Early MRIs May Predict MLB Pitching Injuries

Elbow injuries in Major League Baseball (MLB) pitchers continue to be of concern in the bullpen, leading to costly surgery and rehabilitation and time on the bench.

To improve preventive measures, Nikhil N. Verma, M.D. an orthopedic surgeon with Midwest Orthopaedics at Rush and Rush University Medical Center in Chicago and his colleagues studied (“Magnetic Resonance Imaging Findings of the Asymptomatic Elbow Predict Injuries and Surgery in Major League Baseball Pitchers”) the link between subclinical MRI findings in asymptomatic elbows of MLB players and later placement on the disabled list (DL) or future surgeries.

Their findings were discussed at the recently concluded American Academy of Orthopaedic Surgeons Annual Meeting in Las Vegas, Nevada.

In this cohort study, the “MRI elbow scans of professional-level baseball pitchers that were taken during routine pre-signing medical screens between 2005 and 2017 were retrospectively reviewed.” All MRI scans came from one organization and were evaluated “for the presence of chondral damage to the joint, loose bodies, ulnar collateral ligament (UCL) heterogeneity or tears, flexor pronator mass defects, and signs of posteromedial (PM) impingement.”

According to the data collected, “…41 pitchers had asymptomatic MRI findings with no prior DL placements. For players who eventually went on the DL, there were a statistically greater number of players with UCL heterogeneity (p = .021), humeral-sided partial UCL tears (p = .031), and PM impingement (p = .004) on preinjury MRI compared with players who remained healthy.”

In addition, “PM impingement was related to future elbow-related surgery (p = .003). Pitchers with UCL heterogeneity were associated with reduced career strike zone percentage, innings pitched, and fastball percentage (p < .05 for all).”

Verma and colleagues concluded that “UCL heterogeneity, PM impingement, and humeral-sided partial tears were all correlated with future DL placement for elbow-related injuries. They also suggested that asymptomatic PM impingement may be a precursor to future surgery.”

The researchers wrote, “While placement on the DL has significant economic impact on an MLB team, players needing surgical interventions are even more detrimental. The fact that PM impingement may predict the need for future surgery (majority UCL reconstruction) is highly relevant. Primary UCL reconstruction boasts very impressive results, with up to 90% returning to play and 67% resuming the original level of play.”

Adding, “Although the revision rate is low, 37% of revision reconstructions occur within 3 years of index surgery, after which there is a steep drop in performance. Ideally, an intervention should begin during the subclinical phase so that efforts may be placed toward injury prevention to avoid future surgery. Time missed because of an injury and surgery accrues high opportunity costs for the organization and may affect future contracts for the pitcher.”

While previous studies have suggested that stretching protocols can be helpful in injury prevention, the researchers recommend decreasing pitch counts and longer periods of rest as alternative methods of prevention in pitchers with these subclinical findings.

The study’s findings were also published in the Orthopaedic Journal of Sports Medicine on January 29, 2019.