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Progression from “Pop” Back to Pitching

Progression from “Pop” Back to Pitching

by | Oct 20, 2023 | Sports Medicine

A young baseball player hears a pop and immediately feels pain in his throwing elbow while playing club baseball. At his first visit to Scottish Rite for Children’s Fracture Clinic, Parker and his family were told that surgery was necessary to reattach a separated piece of bone in his elbow. That was tough news for this young pitcher nearing his 12th birthday.

A Note About Sport-Related Overuse Injuries in the Elbow in Baseball

Though a completely displaced fracture in this area is uncommon, pain and injury on the middle side of the elbow is common in young throwers. There are immense stresses placed on the elbow during throwing.

Many pitchers and others perform many throws during practice, private training and year-round games and tournaments, and the damage continues and worsens. For many young athletes, early recognition and rest can prevent the condition from worsening to the point of an acute injury, like a medial epicondyle avulsion fracture, that needs surgery. Learn more about preventing elbow overuse injuries in young athletes in this article, Injury Prevention Tips for Young Baseball Players and Parents.

“This area of the elbow is weak in young throwing athletes around Parker’s age, he was 11 at the time of this injury,” occupational therapist Savana Ashton says. The area is an epiphysis, a growth center, where the bone fragment is connected to the humerus by cartilage that will become bone when growth is complete. With or without a history of overuse, a sudden and forceful injury causes the muscle tendon attached to the fragment to pull it off the humerus completely, this is called an avulsion fracture. Like Parker, an athlete often describes hearing a “pop” and instantly feeling severe pain with this injury.

Parker was in good hands. Pediatric hand surgeon, Chris Stutz, M.D., performed the ORIF surgery where he used a screw to reattach the piece of bone. The procedure is called an open reduction and internal fixation (ORIF) of the medial epicondyle. After surgery to secure the bone fragment back in place, patients require intensive rehabilitation to return to activities and sports that are meaningful to them. In occupational therapy (OT), Ashton provided many therapeutic interventions including skin care and scar management as well as exercises to regain motion in the elbow and strength in the entire arm.

“From the beginning of Parker’s journey, he was eager to return to baseball, so a strategic path through postsurgical rehabilitation including safely reintroducing throwing was critical,” Ashton says. “Once Dr. Stutz cleared him for throwing, I advanced Parker’s plan to include evidence-based throwing programs, which include general baseball strengthening exercises and a multiphase guide to gradually return-to-pitching.”

Similar to other young athletes recovering from a serious sport-related injury, Parker was ready to be discharged from formal rehabilitation, but he was not quite ready to return to full activity, including baseball. In September, Parker transitioned from OT to the Bridge Program, a group training option offered by our Therapy Services team at Scottish Rite for Children. The program provides athletes like Parker a safe “bridge” to maintain progress made in therapy and continue strengthening in the previously injured area. Simultaneously, the coaches emphasize proper body mechanics and total body strength and conditioning, which will likely help reduce the risk of reinjury. “We were grateful Scottish Rite had an environment for him to continue his recovery,” Parker’s mom, Michele, says. She has entrusted Scottish Rite to care for several of her children now.

The program is not baseball-specific, but it is beneficial for baseball players and many others. Certified strength and conditioning coach Justin Haser, M.S., CSCS, says, “The kids that consistently come in, give a good effort and are coachable see great improvements in their movement economy and improvements in their overall strength outputs.” When athletes enroll in the Bridge Program or Athlete Development Program, they can attend up to three times each week.

In pediatric orthopedics, follow-up visits are particularly important when a growth area was involved in the treatment. Complications with this treatment are rare, but monitoring periodically and confirming recovery is on the right path ensures there won’t be surprises later.

Parker is now 13 and has been happily back on the mound and hitting home runs. “Parker is thrilled to be back playing baseball after his full recovery from surgery,” Michele says. To help other young throwers like himself have a safe season, Parker helped us create instructions for evidence-based exercises for all throwers. These are designed to be performed before practice or a game and can help to reduce elbow injuries.

Download the Thrower’s Program PDF (English | Spanish)

Expert Care for Extra Fingers and Toes

Expert Care for Extra Fingers and Toes

by | Jul 25, 2023 | Hand Conditions

Published in Rite Up, 2023 – Issue 2. 

“Holden is very much the baby of the family,” says Ashley, his mother. “He likes being the center of attention and being constantly held. He’s also a little mischievous.” The youngest of three children, Holden, of Dallas, turned 1 in April and, according to Ashley, is into everything. “He’s in that ‘I now can get myself anywhere I want to be, so I’m going to explore anywhere I can’ phase,” she says. But, for the first nine months of his life, he could not wear a shoe on his left foot.

Holden was born with polydactyly, a condition in which a baby is born with extra digits. In Holden’s case, he had an extra pinkie finger on each hand and an extra toe on his left foot that sat on top of his other pinkie toe.

Ashley was prepared for the extra toe because her doctor had spotted it in her 20-week ultrasound. He said that they would have a pediatrician at her delivery who would put a clamp on it, and it would fall off like an umbilical cord. The two extra fingers were a surprise. “When Holden was born, the pediatrician said that given the number of extra digits and the way some of them were connected, they weren’t confident clamps would work,” Ashley says. Within 24 hours, they were referred to Scottish Rite for Children.

Hand surgeon Chris Stutz, M.D., evaluated Holden when he was just 3 weeks old. A leader in training hand surgeons from around the world, Scottish Rite was the first pediatric orthopedic facility in the nation to employ full-time hand surgeons. Dr. Stutz recommended surgery to remove the three extra digits at 9 months of age. The timing of surgery was scheduled late enough in Holden’s development to mitigate the risk of complication due to anesthesia and early enough to ensure that he could learn to walk.

“The idea of handing over your 9-month-old baby for surgery is terrifying,” Ashley says, “but it was so much easier knowing that he was with people who specialized in that.”

Holden came out of surgery with soft wraps on his hands and a hard cast on his foot. “As soon as the cast came off, we put him in a hard-soled shoe,” Ashley says. “His ability to stand and move around has been really great.”

“While this is a common procedure for our team, it is uncommon for the patient and family,” Dr. Stutz says. “We were happy to provide the comfort, confidence and expertise for this wonderful, sweet family.”

“We loved our Scottish Rite experience,” Ashley says, “and we’re glad that Holden can move on with being a 1-year-old who can wear shoes!”

Read the full issue.