UNMC surgeon alarmed at rising number of preventable pitcher injuries

Baseball pitching injuries are preventable

As an orthopaedic surgeon specializing in the elbow and shoulder, it bothers Matt Teusink, M.D., to see the alarming rate of elbow and shoulder injuries in baseball pitchers – from Little League to professional. He said many of the injuries are preventable.

“One of the most alarming things with baseball in America is the increased rate of elbow injuries in pitchers. It’s becoming an epidemic,” said Dr. Teusink, assistant professor of orthopaedic surgery at the University of Nebraska Medical Center. “This year, there have been 16 major league pitchers that have gone down with elbow injuries and it’s a season-ending injury.

“It takes them out of baseball for at least a year,” he said. “I think certainly any orthopedic surgeon or those in sports medicine find this trend very concerning.”

Dr. Teusink said prevention is the key to avoid throwing injuries. His interest in baseball injuries stems from playing Little League baseball through high school and seeing a high school friend’s baseball career hopes cut short by an elbow ligament tear.

“It’s imperative that coaches and parents be educated on the importance of limiting pitch counts especially at the younger youth levels,” Dr. Teusink said. It’s also important to monitor for fatigue and take kids out when their arms get tired, as that is when mechanics break down and injuries occur.

“Perhaps the biggest key to preventing injuries is encouraging kids to take extended breaks from baseball (several months) and really emphasizing mechanics with  core strengthening (abdomen, back, glutes and thighs) and stretching.”

One of the most common injuries for pitchers is a torn medial collateral ligament on the inside of the elbow. If one wants to continue pitching, it requires Tommy John surgery, a procedure first performed in 1974 when John was pitching for the Los Angeles Dodgers. In the reconstruction, surgeons take a tendon, most commonly from the wrist and fashion it into a new ligament, weaving it through bone tunnels on the inside of the elbow, he said.

The surgery re-stabilizes the elbow but takes a year of rehabilitation before athletes can pitch again.

Dr. Teusink said surgeons have started seeing the injury in pitchers as young as 14 or 15. Little League pitchers also can suffer a growth plate injury in the elbow.

“The good news is that this injury heals if you just sit out a little bit and give it a chance to heal,” he added. “But not all coaches are totally up to speed on how to prevent these injuries. 

“Some pitchers will sort of whip throw it where they’ll open up their body – open their shoulders up wide and trail the arm,” Dr. Teusink said. “The whipping motion can create good velocity, but also puts a lot of force on the inside of the elbow and the shoulder.”

He said pitch counts in Little League – based on age – may help prevent injuries. The USA Baseball Medical & Safety Advisory Committee recommends the below pitch counts. Pitch counts work well if players are pitching in just one league, but, he added, some are playing in multiple leagues, and year round, which increases the cumulative wear and tear and fatigue on the elbow. 

Pitch count suggestions age 8-18 (USA Baseball Medical & Safety Advisory Committee recommends the following pitch counts:





8 - 10



11 - 12



13 - 14



15 - 16


2 games / week

17 - 18


2 games / week

“I would reinforce to parents that it’s really important that kids have a break during the year – so they’re not throwing year-round, especially pitchers. They should take several months off during the year. It doesn’t mean they should be doing nothing during that time. They can be playing other sports or batting. Most of us believe that the increased incidence of these injuries is related to year-round pitching and fatigue.”

He also suggests any child who will be pitching have their pitching mechanics evaluated to ensure proper pitching form and avoid undue stress and strain on the elbow.

Most common pitching injuries

  • Little Leaguer’s elbow (medial apophysitis) — Pain on the inside of the elbow.
  • Osteochondritis dissecans of the elbow- Pain on the outside of the elbow.
  • Ulnar collateral ligament (UCL) injury -- the most commonly injured ligament in throwers. Injuries of the UCL can range from minor damage and inflammation to a complete tear of the ligament.
  • SLAP tears (Superior Labrum Anterior and Posterior) – an injury to the labrum of the shoulder, which is the ring of cartilage that surrounds the socket of the shoulder joint.

Source: American Academy of  Orthopaedic Surgeons

Dr. Teusink’s tips on how to prevent injuries:

  • Avoid overuse. At the youth levels, pitch counts have been implemented. For more info, see littleleague.org
  • Play a variety of sports. Don’t play baseball year-round to give the elbow a break
  • Work on proper throwing mechanics
  • Do proper stretching
  • Strengthen the core (abdomen, back, gluts and thighs)

 Symptoms of pitching injuries

  • Pain for more than a day or two after throwing that doesn’t go away with icing and anti-inflammatory medication
  • A “pop” on the inside of the elbow then pain with a sudden loss of throwing velocity
  • Shoulder pain in the late cocking phase of throwing (when they bring the ball back to throw it)
  • Elbow swelling

Tommy John surgeries by year (Major League Baseball players only)


2014 - 16*

2013 – 19

2012 – 36

2011 – 18

2010 – 16

2009 – 19

2008 – 18

2007 – 20

2006 – 18

2005 – 16

2004 – 12

2003 – 15

2002 – 13

2001 – 12

2000 – 13

Source: Baseballheatmaps.com

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Vicky Cerino
UNMC Public Relations
(402) 559-5190