Coastal Orthopedics

LITTLE LEAGUE ELBOW

By: Arthur Valadie, MD

The Little League elbow is a term used to describe a common overuse injury of the elbow in young throwing or overhead athletes.  It is a condition caused by repetitive stress to the inner or medial aspect of the elbow.  The throwing motion in particular puts significant tensile forces on the medial stabilizing structures of the elbow and can cause an overuse injury to the cartilage growth plate in this area.

DEFINITION:  The term Little League elbow is specifically used to describe an injury to the medial growth plate called the medial epicondyle.  The repetitive stress of throwing causes injury to the growth plate cartilage and can cause inflammation of this tissue as well as alterations in the growth pattern of this growth center.  Another overuse syndrome called osteochondritis dissecans is caused by the compressive forces across the lateral or outer aspect of the elbow. While not strictly defined as Little League elbow, this condition is still commonly found in young throwing or overhead athletes.

CAUSES:  We now live in an age where young athletes are commonly encouraged to play a single sport year-round and where athletic performance is being stressed in younger and younger athletes.  This has resulted in young pitchers throwing too hard, too frequently, and without enough rest, causing an increasing incidence of overuse injuries in skeletally immature athletes.  It is estimated that at least a third of young baseball players experience some sort of overuse injury during their adolescent years.

SYMPTOMS:  The typical player that experiences Little League elbow develops pain on the inner aspect of the elbow with throwing.  He or she may also develop some swelling and localized tenderness.  It is also commonly associated with decreased velocity and/or accuracy.  Typically, the pain is of gradual onset, but occasionally can occur fairly acutely.

DIAGNOSIS:  The diagnosis of Little League elbow is commonly made with simply a combination of a description of the symptoms as well as a physical examination.  Again, there is typically localized tenderness over the medial aspect of the elbow.  There is commonly pain while applying a stress to the medial ligaments.  X-rays are occasionally helpful in the diagnosis as they may show some abnormal appearance to the medial elbow growth plate.  Other conditions caused by increased compression of the lateral or outer surface of the elbow may also be seen on an x-ray.  MRI scanning is not typically needed to diagnose Little League elbow.

TREATMENT:  As with most overuse conditions, the most obvious and effective treatment is often the hardest one to comply with; rest from the offending activity.  The most important treatment for Little League elbow is to avoid throwing for a period of time to rest the injured structures.  This may take several weeks, but it is important to allow complete healing to prevent recurrent symptoms.  It is also important to maintain range of motion during the rest period.  Ice, anti-inflamatories, and physical therapy to maintain range of motion and strength can also be helpful.  It is also important during the rest period to avoid other activities that may place a stress on the injured structures of the elbow.  Once an athlete begins to throw again, it is important that he or she resume throwing in a gradual controlled manner.  If a player ignores the symptoms and continues to throw despite pain, they are likely at increased risk for a fracture of the medial growth plate of the elbow, which could potentially require surgical intervention.

PREVENTION:  The best way to avoid Little League elbow is to follow appropriate preventative steps.  It is important that players’ parents and coaches be educated as to the cause of Little League elbow.  Pitch counts, rotation schedules, and throwing mechanics can then be managed in an appropriate way.  Pitchers who are 16 and under should not throw more than 60 pitches in a day and there should certainly be adequate rest between pitching appearances.  If a pitcher does throw close to 60 pitches, the rest period should be at least 3-4 days.  Through appropriate education and monitoring, the incidence of Little League elbow and other overuse conditions can be reduced.