»» Thank you so much. Good afternoon. I have no disclosures. It's not going to the next slide for me. Yes, thank you. I have no disclosures. So in baseball, there really is a high rate of incidents of elbow and shoulder injuries, especially at the elite level where there's beginning to be more and more elbow injuries. Recent data has showed us that more than 25% of Major League Baseball pitchers have actually undergone UCL reconstruction. And we look at this history and we wonder, you know, is a history of Little League elbow or Little League shoulder, does this actually increase the risk for future surgery or does it limit the duration of a player's career? So Little League elbow and Little League shoulder are very common injuries in the pediatric sports population with the throwing motion causing damage to the medial epicondyle hypothesis and the proximal humeral physis. And normally we think that the prognosis of Little League elbow and Little League shoulder is good because there's very few patients that actually require surgery and they return to sport very quickly. But really there's minimal recent data on short-term follow-up and there's really a complete lack of mid to long-term follow-up on these patients. So really the purpose of this study was to examine these mid to long-term outcomes of patients diagnosed with Little League elbow and Little League shoulder who were treated with non-operative management and follow them into their high school and even college careers. So we had a retrospective cohort and we had 61 patients and we included patients diagnosed in tertiary referral centers with Little League elbow or Little League shoulder between the years of 2013 and 2017 with an injury that occurred while playing Little League baseball or softball. And we excluded any patients that had any other bony abnormalities like osteochondral defects or fractures and we also excluded any patients with imaging findings consistent with a ligamentous injury. We performed a standardized phone questionnaire for all these patients and asked baseball specific questions for them. And we also had patient reported outcomes such as the quick dash, the ACES, the SANE, the KJOC and the PASS for these patients. At our institution for Little League elbow and Little League shoulder we apply a standardized regimen for all patients. They are advised to stop throwing for six weeks and all patients with fragmentation like we can see here, all patients at our facility are placed in a cast for three weeks. Then after this they complete an advanced throw-as-ten program with posterior shoulder stretches included and then they're offered physical therapy if wanted. The athletes are then advised to discontinue playing pitcher or catcher for the year after their diagnosis. We had 61 patients of those 44 had Little League elbow and 17 had Little League shoulder with 60 being male, 1 being female. The mean age at their initial diagnosis was 13 years with the mean follow-up about five years later. All of our patients, 80% reported being year-round baseball players. After the diagnosis, 82% of the patients reported that they did reduce their throwing with almost 79% reporting that they did stop throwing altogether for a time. 69% of them reported attending physical therapy with almost about 26% of our patients saying that they changed positions after they received their diagnosis. In terms of the recurrence of the symptoms of these patients, 26% of our patients have recurrence at an average of 8.8 months. These recurrences were not associated with laterality, with attendance of physical therapy, changing positions, duration of their throwing cessation, the age, or being a year-round baseball player. But those without symptom recurrence were more likely to continue playing baseball. There's also no difference in the recurrence between patients with Little League elbow and Little League shoulder. Five years afterward, their diagnosis at follow-up, many were still involved in recreational sports, but almost 46% reported they were no longer playing baseball. Of that 46%, 39% of them listed pain as one of the reasons why they had quit, while many listed going to college, loss of enjoyment of the sport, or different hobbies. One of our 61 patients did ultimately undergo surgery. They were a patient with Little League shoulder and underwent a labral repair. But none of our patients with Little League elbow ultimately required surgery in our time. The patient-reported scores were not statistically significantly different from Little League elbow to Little League shoulder, with outcomes being very good, with a quick dash of 1.7 versus 1.1, an ACES of 96.7 versus 93.1, and a KJOC for those that were still involved in playing the sport of 89.4 and 93. This retrospective study obviously introduces recall bias. And as Sammy already mentioned, it's very difficult following up with patients when they're transitioning from high school to college. It's difficult to follow up with them. And this relatively small sample size limits our ability to risk stratify. In conclusion, patients diagnosed with Little League elbow or Little League shoulder rarely require operative treatment in this five-year window. We saw that there was a 26% recurrence of these injuries. And recurrence of symptoms were not associated with whether the patient was playing year-round, changing positions, or attending physical therapy. And patients who did experience a recurrence of symptoms were significantly less likely to remain active in baseball at five years. Thank you. �

elbow injuries

shoulder injuries

baseball players

Little League elbow

Little League shoulder