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The American Journal of Sports Medicine 30:463-468 (2002)
© 2002 American Orthopaedic Society for Sports Medicine

Effect of Pitch Type, Pitch Count, and Pitching Mechanics on Risk of Elbow and Shoulder Pain in Youth Baseball Pitchers

Stephen Lyman, PhD*, Glenn S. Fleisig, PhD*,{dagger}, James R. Andrews, MD* and E. David Osinski, MA{ddagger}

* American Sports Medicine Institute, Birmingham, Alabama
{ddagger} American Baseball Foundation, Birmingham, Alabama

{dagger} Address correspondence and reprint requests to Glenn S. Fleisig, PhD, American Sports Medicine Institute, 1313 13th Street South, Birmingham, AL 35205

Background: Joint pain is thought to be an early sign of injury to a pitcher.

Objective: To evaluate the association between pitch counts, pitch types, and pitching mechanics and shoulder and elbow pain in young pitchers.

Study Design: Prospective cohort study.

Methods: Four hundred and seventy-six young (ages 9 to 14 years) baseball pitchers were followed for one season. Data were collected from pre- and postseason questionnaires, injury and performance interviews after each game, pitch count logs, and video analysis of pitching mechanics. Generalized estimating equations and logistic regression analysis were used.

Results: Half of the subjects experienced elbow or shoulder pain during the season. The curveball was associated with a 52% increased risk of shoulder pain and the slider was associated with an 86% increased risk of elbow pain. There was a significant association between the number of pitches thrown in a game and during the season and the rate of elbow pain and shoulder pain.

Conclusions: Pitchers in this age group should be cautioned about throwing breaking pitches (curveballs and sliders) because of the increased risk of elbow and shoulder pain. Limitations on pitches thrown in a game and in a season can also reduce the risk of pain. Further evaluation of pain and pitching mechanics is necessary.




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