• Little League Elbow

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


    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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    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

    Little League elbow is more common in boys and in those aged 10-15 years old. Baseball pitching, especially throwing curve balls or sliders also increases risk.


    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)


    You will be asked about your child's symptoms and medical history. Other information needed will include how the injury occurred, when the pain occurs, and about previous 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 scan done to look for damage to the bone


    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—Regular use of an ice pack to reduce swelling and pain.
    • Medication—Medications to reduce swelling and pain. Aspirin is not recommended for children with a current or recent viral infection. Check with the doctor before giving your child aspirin.
    • Physical therapy—After the pain is gone, your child may be referred to physical therapy for strengthening exercises.
    • Gradual return to pitching—Begin with throwing motions. Gradually progress to pitching as recommended by your doctor or physical therapist.
    • Surgery—This may be needed to reattach the ligament and bony fragment. This is rarely needed.


    To reduce your chance of Little League elbow:
    • 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 2 or more 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.


    Family Doctor—American Academy of Family Physicians http://familydoctor.org

    Ortho Info— American Academy of Orthopaedic Surgeons http://orthoinfo.org


    About Kids Health—The Hospital for Sick Children http://www.aboutkidshealth.ca

    Canadian Orthopaedic Foundation http://www.canorth.org


    Committee on Sports Medicine and Fitness. American Academy of Pediatrics: Risk of injury from baseball and softball in children. Pediatrics. 2001;107(4):782-784.

    Throwing injuries in the elbow in children. American Academy of Orthopaedic Surgeons Ortho Info website. Available at: http://orthoinfo.org/topic.cfm?topic=A00328. Updated April 2011. Accessed November 15, 2017.

    Why counting pitches counts. The National Athletic Trainers' Association website. Available at: http://www.nata.org/nata-news-blog/why-counting-pitches-counts. Published October 28, 2014. Accessed November 15, 2017.

    Revision Information

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