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Invited Clinical Commentary

Throwing Injuries in the Adolescent Athlete

Authors: Shanley E, Thigpen C

Adolescents ranging in age from eleven to fifteen years of age (early-mid adolescence) comprise the largest percentage of baseball and softball athletes in the United States. Shoulder and elbow injuries are commonly experienced by these athletes with baseball pitchers and softball position players most likely to be injured. This paper focuses on three areas:

Common Injuries: Physeal injury often termed "Little League" shoulder or elbow is common and should be differentiated from soft tissue injuries such as biceps, rotator cuff, or UCL injuries. Regardless of diagnosis, rehabilitation of these athletes' shoulder and elbow injuries provide a unique challenge given their rapidly changing physical status.

Treatment: Common impairments include alterations in shoulder range of motion, decreased muscle performance, and poor neuromuscular control of the scapula, core, and lower extremity. A criterion based, progressive rehabilitation program is presented. Discharge from formal rehabilitation should occur only when the athlete has demonstrated a resolution of symptoms, acceptable ROM, muscle performance, and neuromuscular control while progressing through a symptom free return to sport.

Prevention of Re-injury: Reintegration into the desired level of sport participation should be guided by the sports medicine professional with a focus on long-term durability in sport performance as well as injury prevention. A prevention program which includes parent, coach, and athlete education, regular screening to identify those athletes at the highest risk, and monitoring athletes for the development of risk factors or warning signs of injury over the course of participation is indicated.

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