Stress fractues


#1

does anyone have exsperience with stress fracture of olecron(elbow)?

My son had MRI in Dec showing and old stress fracture(5-6months) All liagaments, tendons and muscle are fine.

He has no pain except when throwing. This is decribed as ache and does not occur on every pitch but is uncomfotable. He does not require any medication. The pain does not appear to be getting better or woese. He also has lost 3-4 mph on velocity of fastball

He is 20 yo and has pitched since age 11. He has had no prior history of arm problems prior to current episode. :?:


#2

This is likely caused by the Olecranon slamming into its fossa.

If he learns to pronate while his forearm is flying out and his elbow is rapidly extending, then he might reduce some of this force.

You might also want to see…

  1. What is the angle of his elbow at the moment his shoulders start to turn? I’d bet its more like 135 degrees rather than the more traditional 90 degrees.

  2. If he can strengthen the muscles of his arms so that they can keep his forearm from flying out so quickly.


#3

Don’t listen to people who don’t know what they are talking about is the first step.

It sounds like you may be trying to let him pitch through the problem. Stress fractures typically start out as pain only during the aggravating activity. They eventually progress to pain during daily activities.

The second step is to have him see a sports doctor or orthopedist and do what they tell you. If the injury hasn’t healed it needs rest to heal. If rest isn’t enough to help it heal or you’d like to speed up the process you may want to consider an ultrasonic or electrical bone growth stimulator if your physician concurs.

Work with his physician and do what is necessary to let it heal even if that means taking time off from baseball.


#4

CADad,

She’s already been to see the doctor and has a DX.

What she seems to be looking for is information about how to either…

  1. Fix the problem (it doesn’t seem to be resolving itself).

  2. Prevent the problem from recurring.

Rest alone may not fix the problem. If the problem doesn’t go away, or comes back again, then it may be that the stress fracture is caused by a mechanical problem (e.g. supinating the forearm upon releasing the ball). Therefore, it may only be resolved via a fix to her son’s mechanics.


#5

[quote=“Chris O’Leary”]This is likely caused by the Olecranon slamming into its fossa.

If he learns to pronate while his forearm is flying out and his elbow is rapidly extending, then he might reduce some of this force.

You might also want to see…

  1. What is the angle of his elbow at the moment his shoulders start to turn? I’d bet its more like 135 degrees rather than the more traditional 90 degrees.

  2. If he can strengthen the muscles of his arms so that they can keep his forearm from flying out so quickly.[/quote]

Chris, exactley when does the slamming of the olecranon into the fossa occur within the throwing motion? I readily admit that pronation is a good thing. You overemphasize its role. There is no evidence that “early Pronation” does anything. There is evidence that excessive pronation/supination can lead to tennis elbow [generic term] as well as medial side pain [ucl]. There is another ligamant within the elbow that you would do well to investigate. Look at the role it plays in keeping the elbow intact. It is the annular ligament it is also responsible for many articulation injuries, excessive uneeded motions are critical to not upsetting the elbows tight structure. no matter how hard you try you will never stop either varus/valgus torque. Simply put if you throw your arm has to endure high degrees of both. There is such a position called the neutral position in regards to the elbow. This would be hand behind ball, fingers on top. No supination or pronation, neutral. This would be the ideal position to acellerate an object from proximal to distal. Pronation should be thought of as a last effort/extension, in fact many believe that this is where that illusive “pop” that some pitchers achieve comes from. There is no scientific data that states “early pronation” will do anything in regards to staving injury or increase performance that I have seen. there is much data that concludes pronatin upon release is a mechanicsim for improved performance and injury protection. If you have some documentation/research that clearly states through research that “early pronation” is a sure fire way to stop injury please post it.


#6

Dear Chris:

If you do not have documentation of the effects of early pronation, it would be a great study to setup. The effectives and outcomes could lead to great insights for future coaches in teaching arm action of pitchers in their program. I get excited thinking about the data that could come out of the research.

Thanks.


#7

go to a sports doctor or trainer. the olecranon slamming into the fossa means nothing from someone who is not a sports doctor.


#8

[quote=“CoachKreber”]Dear Chris:

If you do not have documentation of the effects of early pronation, it would be a great study to setup. The effectives and outcomes could lead to great insights for future coaches in teaching arm action of pitchers in their program. I get excited thinking about the data that could come out of the research.

Thanks.[/quote]

I have hundreds of research papers and from what I have seen not a single one says anything in regards to “early pronation”. I would suggest going to asmi website and downloading the ppt presentation they give on the elbow and shoulder. There is a third one too but I cant recall it. From high level pitchers right down to the young guys the stress put on the elbow as well as shoulder is inherent if they are going to pitch. The load on the elbow is equivilent to the pitcher holding 55 baseballs in his hand as he accels the ball. This is actually real research done by real doctors who actually know. Look all you want you will not find any research without Marshalls fingerprints on it that specifically says anything in regards to “early pronation” being an end all to elbow problems. If there is some data out there Id love to see it.


#9

As the rate at which the shoulders turn decreases, the forearm of the pitching arm flies out and the elbow rapidly extends 90 to 135 degrees. This fly-out happens so quickly and with so much force that the muscles of the upper arm (e.g. the Brachialis) are unable to completely resist it. The more the forearm flies out, the greater the stress that is applied to the Olecranon.

My emphasis on Early Pronation comes from articles like “Articular and ligamentous contributions to the stability of the elbow joint” (http://ajs.sagepub.com/cgi/content/short/11/5/315) which indicate that the UCL is the primary structure for maintaining the integrity of the elbow joint as the elbow extends through 90 degrees. This and other articles suggest that it is at this moment, as the elbow is extending through 90 degrees, that the maximum load is placed on the UCL. To protect the UCL, I believe that this means that you must be pronating at this moment, which is considerably earlier than the release point.


#10

“He has no pain except when throwing. This is decribed as ache and does not occur on every pitch but is uncomfotable. He does not require any medication. The pain does not appear to be getting better or woese. He also has lost 3-4 mph on velocity of fastball”

Does this sound like someone who is resting a stress fracture? Giving someone like this any advice except shutting down immediately and going to see a sports medicine doctor or an orthopedist is irresponsible. Rest does not always heal stress fractures. Sometimes it takes surgery. Use of a bone growth stimulator can in some cases prevent the need for surgery. However, one should consult a qualified physician before using a bone growth stimulator.


#11

The original post indicated that he did rest it for 5 or 6 months.

My concern is that either…

  1. It didn’t heal completely

  2. He is re-aggravating the original injury by sticking to his old (and in my opinion problematic) mechanics.


#12

No. The original post indicated that the MRI showed that it was an old stress fracture when they discovered it a couple months ago. It sounds to me like they found the fracture on an X-Ray and then did an MRI to see if it was acute. Many times a stress fracture caught that late will never completely heal unless something extra such as bone growth stimulation or surgery is performed.

If the physician decided that it was a non-union and wasn’t going to achieve bony union he may have told him that he’d could go ahead and try to pitch as long as there was no pain.

However, we don’t know that from the post and the only responsible reply is to tell him to see a sports medicine doctor or orthopedist unless he’s gotten an OK to go ahead with throwing from his doctor. Personally even if he did get clearance from his doctor, I’d recommend he shut down, get a second opinion and look into bone growth stimulation as a preferred option prior to the last resort of surgery.


#13

As the rate at which the shoulders turn decreases, the forearm of the pitching arm flies out and the elbow rapidly extends 90 to 135 degrees. This fly-out happens so quickly and with so much force that the muscles of the upper arm (e.g. the Brachialis) are unable to completely resist it. The more the forearm flies out, the greater the stress that is applied to the Olecranon.

My emphasis on Early Pronation comes from articles like “Articular and ligamentous contributions to the stability of the elbow joint” (http://ajs.sagepub.com/cgi/content/short/11/5/315) which indicate that the UCL is the primary structure for maintaining the integrity of the elbow joint as the elbow extends through 90 degrees. This and other articles suggest that it is at this moment, as the elbow is extending through 90 degrees, that the maximum load is placed on the UCL. To protect the UCL, I believe that this means that you must be pronating at this moment, which is considerably earlier than the release point.[/quote]

Okay but its still just your opinion correct? The article does not say anything in regards to “early pronation” helping to aleviate this, correct?


#14

Well, it’s basically Dr. Marshall’s idea. I’m just trying to clarify it.

This opinion is based on an understanding of the physiology of the elbow; the fact that the UCL is most vulnerable as it extends through 90 degrees.