I'm a second-string pitcher in the minor league hoping for a break and step up. But I've started experiencing elbow pain that the team doc thinks may be a torn ligament or at least a chronically irritated tendon. I could have surgery early and head the problem off at the pass. Or I could have a series of steroid injections to get me through until I get the boot up. What should I do?
Treatment and management decisions around elbow injuries can be difficult to second-guess. There's some evidence that early intervention helps prevent problems later on. But surgery puts you on the bench and out of the running for those upper division slots. On the other hand, the number of repetitive motions needed in practice to step up could turn a mild injury into a severe one.
There are several things to think about. Your age is one of them. Older players (late 20s, early 30s and older) are at increased risk for injury on top of injury. Combined injuries of more than one ligament, tendon, or other important soft tissue around the elbow are more common in older players and reduce the likelihood of a full return-to-play.
The severity of injury right now can also help direct your path. What can your surgeon tell you? Using your history, the clinical exam, and results of MRIs, there should be a fairly good idea of the extent of the damage you are trying to deal with. If it's mild, then rest and rehab may be all that you need to get back into action. If there's more to it than that, early surgical intervention to clean up the area and promote healing may set you back a bit but could keep you in the running.
Steroid injections provide short-term relief from pain and inflammation. But there is some evidence that it's these very injections that add to the risk of tears (and retears of repaired tears). It appears that one injection may be helpful but multiple injections are more likely to be harmful in the long-term.
Daryl C. Osbahr, MD, et al. Combined Flexor-Pronator Mass and Ulnar Collateral Ligament Injuries in the Elbows of Older Baseball Players. In The American Journal of Sports Medicine. April 2010. Vol. 38. No. 4. Pp. 733-739.
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