Professional and Amateur Pitchers’ Perspective on the Ulnar Collateral Ligament Injury Risk

BACKGROUND: Medial ulnar collateral ligament (UCL) injury is increasingly prevalent in professional baseball pitchers, and significant research has been devoted to understanding the risk factors and prevention strategies associated with it. To date, no study has investigated what the players themselves believe causes and prevents the injury. PURPOSE: To evaluate the opinions of UCL injuries among pitchers, including professional athletes. STUDY DESIGN: Cross-sectional study. METHODS: A total of 214 baseball pitchers (45 high school/college, 169 Major League Baseball [MLB]/Minor League Baseball) completed a 52-item questionnaire designed to evaluate their opinions on the cause of UCL injuries, injury prevention, and Tommy John surgery. Overall, 51 of the 214 pitchers had previously experienced a UCL injury. The frequency of the selection of each answer option was measured. Additionally, chi-square tests were used to compare (1) responses between professional and nonprofessional pitchers and (2) responses between pitchers with and without a previous UCL injury. RESULTS: Only 45% of pitchers thought that UCL injuries are avoidable in MLB. Additionally, 55% of pitchers with a UCL injury had a history of elbow injuries as an adolescent/child, compared with 18% in the uninjured group (P < .0001). Also, 72% of all surveyed pitchers agreed that fatigue over the course of a season increases the risk of UCL injuries, and the majority of pitchers agreed that inadequate rest from throwing both during the off-season (61%) and the season (59%) increases the risk of UCL injuries. Moreover, 59% of pitchers believed that a 6-man starting rotation would decrease the incidence of UCL injuries. Professional and nonprofessional pitchers significantly differed (P = .005) in the type of pitch most prone to causing UCL injuries. CONCLUSION: Pitchers with a previous childhood elbow injury had a significantly higher incidence of UCL injuries during their adult career, suggesting possible predisposition to UCL injury and warranting further research. Fatigue and inadequate rest were of greatest concern among all pitchers for an increased risk of UCL injuries. Understanding and acknowledging the opinions that players have regarding UCL injuries are important to improve UCL education, prevention, and treatment.