Youth Baseball Pitcher Eval: What basics do I include? What differences are their between older & younger pitching injuries?

I recently evaluated a youth baseball pitcher who was referred to me from another patient I treated.  His original dx was muscle strain of shoulder.  Now before going into the evaluation I performed, lets talk about what ideally should be included at a minimum for a youth baseball pitcher.  

-  Differential Dx:  Youth pitchers don't get torn cuffs or SLAPs as often as older pitchers.  Instead x-rays are almost a must to differentiate Little League shoulder and other growth plate injuries.  

-  Pitcher:  How many pitches per game? How many innings per game/season? How many teams are they playing on? What is their specialty pitch? What kind of pitches do they throw each game?  What kind of thrower are they- where is their arm slot? 3/4s, etc, Has their velocity increased or has their throwing mechanics changed recently?

- When do they have pain? First pitch or after many?  Pain at rest?  Past injuries at shoulder or elbow?  Does their velocity drop significantly?  

-  Who is the coach/pitching coach?  

- Objective:  Shoulder ROM (GIRD?), Muscle imbalances (strength, stiffness), Lower extremity & core assessments, if appropriate- look at their pitching mechanics, special tests, laxity (bilateral?)- remember some laxity is normal, cardiovascular endurance

** The above is not any specific order **

What else do you include in your youth pitchers evaluations?  

- Brian

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