In my previous post, I outlined the history and findings related to my son’s medial elbow pain. Since publication of that blog post, I have since been given the results of his MR arthrogram and have further updates. If you did not read the prior post, you can click here to read it.

Initially, my concern was tendinitis or more of a flexor/pronator strain given his mild yet persistent soreness and response to rest. The imaging revealed that his UCL was pristine, the radiocapitellar joint liked good, no osteophyte formation or really any inflammation in the soft tissue. The surge told me he had to look closely, but there was evidence of mild fluid around the apophysis. So, in essence, there was some overload/strain being placed on the growth plate.

Given that my son’s growth plates are still open at age 15, he was experiencing some overload (apophysitis) rather than strain on the UCL itself. Had he been skeletally mature, there likely would have been more stress being placed directly on the ligament itself. So, this was good news for all of us.

We received the results on Tuesday October 31. With clearance to pitch last weekend as tolerated by the MD, I elected to have my son throw a bullpen last week. He threw 25 pitches on Wednesday night (one week ago) and was at 100% and pain free. As such, I let him throw 40 pitches in our showcase game last Saturday. He again threw pain free. Now that Fall baseball has ended, we will shut him down for some extended rest and focus on arm care and overall strength and conditioning as he continues his HS workouts.

Some key takeaway points for players, parents and coaches:

  • Never dismiss pain that occurs with throwing
  • Educate players about throwing related soreness/tightness (such as lactic acid build up that would be typical after a start on the mound) so they can differentiate that from true pain
  • If velocity, mechanics or performance in a player suddenly drops, be suspicious of a potential injury knowing that most players will try to throw through it (look for shaking/rubbing of the arm, grimacing or other body language that is outside the player’s normal routine)
  • If you suspect an injury, seek out an immediate assessment from a knowledgeable physical therapist and/or MD who treats baseball players as they will do a more comprehensive evaluation and uncover the root cause of dysfunction faster
  • Getting imaging in a higher level player will provide peace of mind for the athlete, parent and coach allowing for proper care and progression back to pitching as evidenced in this situation
  • Managing pitch counts, innings pitched and recovery between appearances will be instrumental in preventing or reducing injuries

In the end, we must rely on the athletes to communicate what they re feeling. Often, pitcher push through fatigue and pain in the spirit of competition. It is imperative that we advise against this in order to promote long term health and prevent more serious injuries. I know I feel fortunate that my son’s injury was not serious at all.

Moving forward, I will adjust his off season and in-season throwing to ensure he actually conditions his arm with more frequent throwing (not pitching) to ensure his endurance is better, as I feel this may have been a factor in his overuse scenario. While he threw a weekly bullpen this summer, he only threw on average 2 days per week on top of that. He threw daily in middle school ball last year and never had any arm related issues on the mound.

Each player is different in terms of their build, pitching capacity, arm talent, etc. With that said, I think it is important to analyze their performance over the year based on innings pitched, pitch counts, rest between outings, strength program, throwing programs and perceived fatigue to evaluate what works bets for the player. Educating players and parents about arm care and health management strategies will reduce injuries and facilitate long term success for pitchers that have a chance to play in college and beyond.