superior labral tear and minimal undersurface fraying of the rotator cuff.

The findings from the patient’s electrodiagnostic study were markedly abnormal. The left axillary motor response had a prolonged distal latency with CMAP amplitude 90% lower than the normal right response. The findings from sensory studies, including medial/lateral antebrachial cutaneous, were normal. Concentric needle examination showed marked active denervating changes (i.e., fibrillation potentials, positive sharp waves, and polyphasic motor units) of the left deltoid, with all other muscles examined, including C5–6 root/axillary nerve innervated, being normal. The patient was diagnosed with neuralgic amyotrophy with severe involvement of the left axillary nerve.

Neuralgic amyotrophy (also known as Parsonage-Turner syndrome) is a neurologic syndrome affecting the brachial plexus. Clinically, it is characterized by the acute onset of intense pain with resolution in 1–2 wks followed by weakness and atrophy of the arm/shoulder girdle muscles. Sensory loss in the axillary nerve distribution is common. Neuralgic amyotrophy may have an antecedent triggering event, such as a viral illness, immunization, pregnancy, or surgery; however, as in this case, an inciting etiology is frequently not identified. Although most cases present with unilateral findings, bilateral involvement may occur. Discrete mononeuropathies (e.g., suprascapular, long thoracic, or axillary nerve) are relatively common (6%–41%). Recovery may require up to 2–3 yrs.

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