"Little Leauge Elbow"- Issue 5

             Little League Elbow, also known as medial epicondyle apophysitis, is the irritation and inflammation of the growth plate along the inner side of the elbow.

          In a pitcher who is not finished growing, the soft, cartilaginous growth plate of the elbow is the weak link during the throwing motion.  During an overhand throw, the inside of the elbow has traction pressure while the outside of the elbow has compression influences.  Frequent and excessive throwing results in repeated traction on the inside of the elbow. This repetition creates a pulling action on the growth plate causing it to become irritated and inflamed over time.

          In Adults, whose growth plates are closed, the ligament along the inside of the elbow is the weak link in the throwing motion, which can result in the common injury: Tommy John Syndrome.

         Little League elbow most frequently affects pitchers between 9 and 14 years of age, but it can also impact other players in high throwing positions such as shortstop and third base.  It can even be seen in other overhead sports such as water polo, volleyball and football (quarterbacks). The young athlete will typically complain of pain along the inside of the elbow that occurs with throwing and worsens with each additional throw or inning.  This start of pain can often be tied to a recent increase in the number of innings thrown or the number of games pitched by the athlete.

         Upon exam, there will be tenderness along the medial epicondyle and there may be some swelling and loss of elbow motion. X-rays are typically normal, but may show irritation or widening of the growth plate.

The most important step in the treatment of little league elbow is rest.  Ideally, the child should undergo a period of complete rest from throwing for a minimum of 4 to 6 weeks until pain is eliminated.

         During this period of rest, the athlete should focus on overall core/abdominal strength while allowing the arm to rest. Using this time to develop sufficient core strength and body control can help correct throwing mechanics and prevent injury.

         Once the athlete is pain free, a structured throwing program should be initiated over the next 4 to 6 weeks, with special attention to the athlete’s throwing mechanics.  Any pain during this rehab period should result in rest from the program until the pain goes away.

         Typically, it takes about 8 to 12 weeks for an injured athlete to return to competitive throwing. The goal is to return to throwing as quickly and as safely as possible, but if the athlete returns to throwing too soon or throws with pain, the injury may worsen and could lead to permanent elbow pain and difficulty with sports. 

         The best ways to prevent little league elbow are: avoid throwing with pain, do not initiate breaking pitches before the age of 14, and follow the guidelines for pitch count and pitch age recommended by USA Baseball Medical Safety and Advisory Committee-Click here to see guidelines!.  For more specific information contact your local physician or physical therapist. 

REFERENCES:

1. USA Baseball Medical and Safety Advisory Committee Guidelines: May 2006.

2. "Preventing Little Leauge Shoulder and Elbow"; Contemporary Pediatrics; 2004; 21:9.

3. www.childrensmemorial.com

4. Adams, Joel. "Little League Elbow"; California Medicine-The Journal of Western Medicine; 1993:118(3).

5. Benjamin, Holly. "Little Leauge Elbow Syndrome". EMedicine-Medscape. April 19, 2011.