Matt Holland joins us on the podcast today from Trinity University to talk about the Thrower’s Elbow. Why do we see so many elbow injuries in throwers? “A great deal of stress is placed on the elbow with throwing, particularly in the late cocking and acceleration phase. The forearm musculature has a limited ability to help with the stress load so the bone and ligaments of the elbow absorb a significant amount.” Also contributing to the rise of injuries is the early commitment of young athletes to year-round baseball, especially in the south. As well as great rehab that doesn’t address mechanics or the importance of core and lower extremity strength as well as balance. Are there factors that can be indicative that an athlete may suffer an elbow injury? Rotator cuff weakness, altered scap position, altered throwing mechanics, GIRD and not using the core or lower extremity during throwing contribute to the elbow being injured. Dr. James Anderson states, “the #1 cause of elbow injuries is bad mechanics, and the #2 cause is overuse. Combine those two factors and you are doomed.” UCL tears aren’t the only injuries we see in the elbow. What other ones might we come across? Triceps tendonitis is common among throwers. Most often this is an overuse issue and athletes recover quickly with rest. Flexor tendon tears can occur but are incredible frequent especially in younger throwers. Valgus extension overload can cause repetitive abutment of the olecranon. It is important to look at mechanics here and ensure that there isn’t a UCL injury causing this. Little League elbow is very similar to a UCL tear. However the weakest link in a skeletally immature body is the growth plate so this becomes injured instead of the UCL. The key to healing this is rest, rest and more rest coupled with parent education. How important is rest with elbow injuries? In a recent study published in 2019 the thickening of the UCL and the increased joint space of the elbow found in thrower’s experiencing elbow pain returned to normal on imaging after rest. However, if these athletes had GIRD that wasn’t addressed, that correlated with a continued increased joint space in the elbow. What questions should we ask an athlete who comes to us with elbow pain? What position do you play or combination of positions? What is your volume of play? Do you take time off? Where is your motion does it hurt? This question is of particular importance because if the pain is happening during the maximum external rotation found in late cocking it is usually a UCL issue. What are the rehab guidelines post-TommyJohn surgery? Protect the graft for 6 weeks and return normal strength to not only the elbow but to the shoulder, core and lower extremity. Focus on balance and at the 4-5 month mark throwing can begin. It is a long process because once throwing is started that is how we strengthen the ligament with little stressors. Throwing should include working on mechanics but stressing the ligament a little bit followed by rest. It’s also important to note the type of revision done because some revisions like the modified Jobe move the nerve and this becomes important to know while doing soft tissue work. Does the UCL reconstruction have favorable Return-to-play? Yes! 90% of post-surgical patients return to normal throwing biomechanics post-surgery. What is important to remember regarding elbow injuries in the throwing athlete? Great rehab is important but it doesn’t help if it is coupled with poor mechanics and it is critical that we have continued conversations with parents educating them on detrimental effects of year-round throwing in high volume without rest. High loads with high-speed movements Angular velocity of the shoulder is anywhere between 7 to 8 thousand degrees per second as the shoulder does from max external rotation to an internal rotated position.