Injuries to the Shoulder and Elbow in the Young AthleteInjuries to the Shoulder and Elbow in the Young Athlete

John F. Meyers, M.D.John F. Meyers, M.D.

Shoulder GirdleShoulder Girdle

Ligaments 2-5X Stronger that Epiphyses

Ligaments 2-5X Stronger that Epiphyses

Glenohumeral JointGlenohumeral Joint

Little League ShoulderLittle League Shoulder

Perry-Anterior RestraintsPerry-Anterior Restraints

• Retroversion

• Labrum

• AIGHL

• Subscapularis

• Retroversion

• Labrum

• AIGHL

• Subscapularis

Surgical Treatment86% Returned to Sports

Surgical Treatment86% Returned to Sports

Surgical TreatmentSurgical Treatment

• Remove loose bodies

• Excise Capitellar Lesions

• Curette Base

• Remove loose bodies

• Excise Capitellar Lesions

• Curette Base

Posterior Elbow ProblemsPosterior Elbow Problems

• Triceps Tendonitis

• Traction Apophysitis

• Nonunion Olecranon Epiphysis

• Triceps Tendonitis

• Traction Apophysitis

• Nonunion Olecranon Epiphysis

Long Term EffectsJobe

Long Term EffectsJobe

• Olecranon Spurs

• Loose Bodies

• Stretching of the UCL

• Olecranon Spurs

• Loose Bodies

• Stretching of the UCL

PreventionPrevention

PappasPappas

• Curve – Medial

• Fast Ball – Lateral

• Curve – Medial

• Fast Ball – Lateral

AlbrightAlbright

• Sidearm – 75% Elbow Pain

• Overhead – 27% Elbow Pain

• Sidearm – 75% Elbow Pain

• Overhead – 27% Elbow Pain

TorgTorg

• Limit the number of innings pitched

• Limit the number of innings pitched

GymnasticsGymnastics

Fractures and DislocationsFractures and Dislocations

Valgus InjuriesValgus Injuries

Singer & Roy4 of 5 ReturnedSinger & Roy

4 of 5 Returned

Jackson0 of 12 Returned

Jackson0 of 12 Returned

Thank YouThank You

Orthopaedic Research of Virginia

Orthopaedic Research of Virginia

Elbow Injuries in AthletesElbow Injuries in Athletes

John F. Meyers, M.D.John F. Meyers, M.D.

AnatomyAnatomy

TraumaTrauma

DislocationDislocation

MonteggiaMonteggia

Supracondylar FractureSupracondylar Fracture

Olecranon FractureOlecranon Fracture

Radial Head FractureRadial Head Fracture

Throwing InjuriesThrowing Injuries

Ligament InjuriesLigament Injuries

Osteochondritis DissecansOsteochondritis Dissecans

Little League ElbowLittle League Elbow

Nerve InjuriesNerve Injuries

Overuse InjuriesOveruse Injuries

Tennis ElbowTennis Elbow

Elbow ArthroscopyElbow Arthroscopy

NirschlNirschl

• Tendonitis

• Muscle Weakness

• Upward Migration of Head

• Tendonitis

• Muscle Weakness

• Upward Migration of Head

Micheli GlousmanMicheli Glousman

• Subtle Instability

• Traction Injury to Rotator Cuff

• Subtle Instability

• Traction Injury to Rotator Cuff

Elbow InjuriesElbow Injuries

Baseball GymnasticsBaseball Gymnastics

Little League StudiesLittle League Studies

• 20% Elbow Pain

• 33% X-Ray Changes

• 20% Elbow Pain

• 33% X-Ray Changes

Adolescent PitchersAdolescent Pitchers

• 58% Elbow Pain

• 56% X-Ray Changes

• 4% Loose Bodies

• 58% Elbow Pain

• 56% X-Ray Changes

• 4% Loose Bodies

Ligament InjuriesLigament Injuries

Nerve InjuriesNerve Injuries

Panner’s DiseasePanner’s Disease

• < age 11

• Entire Capitellum

• Self Limited

• < age 11

• Entire Capitellum

• Self Limited

O.C.D.O.C.D.

• > age 11

• Localized

• Loose bodies

• > age 11

• Localized

• Loose bodies

Simonet & CofieldSimonet & Cofield

82% Recurrence in Athletes82% Recurrence in Athletes

Anterior SubluxationAnterior Subluxation

Dead Arm SyndromeDead Arm Syndrome

DiagnosisDiagnosis

• Apprehension

• Arthroscopy

• Apprehension

• Arthroscopy

McGlynn & CaspariMcGlynn & Caspari

• Hill Sachs Lesion

• Labral Tearing

• Incompetent AIGHL

• Hill Sachs Lesion

• Labral Tearing

• Incompetent AIGHL

Arthroscopic Treatment of Anterior Shoulder InstabilityArthroscopic Treatment of

Anterior Shoulder Instability

• Bankart Lesion – Repair

• Incompetent – Graft AIGHL

• Bankart Lesion – Repair

• Incompetent – Graft AIGHL

Posterior Dislocation 4%Posterior Dislocation 4%

Posterior SubluxationAverage Age at Onset

16

Posterior SubluxationAverage Age at Onset

16

Posterior SubluxationPosterior Subluxation

• Voluntary

• Unintentional

• Habitual

• Voluntary

• Unintentional

• Habitual

Function Instability Pappas

Function Instability Pappas