Participation in baseball in the USA has reached nearly 16 million participants as of 2022.1 However, with the growth in amateur baseball, there has come an associated increase in injuries from participation, specifically throwing-related injuries to the elbow and shoulder. The shoulder injury rate in baseball at the high school (HS) level is 1.39 per 10 000 athlete-exposures and the elbow injury rate is 0.86 per 10 000 athlete-exposures at the HS level, with chronic overuse injuries accounting for 40%–57% of all injuries.2 Further, previous data indicated that adolescent baseball pitchers are at a 4–36 times greater risk of sustaining a throwing injury due to overuse and fatigue compared with those pitchers who do not have a history of overuse.3 From a surgical perspective, there has been a substantial increase in ulnar collateral ligament reconstruction in the past two decades.4 Given the injury concerns, a variety of factors have contributed to this concerning trend. These include overuse and fatigue from pitch counts, sports specialisation, training methods including the use of weighted ball velocity programmes and an increase in pitching velocity.5 Due to this concerning trend, in 2024, Major League Baseball (MLB) released a 62-page report after communicating with more than 200 experts on this topic.6 Three main points included:
Zaremski et al. (Thu,) studied this question.