In a suburban St. Louis operating room Monday, orthopedic surgeon Dr. George Paletta worked to repair the right elbow of St. Louis Cardinals’ ace pitcher Adam Wainwright. The season-ending operation is called Tommy John surgery, after the Los Angeles Dodgers pitcher who was the first professional athlete to successfully undergo the procedure in 1974.

The odds of a Hinsdale Little League pitcher becoming the next Adam Wainwright are small, but the chances they could develop a problem like Wainwright’s or some other serious arm injury are greater.

“I see a young player with tendonitis in his shoulder and then by high school or college it is a tear in his rotator cuff,” says Dr. Ken Schiffman of Hinsdale Orthopaedics. “Eventually, he ends up with rotator cuff surgery and later in life, he may require a shoulder replacement.”

The league is taking steps to try to minimize the risk of injury to its players and will provide information on injury prevention during a 7 p.m. seminar Monday, March 7 at Hinsdale Community House, 415 W. Eighth St. Schiffman will be one of the featured speakers, along with Hinsdale Central High School athletic trainer Ted Hirschfeld and Rich Simon, director of the Hinsdale Little League.

Schiffman says it’s important for young pitchers to make sure they are using their whole body in their pitching motion and not just their arms.

“The Little League has an excellent group of coaches,” he notes. “Parents of kids that are interested in pitching should make sure the kids are getting the attention of a pitching coach to make sure their mechanics are correct.”

Incorrect mechanics can lead to injury.

“They can actually damage the cartilage surface of the ball part of the shoulder,” Schiffman explains.

Elbows also at risk

Elbow problems also are common, Schiffman says, including a condition called osteochondritis dissecans.

“When that occurs, that also can potentially lead to damage of the cartilage surface,” he adds.

In some cases, according to the Mayo Clinic, a fragment of cartilage can come loose from the end of a bone and get jammed between the moving part of the joint, requiring surgery.

One of Dr. Schiffman’s patients who knows all about elbow problems is 14-year-old Grant Pitcher. The eighth-grader hopes to play high school baseball next year at Hinsdale Central.

“I’ve been playing baseball since I was in kindergarten,” he says. “I started pitching when I was in second grade. I’ve been pitching ever since.”

Two years ago, the aptly-named Pitcher noticed something was not quite right with his right elbow.

“First, I thought it was tendonitis,” he recalls. “It was painful. Then a bump started to develop and my arm couldn’t straighten out all the way because of the bump.”

Schiffman says parents need to take any reports of pain by their children seriously.

“It’s as simple as it sounds. Pain is the hallmark,” he says. “When kids are complaining of pain, there’s usually a good reason for it.”

Pitcher’s parents did take the matter seriously and brought him to see Dr. Schiffman. Fortunately, the condition didn’t require the sort of serious surgery Wainwright had. Tommy John surgery involves replacing a damaged ulnar collateral ligament (UCL) with a tendon from elsewhere in the body. According to Dr. Glenn Fleisig, research director of the American Sports Medicine Institute, UCL damage can occur from repetitive throwing.

Limiting pitches

In 2009, Wainwright started 34 games and pitched 233 innings, more than anyone else in the National League. In 2010, he started 33 games and threw 230 innings. He won 20 of those games, earning him runner-up honors in the Cy Young voting. Although the success rate for Tommy John surgery is fairly high, the future of his career is now uncertain.

The February issue of the American Journal of Sports Medicine contained the results of a study which followed 481 pitchers for 10 years. The study found that young pitchers who throw more than 100 innings in a year were 3.5 times more likely to be injured than fellow players who pitched less.

The Hinsdale Little League is going beyond placing restrictions on the number of innings a pitcher can throw by instituting firm limits on pitch counts.

“All coaches will be required to properly document pitch count and it will be closely monitored,” says Simon, the league director. “For example, a pitcher age 14 and under is only allowed 66 pitches a day and then four calendar days of rest must be observed. A pitcher under age 8 is only limited to 50 pitches and two innings a game.”

Problem not limited to pitchers

Arm problems can occur for any player who is throwing too much or too hard. Take, for example, the case of Peter Pigatti, a Hinsdale Little League catcher.

“About this time last year, he had a growth plate injury and literally could not throw a baseball if he had to,” recalls his dad, Tony Pigatti. “It was a classic case of just too much use of the arm while growing.”

“I guess I just was throwing too much, too hard,” says Peter, who will soon turn 12. “The doctor said I dislocated a growth plate in my elbow.”

He says the injury occurred near the end of a practice when he was throwing the ball to second base.

“One throw, I tried to throw my hardest,” he remembers. “It felt like I got stabbed in my arm, in my elbow.”

A trip to the doctor and an X-ray confirmed the injury.

“He said it was because I was probably throwing too hard and overusing my arm,” Peter says.

“My son played 80 games of baseball last year,” Tony notes. “Obviously, that’s crazy. … It’s just too much.”

He estimates Peter caught 350 innings in those games.

The doctor’s prescription for the problem was simple: rest.

“I sat out a few weeks,” Peter says. “I had my arm in a sling.”

Tony, who was a Little League coach last year, is hoping the seminar will cover topics like the appropriate amount of time kids can play catch and exercises that can strengthen young arms.

Strength and conditioning key

Dr. Schiffman says kids that “don’t have the overall body conditioning and core strength are more prone to injury.”

“We are already doing strengthening exercises and watching pitch count for high school players,” says Hirschfeld, the Hinsdale Central trainer. “But we can’t control the amount of pitching that is going on outside of school practices and games. Parents also need to be involved if they want to protect their children from injuries and from shoulder problems that may not show up until adulthood.”

Hirschfeld says young athletes need to realize they have to give their bodies a break now and then.

“It can become a problem if they don’t listen to the body and take care of things,” he says. “You have to find a balance.”

Schiffman says even if only one player in 1,000 suffers a serious arm injury, that number is one too many.

“We’re going to try to make sure we keep prevention at the forefront of this,” he says.

“We parents seek out opportunities for our kids. We want our kids to succeed. These kids are performing at a higher and higher level. … It’s important that these simple preventive techniques become known.”

Call (630) 887-0278 to register for the seminar. For more information on shoulder injuries, visit Schiffman's website.

“To me, it’s like concussions,” says Tony Pigatti. “You can prevent a lot of this stuff just by better educating the parents and coaches.”

Adds Hirschfeld: “I think the bottom line is … using some common sense, realizing that the same stresses cannot be put on the kids that you see at the levels where people are doing this for a living.”

People like Adam Wainwright. By all accounts, his surgery went well, and the Cardinals hope he will return to the mound next year. But everyone wishes the injury could have been prevented in the first place.