Dr. David Marshall, Medical Director of Sports Medicine at Children's Healthcare of Atlanta talks about elbow injuries in youth athletes.
Casey Bass: Today on Clubhouse GAS, Doctor David Marshall of Children's Healthcare of Atlanta is here, to talk with us about, little league elbow. What it is? How it would affect your child? How you can prevent it and the treatments available? It's a great show. So stay tuned to Clubhouse GAS. Today on Clubhouse GAS, we're lucky enough to be joined by friend of the show Doctor David Marshall. Dr. Marshall is the director of Sports Medicine here, at Children's Healthcare of Atlanta. Dr. Marshall, thank you so much for joining us. David Marshall: My pleasure. Casey Bass: We want to talk today about, the study that you did involving elbow related injuries and little league pitchers. Now, when a kid gets an elbow injury, a little league kid, that's we all know that's to be tendonitis, correct? David Marshall: Not always. The younger kids, typically don't get tendonitis, the younger kids well, say 14 and below most often, have injuries to their growth plates rather than the tendon. Casey Bass: And that's our target, the audience says, the 14 and under. David Marshall: Correct. Casey Bass: And other physicians, we've talked about, talked a lot about the growth plate issue. You explain to me what the difference in the age and those two injuries is? David Marshall: Well, the age group -- the grow plates. Kids have growth plates all of their body and there is one type of a growth plate called an epiphysis and that growth plate is found at the ends of all the long bones and that's a cartilage bar who's job it is, is to lay down layer, after layer, after layer of a new bone and that's allows our long bones to grow in length. There's another growth plate which is typically, involved in sports injuries called an Apophysis. An Apophysis is still made of cartilage, but it doesn't contribute to getting longer. The bones don't get longer at the apophysis. These apophysis, serve as an anchor point from muscles and tendon units. Very similar to how a cable attaches to a screw, that screws into a plaster wall. If that cable is very powerful which represents the muscle and the tendon, but that plaster is still cartilage and you keep tugging on it. The screw is going to pull out of the wall and that's what happens with the growth plate injuries, especially the elbow in youth baseball players. Casey Bass: So as they get older, the growth plate, it just goes away or goes in/ David Marshall: No, the growth plate goes through a process called ossification, where the cartilage will turn to bone. It's just like your plaster wall turning into cement. Now the anchor point, is no longer the weak spot. Now the weak spot, becomes the muscle or the tendon. So the older kids, the high schoolers, the college kids and of course, the pros they develop tendonitis, because their growth plate showed no longer cartilage. They've turned into bone. Casey Bass: So the younger kids are having a growth plate problem, because that's the weakest point. The older kids, are having the tendon problem or the muscle problem because that's -- David Marshall: That's correct. Casey Bass: Is that growth plate problem coming from overuse or incorrect use? David Marshall: Both. Overused injury basically, is too much too soon. Too much throwing, too many pitches, too much hitting, too much running. Any tissue whether it's a muscle, a tendon, a cartilage growth plate or a bone has a threshold failure. You can have that most perfect technique known. But there is always, going to be some threshold where that tissue fails and that becomes injured. So the kids that have poor techniques, that they might drop their arm, that might open up too soon or throw all arm. Then those kids are going to have an injury resulting, a lot sooner than the kid with better technique. Casey Bass: So how do you know that it's not just regular soreness in an arm or it's just not a kid, who is worked out and he is a little sored, but it's actually a problem? How do you know that? David Marshall: Yeah, that's a tough one. When I talk to coaches and I give lectures to little league baseball programs, it is never normal for a young athlete to have pain, at the elbow, their shoulder or anywhere else. I tell them pain is your body wave, saying, there's something wrong. That means, a tissue down they are starting to fail. Now there are some kids that have a very low pain threshold, that they may step on a rock or they may bump their arm and they're in pain, where you got these other kids that might have a much higher level of pain tolerance. So their injuries are going to go on longer and longer before, somebody knows about it. Sometimes kids won't want to see the doctor, they won't get evaluated, because they have pain but they'll get evaluated when it's start to effect performance. They no longer that zip on the fast ball, they start to loose control and they're not able to strike anybody out. That's when the parents say, Hey! There is something wrong? Does your elbow hurt? Yeah, it's been hurting for 3-4 weeks. Well, let's go see somebody. And I think it's that type of scenario, that we're trying to avoid through, educating these coaches, the parents, and of course, the kids. Casey Bass: And it's not like any other injury, if you catch it early enough, it's easier to treat. David Marshall: Usually it is. Now fracture, well those unavoidable single event broken bone, ruptured tendon, concussions. You can't prevent those and those kind of fall out of the context of overuse or too much too, soon. Overuse injuries are preventable. Casey Bass: So how do you treat the growth plate injury in an arm? David Marshall: Well, when a kid starts complaining of elbow pain and they say, yes it hurts over here, by the inner part of my elbow when I throw. To me, if they're under 14, that's a growth plate injury to approve it, otherwise and I think any young athlete with elbow pain needs to be evaluated. And the first thing you do, is a good physical exam. If they hurt over the growth plate, then definitely you X-Ray it. And you can see specific changes, on their X-Ray in the growth plate. Casey Bass: And is that treatable condition with therapy at eyes or is that something that you have to operate? How do you get better, from the growth point injury? David Marshall: Hopefully, you don't have to operate. It all depends on how far, that growth plate separates. If that growth plate pulls apart, yeah, there's different parameters, but I use 9 millimeters which isn't very far. If it separates 9 millimeters from the main bone, then that's an indication for surgical referral, where the surgeons will have to put a pin in it, to get that growth plate to get back to the mother bone. If it's less, than that, then we typically treat them with rest and sometimes casting. A sling may help or just say you can't throw for 3 to 4 to 6 weeks while the glue dries. While that growth plate heals. Casey Bass: When a kid originally, injures his growth plate from let's just to say overuse. It doesn't automatically, move to 9 millimeters. Does it get bigger over time? David Marshall: It certainly can. Most of the time the growth plate injuries are just irritations of that growth plate that they haven't separated. If it's separates, we call than an avulsion. If it's just irritate, it mean the X-rays are normal, but they still have pain over that attachment side, we call that Apophysitis or an inflammation of that great plate. Casey Bass: So if you catch it early enough, you can maybe keep it from getting into that point, where you have to X-ray. David Marshall: Yes. It's a growth -- Grade 1 injuries can become Grade 2s. Grade 2s can become Grade 3 and Grade 3, can become Grade 4's, if not taking care of. Casey Bass: So first and foremost, good form, don't throw too much, try to stay away from overuse and if you do have an injury get it to a doctors as quick as possible. David Marshall: Let somebody know right away, if your elbow or your shoulder starts hurting. Casey Bass: Alright, Dr. Marshall, thank you so much. We really appreciate it. David Marshall: my pleasure. Casey Bass: As it is going to do it for us, today. We really appreciate you joining us. And we'll see you right back here, tomorrow for another great addition of Clubhouse GAS.