Saw a patient yesterday who is an Aussie pro baseballer with a contract for a major league team in the US, but injured playing minor leagues over there. Has returned home to get the problem sorted out and surprisingly it didn't sound like they set out a good management plan for him.
He has elbow pain on the medial side, with definite ulnar nerve symptoms (radiating pain, some pins & needles and hand muscle weakness). He doesn't appear to have medial ligament insufficiency but has some medial flexor origin tendinopathy.
I think he should have surgery (ulnar nerve transposition) to get rid of his ulnar nerve symptoms long-term, as his injury has temporarily stopped him in his tracks. This is not too difficult a procedure surgically and there would be a few good surgeons who could do it in Sydney (or Melbourne). I am more looking for advice from either baseballers or physios or doctors who have referred any pro baseballers off for this type of surgery in Australia. It would be a common procedure in the US, but good to know if there was a surgeon over here with some substantial baseball experience.
Being in Sydney, I was thinking possibly Jeff Hughes, Mark Perko, David Duckworth, Stuart Kirkham, but again wasn't sure if any of these surgeons had a special baseball interest. The player himself is happy to fly to Melbourne, for example, to see Greg Hoy, if it turns out this might be the best option in terms of surgical experience with baseball.
Would love it if someone can recommend specifically any of these surgeons for experience doing this surgery in high level baseball pitchers.
Whilst the ulnar neuritis certainly could be dealt with via an ulnar nerve transposition (and I'm sure the guys you mention along with Des Bokor could all do this in their sleep) in my experience, Ulnar neuritis in throwers is never an isolated event, and never the primary pathology.
I'd be making sure you sorted out the concomitant pathology. At the postero medial elbow you'd be wanting to ensure principally that he wasn't unstable (ruptured his UCL) and that his postero medial olecranon fossa wasn't being beaten up due to the instability causing the inflammation related neuritis. The ulnar nerve transposition may end up being the trivial aspect of the surgical intervention that he gets.
In my experience, the ulnar transpositions have been getting done much more rarely as this part of the problem often settles and there's a reasonable amount of morbidity associated with ulnar nerve transposition in this group. Recently I looked after a guy who had a subluxing ulnar nerve along with his UCL rupture and Frank Jobe (no less!) didn't transpose. I was certain he wasn't going to do well, and it proves what an Einstein I am that he recovered completely (his ulnar nerve still subluxes by the way).
[QUOTE=Rod Whiteley]Whilst the ulnar neuritis certainly could be dealt with via an ulnar
Hello-I know I may not be doing this correctly, but i hope you will bear with me. I am a worried mother of a 13 year old left handed boy who injured his pitching elbow 9 months ago and has had no relief with 9 months of "rest" (it's terribly difficult to get a sporty 13 year old to rest). The problem didn't get properly diagnosed for 7 months and now he is scheduled to have orthoscopy, debridement, and probably have the nerve moved May 30. He thinks that this is going to be a cure all and that he will be playing baseball next year. do you have any advice for me on this topic?:: thanks for any advice you can offer.
This info is too late for the original question, but may help in the future...Originally Posted by sydunisportsmed
Des Bokor apparently has a special interest in baseball injuries (according to the info on him on the Sydney Sports Medicine Centre website).
[QUOTE=worriedmom]Originally Posted by Rod Whiteley
I am also a worried mom, my 14 year old is a left handed pitcher who developed ulnar nerve imflamation several months ago, after many trips to the Dr.'s and an MRI he was told to rest his arm, he has not pitched in several weeks but is still bothered every now and then if he throws a ball at all or does other arm related activites. He is very frustrated and will be entering high school this fall wanting to try out for the baseball team.
I wanted to see how your son was doing, did he have the different procedures you mentioned? Look forward to hearing back from you,
[QUOTE=worriedmom]My only advice would be to pay attention to the surgeons who have looked after your son. That said, make sure you understand what they have done, and what needs to be done from here on in. Occasionally things can get a little lost in translation between the surgeon, yourself and your son, so keep asking questions (no matter how dumb you think they are) and best of luck.Originally Posted by Rod Whiteley