This is the second part of a series centering around my interview with a leading Tommy John surgeon in Japan, Dr. Kozo Furushima.

Amid all the talk of the first pitch limits in Japan’s high school baseball world, Japan’s national elementary school tournament quietly received a 70-pitch limit this year. Working with the reform-minded head of the Japan Rubber Baseball Federation, Toyomi Munakata, Furushima assisted in the drive for change in Japan’s dogma-driven baseball world.

In this part, Furushima discusses the changes to this year’s system and gets down to the nuts and bolts of Japan’s problem — endless practice among players at the youngest ages that lead to more serious injuries as players grow older.

“I’ve been studying this issue for 12 or 13 years, in different sports but mainly baseball,” Furushima said. “I’ve examined the injuries of 6,000 to 7,000 baseball players, with more than 2,000 surgeries on baseball players alone. Why is it that junior high school and high school kids have to have surgery? I was thinking that for a long time.”

In the interview, Dr. Furushima explains avulsion fractures, caused when the pull from a ligament yanks the part of the bone it is attached to free from its surrounding bone.

These medial elbow avulsion fractures, if allowed to rest, will heal naturally, he said.

“Compared to adults, kids recover more quickly,” Furushima said. “For example, if a child breaks a bone, it will heal about a week faster than that of an adult. Adult bones take a month to regrow, children take about three weeks.”

Unfortunately, with kids practicing their sports year round, the time required to rest is very difficult to get. Compounding this, he said, is that the fractures only cause pain when under extreme stress. They don’t hurt in day-to-day activities so sufferers may not even realize the need for rest and treatment.

Dr. Furushima believes that about half the kids playing youth baseball between the fifth and seventh grades may have suffered from medial elbow avulsion fractures. His facility performed a study, with coaches alert to the problem bringing in their teams for examination. Of the 406 players examined, 167 showed signs of the injury.

“We had 406 children come for tests as part of a study. They didn’t particularly want to come,” Furushima said. “Of them, 167 had a history of pain in their inner elbow, 41.1 percent. These players came with their teams, whose coaches had a good awareness of the situation. These were good teams and even then, 40 percent had a history of pain. I have to think that among the teams that would never participate, the percentage would be higher than the teams whose coaches would willingly take part.”

Although the consequences of these injuries are not overwhelming when the kids are young, as their bones become mature and more rigid, the fractures that have not healed are going to be a problem, particularly for ballplayers who have to throw hard using joints in which the ligament is loose and not properly attached to the bone.

In the MRIs below, the loose ligaments in the previously injured elbow can be seen as a squiggly line.

Find the full story on Kyodo News HERE.

The introduction to the series was posted on Feb. 17.

All graphics courtesy of Dr. Furushima, Keiyu Orthopaedic Hospital Sports Medical Center.