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Elbow Problems

coach2709coach270910,000+ posts
First game of the season and my starting pitcher hurts his elbow. It's right on the inside where the ligament is. He threw a pitch, looked over at me and told me to come out. I knew it wasn't good because this kid is hard nosed. I went out there and asked the questions, did the push / feel things and talked to him. I took him out immediately and put ice on it.

I'm looking for those of you who have experience with elbow problems and what to look for in terms of a serious injury.

I really don't think he's hurt that bad but I don't really know. He was in the third inning and was around 35 pitches (our cap for him tonight wss 65). He threw a fastball and he bounced it. The next pitch is when he called me out. He said he felt it pop and it got tight on him. I couldn't tell if there was any swelling.

After he comes out I gave him a few minutes then went back over and gave him another look. He had a full range of mobility and could take his fingers and pull them back (like the stretch - if that makes sense) with nominal pain. He would do it and look at me and say in a calm voice it didn't hurt but he could feel it.

I told his mom to take him to the doctor in the morning and she is.

I'm hoping for the best but not real sure because I have never had a guy with an elbow injury. I don't really know what to look for or signs of a problem.

Nothing can stop the man with the right mental attitude from achieving his goal; nothing on earth can help the man with the wrong mental attitude. Thomas Jefferson

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CADadCADad5,000+ posts
One check is to hold the elbow on the outside (away from the body) with the elbow bent a bit less than 90 degrees, the push on the side of the hand pushing the hand away from the body. To get a better description google valgus stress test. That will usually cause pain if there's a UCL problem, but other things can mimic a UCL problem.

It sounds like you did the right thing by pulling him and sending him to the doctor.
S switchitter100+ posts
Very possible UCL injury but it could just be a sprained ligament. A sprained ligament is still a tear so one must be careful, however, it's the best-case scenario from the sound of the "pop" symptom. The inside area is the key area and thus the mention of the UCL. ICE, ICE, ICE in moderation, along with swelling reducers and such until doctors visit tomorrow at the ortho specialist.

My opinion: Didn't rip it off the bone. If he stays in the game it's curtains. You did the wise thing and I think he'll be pitching again in about 3 to 4 weeks. Just my opinion and I am NOT a doctor nor an arm expert nor an athletic trainer of any kind. But you are asking and I am responding. Good luck coach, I hope he has a full recovery and is back in action in 2-3 weeks as opposed to 3 to 4.
06catcherdad06catcherdad1,000+ posts
My son is a catcher, and when his UCL let go, it happened on a single throw. He was throwing down to second between innings and felt a "pop" and burning sensation right after that.

More than anything, he needs to be seen by a qualified orthopedist, soon. If he goes to a primary care physician, chances are great that they won't know how to manipulate the elbow, i.e. valgus stress, and will probably diagnose it as tendinitis or a strain. Hopefully, that's all it will be, but if he goes to an orthopedist who is familiar with elbows, they can tell pretty quickly whether there is any likely injury to the ligament and will decide whether to prescribe an MRA.

Please let us know how he's doing after he sees the doc.
coach2709coach270910,000+ posts
Thanks for your help and advice guys. I saw him this morning and he said it was tight and sore. I asked him when he was going to the doctor and he said he probably won't go. So the first thing I did was email his mom. Haven't heard back from her yet.

He's going to the doctor even if I have to drive him.

06catcherdad - great advice about the ortho doc instead of family doc. I will pass that on to his mom.
06catcherdad06catcherdad1,000+ posts
If it's tight and sore, something is wrong. The key is to find out WHAT. He can waste time not going to the doctor, but that's all he's doing. He'll have enough time stretch out between when he's seen by a doctor and anything is done to treat it, other than rest and anti-inflammatories, so he might as well get in there sooner, rather than later.

One thing you should consider is advising him and his parents that he won't be allowed to throw on your team until he gets it checked out and provides a clearance from the doc, assuming it's nothing serious. That'll probably get him in there more cooperatively and sooner.
play baseballplay baseball1,000+ posts
quote:
Originally posted by coach2709:
I asked him when he was going to the doctor and he said he probably won't go. So the first thing I did was email his mom. Haven't heard back from her yet.

He's going to the doctor even if I have to drive him.


Definitely what you need to do. He MUST go to the doctor. That is, unless he WANTS to be out for a year.

I'll echo what 06catcherdad said about going to an ortho rather than a family doc. But I'd take it even a little further than that; he should be seen by an ortho who specializes in ARMS. I also like his advice regarding you not allowing him to throw until he gets checked out. Sore arms are not to be taken lightly.

I hope that the doctor visit reveals nothing very serious. But somehow I don't think that is going to be the case. Let us know, please.
Last edited by play baseball
Nitric_AcidNitric_Acid100+ posts
quote:
Originally posted by coach2709:
First game of the season and my starting pitcher hurts his elbow. It's right on the inside where the ligament is. He threw a pitch, looked over at me and told me to come out. I knew it wasn't good because this kid is hard nosed. I went out there and asked the questions, did the push / feel things and talked to him. I took him out immediately and put ice on it.

I'm looking for those of you who have experience with elbow problems and what to look for in terms of a serious injury.

I really don't think he's hurt that bad but I don't really know. He was in the third inning and was around 35 pitches (our cap for him tonight wss 65). He threw a fastball and he bounced it. The next pitch is when he called me out. He said he felt it pop and it got tight on him. I couldn't tell if there was any swelling.

After he comes out I gave him a few minutes then went back over and gave him another look. He had a full range of mobility and could take his fingers and pull them back (like the stretch - if that makes sense) with nominal pain. He would do it and look at me and say in a calm voice it didn't hurt but he could feel it.

I told his mom to take him to the doctor in the morning and she is.

I'm hoping for the best but not real sure because I have never had a guy with an elbow injury. I don't really know what to look for or signs of a problem.


The primary care physician will usually say "ice, rest, no throwing for 3-4 weeks." You need to get this kid to an elbow specialist. They will push on the inner elbow to see where it hurts, then they wrack your arm in all different directions to see what is going on. For a high school aged player, they will likely (and should) do an MRI to get a better idea of what happened.

I've been down this road myself as an adult and it's not fun. Keep throwing and 3-4 weeks off can easily become 6-12 months.
coach2709coach270910,000+ posts
Thanks again guys.

I have already told him he's not throwing for a long time. In fact after I took him out last night I was still on the field talking to the umpire and making sure my new pitcher got enough throws to get loose (I know you get as many as you need but wanted to make sure he took them). I look over at the dugout and the guy I just took out was getting ready to start tossing on the side.

I yelled at him to stop and thankfully did.

His mom does have an appointment scheduled for tomorrow to see an ortho doctor. She is a nurse so she is pretty knowledgable in most of this stuff.
S switchitter100+ posts
quote:
Originally posted by coach2709:
Thanks again guys.

I have already told him he's not throwing for a long time. In fact after I took him out last night I was still on the field talking to the umpire and making sure my new pitcher got enough throws to get loose (I know you get as many as you need but wanted to make sure he took them). I look over at the dugout and the guy I just took out was getting ready to start tossing on the side.

I yelled at him to stop and thankfully did.

His mom does have an appointment scheduled for tomorrow to see an ortho doctor. She is a nurse so she is pretty knowledgable in most of this stuff.


Great, just make sure she verifies that they do a valgus stress.
Last edited by switchitter
06catcherdad06catcherdad1,000+ posts
By the way, if the doc does a valgus stress test and they have to peel him off the ceiling, or revive him, that's not a good sign. Wink I can remember when Dr. Akizuki (SF Giants team doc, and one of the best elbow guys around) checked my son's elbow, he had him turning beet red, then sweating, then about to pass out. Dr. A's words "BAD sign!" His UCL was torn in two places. He's been trowing for a while with a partial tear that caused no pain, so nobody knew about it. The second one partly avulsed the ligament from the bone, and that is the one that hurt.

Since his surgery, he's had a rehab with no setbacks in his rehab and his arm is great. Go to the right surgeon if it's torn, not who your insurance wants to send you to, and get an equally good Physical Therapist, as they are as important after the surgery as the doc is who does the surgery.

Hopefully, he'll just need some rest and rehab, and will be good to go without getting that 6" scar.
coach2709coach270910,000+ posts
Had a game tonight and there was a certified athletic trainer there. He gave him a really good look over and said it wasn't the ligament but just above it in some soft tissue.

He said the ligament still felt very strong and he had full movement. Said needed to rest and ice with antiinflamatories. Thinks he can start tossing by Friday.

I told him mom he still needed to go to the doctor and I think she is still taking him. The trainer did make me feel somewhat better.
RacabRacab1,000+ posts
Coach2709
The most commun cause of pain in the inside part of the elbow is tendinitis and is probable the best prognostic of all possibles. Anti-inflamatories and complete arm rest is the main remedy. This is just for information, because the doctor is the one that could determinate what it is and what to do. Good luck to your player.
coach2709coach270910,000+ posts
Good news - he got back from the doctor and he said it was not the ligament. It is in the bicep close to the ligament.

My guy said he twisted and turned his arm every which way imaginable. His mom verified that he gave it a good exam in different twists and turns.

The doctor gave him exercises to do, he can lightly toss and play a position this weekend. If things go well he can start back pitching next week.

My plan is to make him do the exercises religiously. He is going to toss tomorrow. I told him any discomfort and he shuts it down.

He will start to stretch it out to long tossing next week on Tuesday.

We are going to basically restart his preseason pitching program. We start them at around 30 pitches for a week every other day, then jump to 45 for a week every other day, then jump to 60 a week every other day and then once games start we cap their first couple of starts around 70 - 80. By their third start we should have them around 100 max. After that we get them out.

Right now he should be on pace for 60 - 70 for a game but we are just starting him over and have him go 30 for a week.

All our guys know (or are told) any pain they shut it down and we talk.

I got to admit this is my first major injury with an elbow. I have had some minor shoulder injuries but nothing that could have been this serious.

Thank you everyone for your advice, hints, tips and well wishes. He is a great kid and has a great future. I would really hate to see such a future ended this early (he is a sophomore). Of course I would be this worried even if this was a kid who I know would never pitch past freshman level.
S switchitter100+ posts
quote:
Originally posted by coach2709:
Good news - he got back from the doctor and he said it was not the ligament. It is in the bicep close to the ligament.

My guy said he twisted and turned his arm every which way imaginable. His mom verified that he gave it a good exam in different twists and turns.

The doctor gave him exercises to do, he can lightly toss and play a position this weekend. If things go well he can start back pitching next week.

My plan is to make him do the exercises religiously. He is going to toss tomorrow. I told him any discomfort and he shuts it down.

He will start to stretch it out to long tossing next week on Tuesday.

We are going to basically restart his preseason pitching program. We start them at around 30 pitches for a week every other day, then jump to 45 for a week every other day, then jump to 60 a week every other day and then once games start we cap their first couple of starts around 70 - 80. By their third start we should have them around 100 max. After that we get them out.

Right now he should be on pace for 60 - 70 for a game but we are just starting him over and have him go 30 for a week.

All our guys know (or are told) any pain they shut it down and we talk.

I got to admit this is my first major injury with an elbow. I have had some minor shoulder injuries but nothing that could have been this serious.

Thank you everyone for your advice, hints, tips and well wishes. He is a great kid and has a great future. I would really hate to see such a future ended this early (he is a sophomore). Of course I would be this worried even if this was a kid who I know would never pitch past freshman level.


Great news! Glad to hear. It was comforting to know that you were able to get a friend of a friend to look at it. The ligament is always a scary thing. The ucl (or mcl as some call it) is very touchy but incredibely durable. It attaches to both bones (upper and lower) and therefore is very important but it really takes a bunch of overuse and whipping, twisting and snapping to screw it up bad. it will sustain micro-tears and larger tears and heal on its own. if it gets too swelled up it gets vulerable to larger tears. Thus, icing and NSAIDS really do help and are not just a pacifier or myth (something to keep in mind going forward).

Hope this helps and this is really great news. Tell him some of us were really pulling for him through this situation and that we wish him well through the recovery period and we will be eager to hear some success stories soon!
Last edited by switchitter
S switchitter100+ posts
quote:
Originally posted by scissorbill:
That's good news. I have a kid who does not hurt when he throws but has pain/ache in the tendon right in the crook of the elbow at the bottom of the bicep.Its not on the inside where ucl is and he was MRIed a year ago no tears, Any ideas or experience with this. Again he says no pain on the actual throw but afterward.


you say "does not hurt when he throws but has pain"

When does this pain occur? Does it occur after pitching? Does it occur after normal throwing in practice (non-pitching)? You said "afterward" ...is this right after each throw or collectively after the entire practice/game/or pitching session?

There is a radial tendon about where you are talking about. The one that runs tranverse called the anular tendon of radius . The band that would generally be affected by elbow pain during throwing would be the UCL, where there is a Posterior band, an Intermediate band, and an Anterior band. There is a slight (very slight) possibility he could be experiencing biceps tendon pain or strain (this is the tendon that connects the bicep muscle to the upper forearm bone (radius) right in front (anterior) of the anular tendon of radius. Elbow pain in pitchers or baseball players is usually on the medial side of the elbow right by the medial epicondyle (inner bone sticking out). Tennis elbow and injuries to the forearm muscle in racquet ball will be generally on the outside or lateral side of the elbow close to the epicondyle on outside (bone sticking out on outside). This is NOT always the case and elbows are so very tricky that they need to be examined by valgus stress test and other complicated examination movement by a qualified doctor specializing in upper extremity orthopaedic medicine.
Last edited by switchitter
S scissorbill10+ posts
It is after he throws not on the acceleration phase of the throw.It is right in the tendon on the bottom of the bicep right where your elbow bends.I don't know what to tell him other than stretching really well,ice rest etc.He has had this ongoing for several years. He has the best arm on the team and this is problematic and frustrating to him as well.AS I stated he has had the mri's with contrast and the ortho docs don't see any tears,just said tendonitsis,but what can be done to help him? Thanks for the input.
S switchitter100+ posts
quote:
Originally posted by scissorbill:
It is after he throws not on the acceleration phase of the throw.It is right in the tendon on the bottom of the bicep right where your elbow bends.I don't know what to tell him other than stretching really well,ice rest etc.He has had this ongoing for several years. He has the best arm on the team and this is problematic and frustrating to him as well.AS I stated he has had the mri's with contrast and the ortho docs don't see any tears,just said tendonitsis,but what can be done to help him? Thanks for the input.


"Racab" is partially correct. If they diagnosed that as tendonitis, full rest is required for full healing. However, I want you to give me the LONGEST period of time he has NOT thrown a baseball in the last year. For example, has he had a stretch where he was away from basbeall completely for 1 week, 2 weeks, 3 weeks, 1 month, 2 months, etc.?? (that means NOT throwing at all & please be honest)

Once you answer that, we will go on to the next question.
Last edited by switchitter
S scissorbill10+ posts
He actually took several months off,just basketball since October. He was in a throwing conditionig program starting in early Feb. Just started to bother again after working up to 80% or so effort. Not really sure how to attack this. Do you think massaging of this tendon or something similar might work, I just don't know. It does get better with rest but always returns. Any help is appreciated.
itsrosyitsrosy1,000+ posts
Sir, I know how frustrating this is both for you son and for you. My son torn is UCL and we went to Birmingham for the surgery. If I lived in California, I'd make sure that one of the top ortho's like Yocum or those that work with the top collegiate baseball programs in you state at least view these MRI's. If you have insurance then know that it's the same nickel to see the very best as it is to see someone less experienced. JMO.
S switchitter100+ posts
quote:
Originally posted by scissorbill:
He actually took several months off,just basketball since October. He was in a throwing conditionig program starting in early Feb. Just started to bother again after working up to 80% or so effort. Not really sure how to attack this. Do you think massaging of this tendon or something similar might work, I just don't know. It does get better with rest but always returns. Any help is appreciated.


Since the pain is not in the traditional "bad" spot for elbows, I don't think you need to take your MRI's to the next level. whom ever looked at the MRI's the first time surely knew where the pain location came from. tendonitis takes a good while to completely go away and sometimes it lingers (reference Michael Jordan's knee -- one entire year). It's a tricky thing but the location of the pain could be the transverse or biceps tendon. If you eventually become 100% confident what this is and it is NOT the UCL or other important elbow ligaments, perhaps some localized treatment for that area becomes appropriate.

http://books.google.com/books?id=omIMAAAAYAAJ&pg=PA336&...IO2g&hl=en#PPA302,M1
Last edited by switchitter
YoungGunDadYoungGunDadHSBaseballWeb member since 2005
quote:
Originally posted by switchitter:

and I am NOT a doctor nor an arm expert nor an athletic trainer of any kind. But you are asking and I am responding



Switch, if you aren't a Doctor, then you sure are one smart fellar. Smarter than the rest of us average Joe's in here.



All I know to do is put a band-aid on it.
M MTS100+ posts
quote:
Originally posted by play baseball:
quote:
Originally posted by coach2709:
Good news - he got back from the doctor

This is good news!

quote:
I got to admit this is my first major injury with an elbow.

And you handled it very well. I wish my son's coach and the trainer were as conscientious as you. Hopefully, you won't have any other injuries. Good luck to your team this season.


I second this opinion
S switchitter100+ posts
quote:
Originally posted by scissorbill:
I would say looking at switchhitter's anatomy chart it is in the biceps tendon. What can be done?


It is unlikely that the below is at issue. But I believe there could be a slight tear or microtears that are not healing because of a currretly active arm. Have you tried no-use, ice, and NSAIDS for a period of one week with no throwing?

What are the symptoms of distal biceps tendon rupture?
Distal biceps tendon rupture is characterized by sudden pain over the front of the elbow after a forceful effort against a flexed elbow.

Usually the patient will hear a snap and have pain where the tendon rupture occurs. Swelling and bruising around the elbow are also common symptoms of distal biceps tendon rupture.
What is the treatment of distal biceps tendon rupture?
Most patients will experience benefit if the biceps tendon is repaired surgically. If the tear is incomplete, or if the patient is very low-demand (not active), then surgery may not be needed. However, most patients who want more normal use of their arm will benefit from surgery to repair the ruptured tendon to the bone.
TRhitTRhit10,000+ posts
If the player is still having pain he had better see another doctor and he should not be throwing if the pain is persisting, he could be doing more damage

Folks nothing against the switchitter but he says nothing about being a doctor much less a sports doc---I would be careful with any medical advice given on this site--too many people think they know more than they actually do
S switchitter100+ posts
quote:
Originally posted by TRhit:
If the player is still having pain he had better see another doctor and he should not be throwing if the pain is persisting, he could be doing more damage

Folks nothing against the switchitter but he says nothing about being a doctor much less a sports doc---I would be careful with any medical advice given on this site--too many people think they know more than they actually do


i was very careful to say i was not in earlier posts. That goes without saying. Doing a little research just gives them more info to chew on. Besides, they already had an MRI.
TPMTPMHSBaseballweb Member since 2003
quote:
Originally posted by scissorbill:
It is after he throws not on the acceleration phase of the throw.It is right in the tendon on the bottom of the bicep right where your elbow bends.I don't know what to tell him other than stretching really well,ice rest etc.He has had this ongoing for several years. He has the best arm on the team and this is problematic and frustrating to him as well.AS I stated he has had the mri's with contrast and the ortho docs don't see any tears,just said tendonitsis,but what can be done to help him? Thanks for the input.


Chronic tendinitous can cause more issues later on than we realize and should never be overlooked. If not treated properly more problems may develop later on OR there may be a problem causing the tendinitous which could be mechanical in nature. My son has had two bouts with tendinitous, both times shut down completely, rehab with a trainer and then rehab innings, after determining there was nothing else seriously wrong. Both times he missed two seasons, one this fall in HS year and another this past summer his first pro season. One cause was throwing a knuckleball (we didn;t know), the other not really sure other than a long season and some bad habits hopefully addressed and corrected with adjustments on mechanics.
Taking anti inflamatories and ice and back on the mound is a quick fix.
Any discomfort anytime you throw a ball other than being sore after a very long season should be carefully diagnosed by a doctor. Tendinitous should be considered serious and treated accordingly with PT, rest and rehab innings.

JMO.
06catcherdad06catcherdad1,000+ posts
OK, enough already. You don't need opinions from amateur docs, you need one from a real doc.

Scissorbill, I didn't look to see where you live until now, but now notice that you're in Chico. Give me a call and I'll put you in touch with THE DOC who you should probably go see. He's in San Francisco, and is pretty widely regarded as one of the top orthopaedic surgeons, from a baseball perspective, in northern CA. He did Tommy John surgery on my son (it went great), and I've referred probably ten other players down to him, and all have had good experiences with him. More to the point, not only is he the orthopaedic surgeon for USF, Santa Clara and several other colleges, he's the San Francisco Giants team surgeon for all of their clubs. His name is Kenneth Akizuki, and you won't find a better doc to look at your kid's elbow. He's also a hell of a nice guy, very easy to talk to. 415-563-2600, talk to Anne in his office to schedule an appointment.

If you'd like to talk about it more, just PM me and I'll gladly talk with you all you'd like about this.
None of us on here are doctors, and this kid should be seen by a qualified doc to figure out what's going on and how best to treat it. You now know how to get in touch with the best out this way.

By the way, from your screenname, I take it you shoot spoonies??? Really???

Dan Sozzi
EDH Vipers Baseball
www.edhvipers.org
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