Stress Fractures in Baseball

Learn more about the risk of stress fractures for baseball players from the Team Physician for the Texas Rangers.
Dr. Keith Meister, Medical Director of Sports Medicine at Medical Center Arlington and Team Physician for the Texas Rangerscontinues to share important tips for parents and athletes here on our blog. Today Dr. Meister discusses the risk of stress fractures for baseball players.
Just as muscle gets stronger in response to stress, so too does bone. With an increased work load, bone can increase in mass in very much the same way a broken bone will heal with new bone. When a repetitive stress placed on a part of the skeleton becomes greater than the bone's ability to strengthen, a “stress” fracture can occur. Pain is usually slow in onset. Symptoms can be well-localized but sometimes not. X-rays done early when symptoms just begin to occur are often normal. MRI’s, CT scans and bone scans may be more useful in the early diagnosis of a suspected stress fracture.
Since baseball is a sport whose hallmark is repetition, the average player can be at significant risk for development of many common stress fractures. No activity in baseball or sport typifies high stress and repetition greater than pitching. Therefore, not surprisingly, the bulk of such injuries are seen in pitchers. 
In the adolescent pitcher whose bones are not yet fully mature, many such injuries can occur thru the growth plates. The two most common such injuries in this lower age group are often referred to as “little leaguer’s” shoulder and elbow. Little leaguer’s shoulder refers to a stress fracture of the upper growth plate of the upper arm bone, the humerus. Little leaguer's elbow refers to stress reaction or fracture through the growth plate on the inner side of the elbow, the medial epicondyle. Generally, both injuries are treated with extended periods of rest from throwing. These young players can often continue to hit during the period of healing. Occasionally, the epicondyle on the inner side of the elbow can be pulled off to require screw fixation.
In the skeletally mature adult pitcher, stress fractures have been known to most commonly occur in the ribs, scapula (shoulder blade), humerus (upper arm bone), olecranon (elbow), and lower back. Typically, these fractures can be treated with appropriate periods of rest and rehabilitation. Fractures to the humerus have, at times, been devastating injuries resulting in completely displaced mid-shaft fractures. Such injuries require surgical management with fixation of the fracture. Unfortunately, in most instances this injury can be career ending. 
Fractures to the olecranon, which is the portion of the forearm bone that meets the upper arm bone (humerus) to form the hinge of the elbow joint, can be one of the most difficult to treat. Elbow pain usually comes on slowly and x-rays are often normal. CT and MRI scans will typically show the fracture. Treatment can consist initially of rest, use of a bone stimulator device, and sometimes new generations of drugs to enhance healing. However, more often, these require surgical treatment with either a single or multiple screws placed across the fracture site. Although healing usually occurs, re-fracture is not that uncommon even after repair
Ultimately, the best treatment is prevention. Paying particular attention to pitch counts, proper conditioning, and proper mechanics will minimize the ultimate risk of such injuries even occurring.
Medical Center Arlington can help diagnose the injury and treat it before it worsens. Please call 1-855-868-6262 for a physician referral.
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