My son started having elbow pain while pitching during a baseball game several weeks ago. It still hurts when he tries to pitch. What should he do?

Sports Medicine Specialist, Matthew Smith, MD:

Pain on the inside of the elbow can be a difficult problem for throwing athletes, especially baseball pitchers. Any pitcher who develops arm pain during a game or practice should stop throwing. If the pain does not go away within a week, or returns with pitching, he or she should seek medical attention.

Pain on the inside of the elbow can come from a number of different sources. Discomfort that develops during the late cocking or early acceleration phase of the throwing motion may be related to an injury to the ulnar collateral ligament (aka Tommy John Ligament). Pain on the inside and by the tip of the elbow that occurs at the end of the throwing motion is more likely due to bone spurs along the inside edge of the joint. Lastly, excessive soreness that is associated with numbness or tingling in the ring and small finger may be related to irritation of the ulnar nerve (the "funny bone" nerve).

The initial treatment for each of these problems is rest from throwing and physical therapy to improve upper extremity strength and endurance. If pain recurs after several months of rest and physical therapy, surgery may be necessary to treat one or all of the sources of pain. Surgery for isolated bone spurs on the edge of the joint can usually be done arthroscopically through small incisions. A longer incision on the inside of the elbow is used to treat ulnar nerve irritation or to reconstruct the Tommy John ligament. A Tommy John ligament reconstruction has an 85-90% success rate in getting throwers back to the same level of play. However it takes about one year of rehabilitation for pitchers to return to competition.

To protect the shoulder and elbow from injury in young baseball pitchers, a few simple guidelines have been developed by the USA Baseball Medical and Safety Advisory Committee. Pitch counts should be limited to 50 pitches per game/day in 9-10 year-olds and 75 pitches per game/day in 11-14 year-olds. Players should not play in multiple leagues or for more than one team in the same season and should avoid pitching in showcases. Players should take at least three months per year off from throwing and other overhead sports.

What is hip preservation surgery and when is it needed?

Joint Preservation, Replacement and Resurfacing Surgeon, Ryan Nunley, MD:

Pain in the groin region, especially with prolonged sitting or driving in a car, may be the earliest sign of a progressive hip problem resulting from a labral tear or hip impingement. If left untreated, this could lead to hip arthritis at a young age. Recent advances in the understanding of groin pain now allow us to accurately evaluate and treat patients before they develop hip arthritis. We now have minimally invasive surgical procedures to slow down and possibly prevent the development of arthritis. While not all groin pain needs evaluation, people with recurrent groin pain may benefit from an evaluation by a dedicated hip specialist.

I have bunions, but my feet don't hurt. My sister says that I should have them fixed before they become worse. Is this true?

Foot and Ankle Surgeon, Sandra Klein, MD:
Many people have bunions, but not all bunions are painful. A bunion is more than a "bump" on the side of your foot. It is actually a deformity of the great toe that frequently runs in families. If bunions run in your family, you may be predisposed to developing a bunion over time. Bunions range from mild to severe and are most common in populations of people who wear shoes.

In fact, shoe wear plays a significant role in the development of a bunion deformity. Bunions can worsen over time and become painful if your shoes are not an adequate width for your foot. High-heeled shoes also influence the development of a bunion by increasing pressure on the forefoot. As bunions become worse, they can become painful or the lesser toes can become painful.

Many bunions do not become painful or change over time. With appropriate shoes, bunions can remain stable and may not limit your activity level. The primary indication for surgical treatment of a bunion is pain. If you are having pain that limits your activities, you may consider surgical correction of your bunion. If yu are not having pain, there is no reason to correct a bunion today due to concerns that it may become worse in the future.

Surgical treatment for bunions usually involves an osteotomy, or a cut in a bone to realign the great toe. Sometimes multiple osteotomies are necessary to correct the deformity. The surgical treatment depends on the specific deformity causing the bunion and may vary from person to person. If hammertoe deformities of the lesser toes develop, these are often corrected at the same time. If you have foot pain related to a bunion, an orthopedic foot and ankle surgeon can provide you with a surgical evaluation.