Contractors build quality structures on solid, reinforced foundations.   Adult pitchers require solid, non-deformed pitching arms.   Therefore, parents must insure that their adolescent pitchers have solid, non-deformed adult pitching arms.

     In my master's thesis, I investigation the association between sexual maturation and physical growth and motor proficiency in males.   In my doctoral dissertation, I compared an estimate of skeletal age with chronological age when classifying adolescent males for motor proficiency norms.   Adolescent male growth and development was my primary research interest.   Therefore, because of my concurrent strong pitching interest, I always thoroughly reviewed research relating pitching and the growth and development of the adolescent male’s pitching arm.

     In the 1961 Journal of Sports Medicine, Little League Baseball, Inc. Director of Research, Creighton J. Hale, analyzed five years of medical reports that physicians submitted to the insurance company that covered 771,810 Little League baseball players.

     Director Hale reported that only two percent, or 15,444 Little League baseball players had their doctors submit insurance reports.   Pitched, batted, caught and thrown baseballs caused 65% of the injuries.   Sliding caused 10%.   Collisions, bats, falling, throwing, running and miscellaneous caused the remaining 25%.

     Director Hale concluded that participants suffered an exceptionally low injury percentage.   Therefore, Director Hale discounted parental injury concerns.   Further, Director Hale highlighted that no doctor ever reported a growth plate injury in the pitching arm.

     In the 1965 California Medicine Journal, Orthopedic Surgeon Joel E. Adams, surveyed the bi-lateral elbow X-rays of one hundred and sixty-two 9-14 year old San Bernadino, CA males of whom 80 pitched, 47 played other positions and 35 did not play baseball.   No subject suffered from elbow fractures, severe elbow infections or genetically deformed elbows.

     Dr. Adams determined that physicians must compare non-pitching elbows with pitching elbows.   Otherwise, physicians frequently incorrectly conclude that X-rays appear normal when accelerated maturation had prematurely closed pitching arm growth plates.

     Dr. Adams found that 95% of the eighty 9-14 year old pitchers had premature medial epicondyle growth plate closure and humeral growth plate separation, 15% suffered medial epicondyle fragmentation and 8.6% suffered osteochondritis (cartilage inflammation) on their capitular and radial head’s articular surfaces.   48.8% of the forty-seven 9-14 year old non-pitchers also suffered from premature medial epicondyle growth plate closure and humeral growth plate separation, 12.8% had medial epicondyle fragmentation and 5.7% suffered osteochondritis on their capitular and redial head's articular surfaces.   Lastly, 7.5% of the thirty-five 9-14 year old non-baseball players had premature medial epicondyle growth plate closure and humeral growth plate diaphysial separation.

                                          |---------------------------------------------|
                                          |  Baseball   |   Baseball    | Non-Baseball  |
                                          |  Pitchers   | Non-Pitchers  |    Players    |
|---------------------------------------------------------------------------------------|
|  Premature Medial Epicondyle Growth     |             |               |               |
|  Plate Closure and Separation           |    95.0%    |     48.8%     |     7.5%      |
|---------------------------------------------------------------------------------------|
|  Medial Epicondyle Fragmentation        |    15.0%    |     12.8%     |     0.0%      |
|---------------------------------------------------------------------------------------|
|  Capitular/Radial Head Osteochondritis  |    08.6%    |     05.7%     |     0.0%      |
|---------------------------------------------------------------------------------------|

     Dr. Adams provided X-rays and case histories of five 12 and 13 year old pitchers with medial epicondyle injuries.

     Case 1:   A 12 year old pitcher with one year of pitching experience complained of elbow soreness.   Dr. Adams found that the growth plate in his pitching elbow’s medial epicondyle had prematurely closed and his humeral growth plate had slightly separated.

     The arrow points to the medial epicondyle of the pitching elbow.   The muscles that attach to the medial epicondyle exerted greater traction stresses than the growth plate could withstand.   Consequently, the medial epicondyle growth plate separated from its humeral connection.

     The medial epicondyle growth plate shows very clearly open.   The capitular growth plate shows very clearly open.   The radial head growth plate shows very clearly open.   The lateral epicondyle ossification center has not yet appeared.   This X-ray indicates an 11 year old male.   Therefore, this 12 year old pitcher was a one year delayed maturer.

     Case 2:   A 13 year old pitcher with two years of pitching experience admitted that he kept his elbow pain secret.   However, during Pony League try-outs, sufficient swelling and tenderness developed over his medial epicondyle that he had to seek medical advice.   (Pony League baseball includes 13-15 year olds.)   Dr. Adams found that the medial epicondyle growth plate of his pitching arm had prematurely closed and showed increased bone density.

     Case 3:   A 13 year old pitcher with four years of pitching experience acknowledged previous elbow soreness.   However, during Pony League try-outs, he experienced severe elbow pain.   Physical examination located soreness over the medial epicondyle.   Dr. Adams found that the medial epicondyle growth plate of his pitching arm had prematurely closed and showed dissecans fragmentation (Cartilage incompletely separates from underlying bone).

     The arrow points to the medial epicondyle growth plate.   The muscles that attach to the medial epicondyle exerted greater traction stress than the growth plate could withstand.   As a consequently, the medial epicondyle growth plate completely tore away from its humeral connection.

     The medial epicondyle growth plate appears mature size and its growth plate only shows faintly open.   The capitular growth plate has almost disappeared.   The radial head growth plate shows open.   The lateral epicondyle growth plate appears mature size with a slight opening at proximal end of the growth plate.   This X-ray indicates a 13 year old.   Therefore, this 13 year old pitcher had equated maturation.

     Case 4:   A 12 year old pitcher with two years of pitching experience complained of elbow pain.   Dr. Adams found that medial epicondyle growth plate of his pitching arm had prematurely closed and showed avulsion fragmentation (Cartilage completely tears away from the underlying bone).

     Case 5:   During a Pony League game, a 13 year old pitcher with four years of pitching experience felt his elbow snap.   Dr. Adams found that the medial epicondyle growth plate of his pitching arm had prematurely closed and showed a complete transverse fracture.

     The arrow points to the medial epicondyle growth plate.   The muscles that attach to the medial epicondyle exerted greater traction stresses than the growth plate could withstand.   Consequently, the medial epicondyle fractured.

     The capitular growth plate has almost disappeared.   The radial head growth plate shows open.   The lateral epicondyle growth plate appears mature size with some opening at its proximal end.   This X-ray indicates a 13 year old.   Therefore, this 13 year old pitcher has equated maturation.

     Irreparable medial epicondyle injuries devastate adolescent pitchers.   However, medial epicondyle growth and development deformations cause another devastating injury.   The posterior aspect of the medial epicondyle forms the canal through which the ulnar nerve travels.   The ulnar nerve sensitizes the skin of the little finger and the lateral one-half of the ring finger and innervates intrinsic hand muscles.   When bumped, the ulnar nerve sends tingling sensations down the forearm to the little finger.   People call this ulnar nerve location, their ‘crazy bone’.

     Medial epicondyle separations, fractures or avulsions alter the ulnar nerve canal.   Consequently, irregularly formed ulnar canals aggravate ulnar nerves.

     Dr. Adams also provided X-rays and case histories of six pitchers with osteochondritis (cartilage inflammation) on the articulating surface between the capitulum and radial head During pitching arm decelerations, the weight of pitchers’ forearms, wrists, hands and fingers pulls the radius bone away from their humerus bone.   Then, during pitching arm recovery, their radial heads elastically slam back against their humeral capitular surface.   Therefore, the growth plates of the radial head and the capitulum are ‘rebound collision’ growth plates.

     Case 1:   During physical examination, a 9 year old male with one year of pitching experience denied that he felt any elbow pain during or after pitching.   Nevertheless, Dr. Adams found that the articular surface of his capitular growth plate had a lesion (pathological tissue change).

     Case 2:   A 13 year old pitcher with five years of pitching experience suffered elbow pain during Pony League games, but he waited until after the season to seek medical attention for pronounced tenderness over his radio-humeral joint.   Dr. Adams found that the capitular growth plate of his humerus had prematurely closed and showed a large osteochondritis area.

     Case 3:   A 13 year old pitcher with four years of pitching experience stopped pitching.   Three years later, he suffered from severe pain and an inability to completely straighten his pitching elbow.   He had pronounced soreness over the radio-humeral joint.   Dr. Adams found that the medial epicondyle growth plate of his pitching arm had prematurely closed, the capitular growth plate showed cartilage erosion, his radial head had enlarged and his elbow had lost thirty degree of its elbow extension range of motion.

     Case 4:   A 12 year old with three years of pitching experience suffered from severe elbow pain during playoffs.   Dr. Adams recommended that he stop pitching until the growth plates in his pitching arm closed.   However, his parents, coaches and he disregarded the advice and, during Pony League try-outs, his elbow pain increased.   X-rays determined that his pitching elbow had radial head osteochondritis.   After two years of complete rest, additional X-rays showed his radial head had permanently deformed.

     Case 5:   An adolescent pitcher with three years of pitching experience stopped pitching when he could no longer completely straighten his pitching elbow.   He had pronounced tenderness over his radio-humeral joint.   Dr. Adams found that the radial head growth plate of his pitching arm had prematurely closed, his humeral capitulum showed a large area of cartilage erosion and his humeral capitulum showed loose articular cartilage fragments.   Dr. Adams exfoliated (stripped layers away) the eroded capitular articular surface cartilage and removed several loose cartilage fragments.   However, his parents would not permit Dr. Adams to remove the deformed radial head.

     Case 6:   Severe elbow pain forced a 15 year old pitcher with three years of pitching experience to stop pitching.   When his elbow became quite painful and he could no longer completely straighten it, he sought medical attention.   Dr. Adams found that his radial head growth plate had deformed and his humeral capitular growth plate showed an osteochondritic lesion.   The patient refused corrective surgery.   However, at 19 years old, he returned with elbow ‘locking’.   Dr. Adams found that his loose cartilage fragments had calcified such that Dr. Adams had to remove the calcified fragments and his the entire head of his radius bone.   Finally, the patient had no elbow pain and, in non-strenuous activities, he regained functional use of this elbow.

     In the 1966 California Medicine Journal, Orthopedic Surgeon Joel E. Adams M.D., reported on five 13-15 year old pitchers with shoulder pain.

     The growth plate of the humeral head unites with the growth plate of the greater tuberosity several years before the combined growth plate of the humeral head and greater tuberosity unites with the proximal humeral shaft.   The supraspinatus, infraspinatus and teres minor muscles attach to the humeral greater tuberosity.   Therefore, during baseball pitching deceleration, the greater tuberosity growth plate is a ‘traction’ epiphysis.

     Case 1:   A 13 year old pitcher with one year of pitching experience and considerable home practice experienced severe shoulder pain when he tried out for Pony League.   After three months of complete rest, he started pitching again and again felt discomfort when he threw hard.   Dr. Adams found that the combined humeral head and greater tuberosity growth plate had prematurely closed.   Dr. Adams advised waiting until the growth plates of his pitching arm completely closed before he resumed pitching.

     Case 2:   A 15 year old pitcher with six years of pitching experience suffered from increasing shoulder pain that forced him to stop pitching and seek medical attention.   Dr. Adams found that the combined humeral head and greater tuberosity growth plate had demineralized and had slightly widened.   Dr. Adams advised waiting until the growth plates of his pitching arm completely closes before he resumed pitching.

     Case 3:   A 13 year old pitcher with one year of pitching experience suffered severe shoulder pain after trying out for Pony League and sought medical attention.   While Dr. Adams examination found pain-free complete range of movement in his pitching shoulder, to firm digital pressure and some pitching arm pull pain, the young man complained of slight tenderness in proximal humerus.   Dr. Adams found that the combined humeral head and greater tuberosity growth plate had severely demineralized and widened.   Dr. Adams advised waiting until the growth plates of his pitching arm completely closes before he resumed pitching.

     Case 4:   A 14 year old pitcher with five years of pitching experience suffered gradually increasing shoulder pain.   Dr. Adams found that the combined head and greater tuberosity growth plate had widened and fragmented.   Several months of complete rest reduced the shoulder pain and his X-rays returned to normal.   Dr. Adams advised waiting until the growth plates of his pitching arm completely closes before he resumed pitching.

     Case 5:   A 15 year old pitcher with five years of pitching experience suffered gradually increasing pain in the back of his shoulder during the deceleration phase of the pitching motion.   Finally, he stopped throwing and sought medical attention.   When Dr. Adams applied firm digital pressure, the young man complained of proximal humeral and postero-inferior glenoid pain.   Dr. Adams found that the combined humeral head and greater tuberosity growth plate had widened, deformed and demineralized and his glenoid fossa’s postero-inferior margin showed an abnormal bony growth.   (The triceps brachii’s long head arises from the glenoid fossa’s postero-inferior margin.)   Complete rest reduced his pain.   Dr. Adams advised that this young man never pitch again.

     Complete rest usually remedies shoulder pain.   Consequently, pitchers do not seek medical attention.   Therefore, the medical literature does not accurately reflect shoulder growth plate injuries.

     For many years, researchers have studied the effects of pitching on adolescent pitching arms.   Unfortunately, few parents know of this research.   Therefore, I am including a list of research articles that parents should locate, copy and read.   Parents must determine for themselves whether and/or how much they want their adolescent pitchers to pitch.   I stopped collecting these articles several years ago.   Therefore, to have your libraries up-to-date, parents will have to search through the research periodicals that I cite for more recent information.