• Little League Elbow

    (Elbow, Little League; Medial Apophysitis; Overuse Elbow Injury Related to Throwing)

    Definition

    Little League elbow is pain in the elbow joint due to repetitive throwing. This injury occurs in young baseball pitchers before puberty.
    The Elbow Joint
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    Causes

    During this injury, the ligament attached to the inner side of the elbow begins to pull one of the growth plates away from the rest of the bone. Since the bones are still growing, the growth plates are weak and susceptible to injury. Certain types of throwing may lead to this condition, such as:
    • Throwing too hard and too often
    • Increasing the number of pitches per week too quickly
    • Throwing too many curves or sliders at a young age
    • Changing to a league where the pitcher's mound is farther away from home plate or the mound is elevated

    Risk Factors

    These factors increase your chance of developing Little League elbow. Tell your doctor if you or your child has any of these risk factors:
    • Age: 10-15 years old
    • Sex: male (more boys than girls are baseball pitchers)
    • Baseball pitching, especially throwing curve balls or sliders

    Symptoms

    Symptoms include:
    • Pain around the bony knob on the inner side of the elbow
    • Swelling (possibly)
    • Pain when throwing overhand
    • Pain with gripping or carrying heavy objects (sometimes)

    Diagnosis

    The doctor will ask about:
    • Symptoms
    • How the injury occurred
    • When the pain began
    • Any prior elbow injuries
    The doctor will also:
    • Examine the elbow for signs of ligament or bone damage
    • Find the source of the pain
    • If needed, have an x-ray or an MRI done to look for damage to the bone

    Treatment

    Treatment and recovery depend on the severity of the injury. Recovery time ranges from 6 weeks to 3 months.
    Treatment includes:
    • Rest—Do not pitch or do activities that cause elbow pain. Do not play sports until the pain is gone.
    • Cold—Apply ice or a cold pack to the outside of the elbow. Do this for 15-20 minutes, four times a day, for several days. Wrap the ice or cold pack in a towel. Do not apply ice directly to your skin.
    • Medication—Ask your doctor about pain medications because they can mask symptoms. If you or your child has elbow pain, be sure to call the doctor.
    • Physical therapy—After the pain is gone, ask your doctor about strength exercises.
    • Gradual return to pitching—Begin throwing motions. Gradually progress to pitching as recommended by your doctor. Your coach should also know about your treatment.
    • Surgery—This may be needed to reattach the ligament and bony fragment. This is rarely needed.

    Prevention

    To reduce your chance of getting Little League elbow, take the following steps:
    • Warm up before pitching with light aerobic exercise (such as, jogging).
    • Stretch your muscles slowly and gently before pitching.
    • Follow the pitching rules of your baseball league. Do not play in two leagues at the same time.
    • Keep track of your child’s pitch count and the number of innings pitched. The American Academy of Pediatrics recommends limiting pitches to 200 per week or 90 per game.
    • Learn and practice good pitching techniques.
    • Do not throw curve balls and sliders until high school. This is when the growth plate in your elbow is fused with the bone.

    RESOURCES

    American Academy of Orthopaedic Surgeons http://www.aaos.org

    American Academy of Pediatrics http://www.aap.org

    American Orthopaedic Society for Sports Medicine http://www.sportsmed.org

    CANADIAN RESOURCES

    About Kids Health http://www.aboutkidshealth.ca

    Canadian Orthopaedic Association http://www.coa-aco.org

    References

    Aydt S. Little league baseball and the pitch count. The National Athletic Trainers' Association website. Available at: http://www.nata.org/. Accessed July 22, 2008.

    Don’t let injuries keep your child in the dugout. Orthopaedic surgeons provide tips to prevent youth baseball and softball injuries. American Academy of Orthopaedic Surgeons website. Available at: http://www6.aaos.org/news/PEMR/press%5Frelease.cfm?PRNumber=468. Published April 2006. Accessed July 22, 2008.

    Overuse elbow injury related to throwing. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. Updated August 24, 2011. Accessed October 3, 2011.

    Professional Team Physicians, Inc. website. Available at: http://www.straws.com/ptp.htm. Accessed July 22, 2008.

    Risk of injury from baseball and softball in children 5 to 14 years of age. American Academy of Pediatrics website. Available at: http://pediatrics.aappublications.org/content/93/4/690.abstract. Published April 1994. Accessed July 22, 2008.

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