Tommy john surgery is the repair of ulnar collateral ligament of elbow. It is named after the pitcher from LA dodgers to get this surgery done in 1974 for the first time. 

This is a very big topic with lot of myths like after surgery you could throw even faster and harder which has been proven completely wrong. 

 

Recently as the need for speed has risen among young athletes these surgeries are becoming more common. 

 

Not only the need for throwing hard but also doing so without proper mechanics, without proper warm up and proper conditioning is also a contributing factor. 

Role of throwing curve balls at an early age before skeletal maturity has been regarded a contributing factor

but certain researches are finding that there might be no correlation.  see reference: 

https://www.ncbi.nlm.nih.gov/pubmed/19448049.

If you walk around the baseball fields during the baseball season and watch pitchers you could see the variety of pitchers throwing different ways with ultimate main goal of throwing hard. 

Not only the young pitchers are at risk of causing damage to the ulnar collateral ligament (UCL) but the Major league pitchers are also in the news frequently even though they have full squad of sports physicians, trainers etc. 

 

My perception is that there should be focus upon full body conditioning, special focus upon throwing mechanics and proper routine before pitching in the game especially in the cold evenings. 

 

As the biometrics is taking over our sports where teams select bigger kids especially hitters, young pitchers strive to throw harder hurting themselves in the process sometimes. Advancement in equipment like composite bats and other material is also making harder for pitchers so they want to throw harder to get ahead in the game. 

There are some steps taken by certain organizations to change the bat composition to maintain a balance b/w bat and ball. 

 

Eventually the onus is on coaches and parents to talk to their young pitchers if they notice any early signs of discomfort before the serious damage is done. 

As some young pitchers would not complain even if they are hurting. One needs to be a good coach to spot these signs. 

Some signs could be shaking of the pitching arm after every pitch, sudden loss of speed and accuracy, sudden change in throwing mechanics to compensate for the painfully joint etc. 

 

Injury to throwing arm could be minimized by proper warm up before pitching, adequate resting period b/w days of pitching. 

 

There are certain group muscles of shoulder and forearm needs to be strengthened to put less strain at the Ulnar collateral Ligament on the medial inner side of elbow. 

 

Please talk to an Occupational therapist Physical therapist with experience in upper extremity rehab. to evaluate your son/daughter as soon as the pain develops. They can guide you with proper rehab. program to make faster recovery and them back on the field with confidence and help them achieve full potential safely. 

 

Arun Sharma 

Occupational Therapist / Certified Hand Therapist

Shoulder Pain In thrower athletes i.e pitchers , catchers has been a common problem.If symptoms are misdiagnosed or left unchecked can result in more severe pathology and disability potentially ending the career or loss of occupation. 

Most of these symptoms originate from minor trauma or cumulative stresses especially in younger athletes eventually leading to proximal instability at scapular region. Sometimes more serious injuries like SLAP tear are the underlying causes. 

Through evaluation by a therapist or doctor is required in order to establish proper diagnoses. Frequently symptoms are present away from the actual site of pathology leading to improper diagnoses. For example patient might c/o pain at the anterior aspect of shoulder , Lateral arm pain etc. 

Some of the symptoms which may require immediate attention :

1. Feeling of severe fatigue in arm sometimes explained by patients as " Dead Arm".

2. Affected arm is significantly lower than the non affected arm.

3. Pain in scapular region especially raised medial and lower part of scapula.

4. Clicking sensation at shoulder sometimes palpable hyper-mobility of joint causing stress on surrounding structures. 

Precautions to be followed in order to prevent these injuries:

1. Following proper bio-mechanics while throwing

2. Do not attempt to throw if in pain or fatigued as it might lead to undue stress or start to cause wear and tear at shoulder muscles and surrounding structures.

Please follow up with Rehab. professional ASAP who can identify the true nature/ cause of pathology because if remains unchecked patient might have to undergo surgery.

Proper interventions might include scapula specific stability exs, taping to support / rest hyper-mobile structures, rest, closely monitored strengthening program. 

Sensory processing refers to the collective process of Reception, Perception, Processing of information and Response to it. Information is being Received from the environment via our sense organs, (vision-eyes, hearing-ears, smell-nose, tongue- taste, nose-smell, skin- touch) as well from our body, through muscles and movement receptors.

This information is consolidated in the mid brain and perceived by the various specialized regions of the brain. This in formation is then processed using previously stored information or"made sense of"  via communication between different parts of the brain. 

This is followed by a response, in the form of a physical movement, speech or social behavior.

Hence, an impairment in one or more of the 4 processes namely,reception, perception, processing and response can lead to visible challenges in physical, speech and language as well as social behaviors. 

Our muscle tone as well as the ability to perceive and respond to movement also provide feedback to the brain regarding the position of our body in space and hence our sense of well being, or feeling grounded. 

Hence we truly have 7 sensations which provide input or sensory input to our brain. 

Spontaneous and efficient acquisition of developmental processes is contingent upon synchronized working of all these processes.These are observed in the form of natural development of motor milestones, speech and language as well as cognitive and social emotional skills. 

Intact processes of of reception, perception, processing and output or response form the building blocks of all acquired skills. 

Motor skills such as sitting, creeping, walking running, reach, grasping and manipulation are centrally programmed skills. This alludes to the fact that these skills do not have to be taught. The human body is programmed to achieve these milestones with or without appropriate environmental conditions.

Language is however, an acquired skill,it is contingent upon afferent as well as efferent functions. Afferent pertains to incoming input or receptive language, also called as the understanding of verbal cues. Efferent refers to the ability to plan thoughts (ideation), execute planned thought and motor plan its verbalization. 

Hence deficiencies in any of the above components will be observed in its earliest form as delayed motor skills, atypical motor skills, language and speech delays and resultant social emotional challenges from being unable to communicate and/or execute motor movements in order to fulfill basic needs for children.

A child with disturbances with processing movement and body position will be seen as atypical motor function, difficulties with balance and motor planning.

This concept forms the building blocks of understanding the complex process of sensory integration. This has now been measured through a breakthrough study at UCSF. Link  https://www.ucsf.edu/news/2013/07/107316/breakthrough-study-reveals-biological-basis-sensory-processing-disorders-kids.

 

We always get patients in the clinic who c/o finger getting stuck in bent position and when patient pushes hard it snaps into extension as if trigger is released.  In worst cases finger gets stuck in bent position and patient has to use the other hand to extend the finger back. 

Often times it starts without pain and slowly gets very painful. Especially, when patients think that this is due to weakness in hand and they either buy some kind of gadget to improve grip strength which often backfires heavy gripping worsens the symptoms. 

Mostly these patients respond very well to steroid injections at the A-1 pulley region. In long standing cases where finger develops tightness in flexion, patients might benefit from Trigger finger release. 

Hand therapy helps in regaining range of motion in the affected finger or thumb after surgery. Splinting/ heat/ massage/ultrasound therapy/ tendon gliding exs/  activity modification could also help in resolving symptoms without surgery in mild cases.