Patients with little league elbow, shoulder rarely require surgery 5 years after diagnosis
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Key takeaways:
- Patients with little league elbow or little league shoulder had a rate of injury recurrence of 26%.
- No athletes with little league elbow and one athlete with little league shoulder required surgery.
WASHINGTON – Patients diagnosed with little league elbow or little league shoulder rarely required operative treatment in the 5 years after diagnosis, according to research presented here.
“We saw that there is a 26% [rate of] recurrence of these injuries and recurrence of symptoms were not associated with whether the patient was playing year-round, changing positions or attending physical therapy,” Evan J. Jensen, said during a presentation at the American Orthopaedic Society for Sports Medicine Annual Meeting. “Patients who did experience recurrence of symptoms were significantly less likely to remain active in baseball at 5 years.”
In the retrospective cohort study, researchers at Rady Children's Hospital searched the electronic medical record for patients who had received an initial diagnosis of little league elbow (LLE) or little league shoulder (LLS) from playing youth baseball or softball between 2013 and 2017. They studied 61 athletes with a mean age at diagnosis of approximately 13.2 years. Of these athletes, 17 had LLS diagnosis and 44 athletes had LLE diagnosis. Mean follow-up was approximately 4.8 years. Athletes stopped throwing for 6 weeks and were recommended to avoid playing catcher or pitcher for 1 year after diagnosis. Athletes with fragmentation of the medial condyle apophysis were casted for 3 weeks. Patients completed an advanced thrower’s ten program with posterior stretches incorporated and were offered physical therapy. At the time of diagnosis, 49 athletes reported playing year-round baseball.
Researchers conducted a standardized phone questionnaire with baseball-specific questions and collected patient-reported outcome measures. At the time of diagnosis, 82% of athletes reported reduced throwing, with 78.7% reporting stopped throwing and 26.2% of athletes reported changing positions after diagnosis. The rate of recurrence of the injuries was 26% at an average of 8.8 months from initial injury.
At 5-year follow-up, 28 athletes (45.9%) reported having quit baseball, with 11 of these athletes reporting persistent arm pain as a reason for quitting.
Recurrence was not associated with laterality, physical therapy, changing positions, duration of throwing cessation, age at injury or year-round baseball playing. Athletes with recurrence of symptoms were less likely to be still playing ball and had lower outcome scores, Jensen said.
No athlete with LLE required UCL reconstruction, however, one athlete with LLS required surgery. Researchers found no difference in patient-reported outcome scores between groups.
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Bastrom T, et al. Paper 16. Presented at: American Orthopaedic Society for Sports Medicine; July 13-16, 2023; Washington D.C.
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