by Herb McReynolds, MD
(This article appeared in the Spring 1992 issue of HardBall Magazine.)
In past columns we have dealt with the notion that MSBL baseball can be a painful proposition. We have stressed injury prevention, as well as covering aspects of basic treatment. Recently, a series of unforeseen and rare injuries has been brought to our attention: spontaneous fractures of the upper arm bone (humerus). A spontaneous (stress) fracture is one that occurs without external trauma, but as a result of the forces exerted by the muscles themselves.
Dr. Clyde Partin and his team at Emory University presented a study that reviewed 12 cases of spiral fractures of the humerus in pitchers over the age of 30. Most were MSBL players, and one fracture occurred during the 1990 MSBL World Series. Since the study, another dozen such fractures have been reported to Dr. Partin.
We believe these findings deserve comment. The study found all players to have several traits in common: they were all 30 or older; none had regular off-season workout regimens; most had not played baseball in some time; most threw very little in between games.
Pain was not necessarily an indicator. Some had pain for awhile, some recently, and several felt pain only on the pitch immediately prior to the fracture. This suggests that there may have been some chronic process (arthritis, osteoporosis) at work before the acute event.
The type of pitch being thrown (fastball, slider, curve) is apparently not significant.
Essentially, what we're seeing is a series of stress fractures of the humerus in poorly conditioned, older athletes. Gentlemen, Dr. Partin and crew are telling us what we already know: proper preparation and prevention coupled with routine maintenance of the body minimizes injuries and enhances performance.
If you experience pain in the shoulder and/or upper arm that persists in spite of rest, or pain that occurs suddenly, stop throwing! Have your arm evaluated by an orthopedic physician, preferably one involved in sports medicine. If you experience a baseball-related fracture of the humerus, make sure it is fully evaluated as to the underlying cause.
If it is a pitching-related fracture, rehabilitate your arm and condition your body properly. Let's learn from the experience of these unfortunate players. Work out regularly, even in the off-season; arrange a regular throwing program and adhere to it; and when the body speaks, LISTEN!
In our next column, we'll present a program for you to put and keep your arm in shape.
ASK THE DOC:
Q: How much and what type of fluids should I drink to prevent heat stroke during our summer ballgames?
A: The body loses heat through conduction, convection and evaporation. As ambient (outside) temperature nears or exceeds body temperature, only evaporation will cause cooling. Sweat is the fluid necessary for evaporation, and lowering of skin temperature. If the air humidity is high, this system becomes less efficient. The body's cooling system is controlled by a thermoregulatory system in the brain. If this system malfunctions, overheating (hyperthermia) occurs.
Hyperthermia, though more common in summer, can occur any time there is a breakdown of the thermoregulatory system. Proper attention to hydrational status is important during any athletic event any time of the year.
Bodily dehydration is the major cause of hyperthermia and thermoregulatory malfunction in athletes. Medications and drugs (such as alcohol) are other causes. Combinations can be disastrous. Heat illnesses fall into three categories: heat cramps, heat exhaustion, and heatstroke.
Heat cramps occur at normal body temperature. The muscles are involved and profuse sweating occurs. These types of cramps are common in men who work outside in extreme heat. Often, men suffering from heat cramps report that they have been drinking fluids in large amounts, but the fluids they have been drinking are usually found to be electrolyte (sodium, potassium) deficient. Electrolyte imbalance seems to potentiate heat cramps. Treatment: rest in a cool place and drink any good electrolyte solution (Gatorade, Super Socco, etc.)
More common to my MSBL experience is heat exhaustion. This presents with weakness, dizziness and nausea. Body temperature may be slightly elevated. Players with heat exhaustion may be somewhat dehydrated, but still able to perspire. Treatment is more aggressive. The player should be moved to a cool place, to rest. Heavy clothing should be removed, and oral fluid replacement begun. If a teammate complains of these symptoms, do not allow him to continue to play. Stop the game if necessary to begin treatment.
Rarely seen, heatstroke is life threatening. Body temperature is usually above 104 degrees. Onset of exertional heatstroke can be sudden, especially in hot and humid conditions which diminish the effectiveness of all three of the body's cooling mechanisms. In heatstroke, the skin is usually dry because the blood flow to the skin is reduced due to dehydration and decreased blood volume within the cardiovascular system. The victim will be very hot and mental function may be impaired to a level of coma. Effects on internal organs are complicated and catastrophic.
Immediate on-the-field treatment should be as for heat exhaustion plus the placement of ice packs in the armpits and groin. The victim can be covered with cold wet sheets and fans can be used. He can be submerged in an ice water bath. He should be transported to a hospital immediately for more extensive treatment.
Heat illnesses, like many athletic injuries and physical insults, can be prevented or minimized. How much fluid should we consume before and while playing ball? There haven't been any fluid loss studies of baseball players during games, but people on treadmills have been shown to lose about 600 cc of body fluids per hour. Runners lose between 1 and 3 liters per hour.
Baseball does not involve the continuous activity level of running, but during very hot games, we must lose something like 600-1000 cc's.
Experts in the field of sports medicine suggest prehydrating before a game with up to one quart and drinking one cup (8 oz. or 240 cc) every 15-30 minutes during activity. Studies show that for prevention of heat illnesses, water works as well as carbohydrate-electrolyte solutions. Nowhere is alcohol mentioned as the fluid of choice for pre- and inter-game fluid replacement. In fact, drinking alcohol does the opposite: it dehydrates.
Finally, poorly conditioned athletes are clearly much more susceptible to heat illnesses (as they are to all athletic injuries) than well conditioned ones. The older we get, the more important it is to get in shape and stay in shape, if we want to enjoy the game we love.
Dr. Herb McReynolds founded the Tucson MSBL and served as its president from 1989 to 1991. He is a former member of the MSBL National Board of Directors and was inducted into the MSBL World Series Hall of Fame in 2009.