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Little League Elbow
(Medial Apophysitis)
by Laurie LaRusso, MS, ELS
Definition
Little League elbow is pain in the elbow due to repetitive throwing. This injury occurs in young baseball pitchers before puberty. 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.
Throwing too many pitches or throwing the wrong type of pitches (i.e., curves or sliders) puts great stress on a young pitcher's elbow ligaments. Because the bones are still growing, the growth plates of the bones are weak and susceptible to injury when the ligaments attached to them are stressed by overhand throwing.
Causes
Little League elbow is caused by repetitive overhand throwing in prepubescent baseball pitchers.
Specific throwing events that may lead to Little League elbow include:
Throwing too hard too often
Increasing the number of pitches you throw 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
A risk factor is something that increases your chance of getting a disease, condition or injury. Risk factors for Little League elbow include:
Age: 10-15 years old
Sex: Male (because 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
Sometimes, pain with gripping or carrying heavy objects
Diagnosis
The doctor will ask about:
Your symptoms
How the injury occurred
When the pain began
Any prior elbow injuries
Your doctor will also examine your elbow for signs of ligament or bone damage, and to find the source of your pain. You may have an x-ray to look for damage to the bone, particularly in the area of the growth plate on the medial side of the elbow.
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 any activities that cause elbow pain. Do not play sports, especially throwing sports, until the pain is gone.
Cold – Apply ice or a cold pack to the outside of the elbow for 15-20 minutes, 4 times a day, for several days. Wrap the ice or cold pack in a towel. Do not apply the ice directly to your skin.
Medication – Medications such as aspirin, ibuprofen (Advil, Motrin), naproxen (Naprosyn), or acetaminophen (Tylenol) should be taken only under a doctor's orders. These may help relieve pain but could also mask symptoms. Pain in the elbow of a young pitcher must be checked out by a doctor, preferably an orthopaedic surgeon.
Physical Therapy – After the pain is gone, begin strengthening exercises for your arm muscles and range of motion exercises for your elbow as recommended by a health care professional.
Gradual Return to Pitching – Begin throwing motions and gradually progress to pitching as recommended by a health care professional. Your baseball coach must be aware of the treatment plan.
Surgery – Surgery may be needed to reattach the ligament and bony fragment if it is widely separated from the growth plate. This is rarely needed.
Prevention
Prevention strategies include:
Always warm up before pitching with light aerobic exercise, such as jogging or jumping jacks.
Always stretch your muscles slowly and gently before pitching.
Always follow the pitching rules of your baseball league and do not play in two leagues at the same time.
Limit your pitching to:
4-10 innings per week
80-100 pitches per game
30-40 pitches per practice
Learn and practice the mechanics of good pitching technique.
Do not throw curve balls and sliders until high school when the growth plate in your elbow is fused with the bone.
Organizations
American Academy of Orthopaedic Surgeons
www.sportsmed.orgAmerican Academy of Pediatrics
www.aap.orgSOURCES:
Professional Team Physicians, Inc.
American Academy of Pediatrics
American Academy of Orthopaedic Surgeons
National Athletic Trainers' Association