Does a Normal Elbow Really Exist?

Written on February 9, 2011 at 8:36 am, by Eric Cressey

I’ve written quite a bit in the past about how diagnostic imaging (x-rays, MRIs, etc) doesn’t always tell the entire story, and that incidental findings are very common.  This applies to the lower back, shoulders, and knees (and surely several other joints).  The scary thing, though, is that we see these crazy structural abnormalities not just in adults, but in kids, too.  Last month, I highlighted research that showed that 64% of 14-15 year-old athletes have structural abnormalities in their knees – even without the presence of symptoms.  Just a month later, newer research is showing that the knee isn’t the only hinge joint affected; young throwers’ elbows are usually a structural mess as well.  In an American Journal of Sports Medicine study of 23 uninjured, asymptomatic high school pitchers (average age of 16), researchers found the following:

Three participants (13%) had no abnormalities. Fifteen individuals (65%) had asymmetrical anterior band ulnar collateral ligament thickening, including 4 individuals who also had mild sublime tubercle/anteromedial facet edema. Fourteen participants (61%) had posteromedial subchondral sclerosis of the ulnotrochlear articulation, including 8 (35%) with a posteromedial ulnotrochlear osteophyte, and 4 (17%) with mild posteromedial ulnotrochlear chondromalacia. Ten individuals (43%) had multiple abnormal findings in the throwing elbow.

For me, the 35% with the osteophytes (and chondromalacia) are the biggest concern.  Thickening of the ulnar collateral ligament isn’t surprising at all, but marked osseous (bone) abnormalities is a big concern.

Also, as a brief, but important aside, this study was done at the Mayo Clinic in Rochester, Minnesota – which isn’t exactly the hotbed of baseball activity that you get down in the South.  Recent research also shows that players in Southern (warm weather) climates have decreased shoulder internal rotation range of motion and external rotation strength compared to their Northern (cold weather) climate counterparts. In other words, I’ll be money that the numbers reported in this study are nothing compared to the young pitchers who are constantly abused year-round in the South.

The next time you think to yourself that all young athletes – especially throwers – can be managed the same, think again.  Every body is unique – and that’s why I’m so adamant about the importance of assessing young athletes. It’s one reason why I filmed the Everything Elbow in-service, which would be a great thing to watch if you’re someone who manages pitchers.

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6 Responses to “Does a Normal Elbow Really Exist?”

1. Andrew Says:
   February 15th, 2011 at 10:17 am

   Eric,
   I have been following your blog for quite some time now. You have a ton of great information. I was wondering if you could point me toward some good sources for additional research? What are some sources you use study on a regular basis? Thanks and keep up the good work.

2. Eric Cressey Says:
   February 15th, 2011 at 10:19 am

   Hey Andrew,

   Thanks for your kind words. Check out my Resources Page; lots of good info there:

   http://ericcressey/resources

3. Andrew Says:
   February 15th, 2011 at 10:44 am

   Ok, don’t know how I missed that, but wow. That’s a couple years worth of reading. Well, I’ll let ya know what I think in about..lets say 2013. Thanks man

4. Karen Says:
   January 27th, 2013 at 6:30 pm

   They discussed this very thing yesterday at the Annual ASMI Injuries in Baseball conference. Another good resource for ongoing research in the topic.

5. Brian Bochette Says:
   January 28th, 2013 at 5:46 pm

   Eric,

   Since you mentioned your resources page, I just wanted let you know how appreciated it is. I am always searching for new sources of knowledge and I’ve pulled a few real gems off your page. Please keep the list going…it hasn’t steered me wrong yet.

6. Eric Cressey Says:
   January 28th, 2013 at 7:49 pm

   My pleasure, Brian; thanks for your kind words!