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Little League Shoulder and Elbow

    Little league shoulder and elbow are the two most common overuse injuries caused by repetitive athletic movements. They most often occur in adolescent baseball or softball players and are most commonly seen in baseball pitchers due to the repetitive overhand motion involved in throwing the ball.



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    Affected Areas

    The elbow joint connects three bones in the arm, the humerus (upper arm bone) and the radius and ulna (forearm bones). There are ligaments (strong, fibrous connective tissue) within the joint that attach bones to one another. They allow the elbow to move properly and provide strength and stability to the joint. When ligaments are stretched, strained, sprained, or torn, it results in pain and instability in the joint.

    Little Leaguer’s elbow results in damage to the medial section of the elbow (the inside of the elbow), including the medial collateral ligament, as well as the medial epicondyle and the medial epicondylar aphophysis. The medial epicondyle is the growth plate on the inside end of the elbow, and this often becomes inflamed in adolescents experiencing Little Leaguer’s elbow.

    The shoulder joint is a ball and socket joint that connects the scapula (shoulder blade) to the humerus (upper arm bone). The physis, or growth plate, is the weak point of the proximal humerus (the upper part of your humerus). Stress to the shoulder blade and arm bone causes widening of the growth plate, resulting in a shear or stress injury. Little League shoulder only affects athletes whose growth plates have not yet closed.

    Little League Elbow

    Causes

    Little Leaguer’s shoulder and elbow are typically a result of repetitive movement and overuse by adolescent-aged baseball and softball players, particularly pitchers. Stress and strain on the medial structures in the elbow and twisting of the shoulder can result due to the repeated cocking and follow-through motions involved in pitching a ball. This can lead to ligament laxity (looseness), which can result in sprains or tears of the ligaments in the elbow and shoulder. Inflammation of the growth plate in the elbow and shoulder can also occur.

    Causes leading to Little Leaguer’s shoulder and elbow include:

    • Year-round playing of baseball or softball, especially pitching, as well as continuous athletic training involving overhand throwing motions;
    • Pitching more than the recommended number of pitches per game or per week for an individual’s age;
    • Some pitches place more strain on the ligaments in the elbow, including curveballs, sliders, and “breaking balls.”;
    • Lack of adequate rest between pitching;
    • Improper warm-up prior to pitching or improper conditioning;
    • Poor throwing mechanics.

    Signs and Symptoms of Little League

    Symptoms of Little Leaguer’s shoulder and elbow can vary based on how severe the condition is, but generally include:

    • Pain, which is usually moderate to severe in nature. Pain may increase when attempting to throw a ball or when throwing an increasing number of pitches;
    • Tenderness on the inside of the elbow or near the shoulder;
    • Weakness, accompanied by the possible loss of motion of the shoulder or elbow joint, although this is not typical unless severe damage has occurred;
    • Stiffness of the elbow or shoulder;
    • Redness, bruising, or discoloration where the injury occurs. A noticeable deformity over the medial epicondyle or an angular deformity at the shoulder may also be seen.

    To properly diagnose shoulder and elbow injuries, our specialist will conduct a thorough physical examination and review the patient’s sports history as well as personal and family medical history. Sometimes, testing such as an X-ray or an MRI may be required to look for any changes where the cartilage meets the bone and any damage to the growth plate. After confirming a diagnosis, your doctor will address the pain level.

    Treating the Injury

    Treatment of Little Leaguer’s shoulder and elbow is typically conservative in nature unless severe damage to the ligaments or the growth plates occurs.

    • Rest and/or immobilization – Resting or temporarily immobilizing the affected joint allows for inflammation and pain to subside. It is usually recommended that the individual refrain from throwing a ball for 4 – 6 weeks while the injury heals;
    • Ice – Reduces inflammation and pain;
    • NSAIDs – Non-steroidal anti-inflammatory drugs may be given to reduce pain and inflammation. In some cases, additional pain medication is necessary so that individuals can perform necessary therapeutic exercises;
    • Physical therapy – Following a period of rest and/or immobilization, physical therapy is designed to restore strength, mobility, coordination, circulation, and flexibility in the elbow or shoulder joint. Analysis and correction of throwing mechanics may also be addressed if the individual plans to resume pitching following recuperation from the injury in order to prevent a recurrence of the condition;
    • Surgery – If damage to the growth plates or ligaments in the elbow or shoulder is severe, surgery may be necessary to reattach the ligaments. Following surgery, a rehabilitation program must be followed to restore strength, mobility, and functionality. Most surgical procedures to treat Little Leaguer’s shoulder and elbow can be performed arthroscopically.

    To learn more about the Little League Shoulder and Elbow treatment options available at Redefine Healthcare, please call one of our offices or use our simple online scheduling system to make an appointment with a highly-skilled physician.

    Managing Your Pain

    Initial treatment of Little Leaguer’s shoulder and elbow typically focuses on temporarily resting the affected joints, as well as reducing pain and inflammation. This allows the patient to proceed through a course of physical therapy to strengthen and stabilize the shoulder or elbow.

    • Rest and/or immobilization – Use of the shoulder or elbow may be temporarily limited and movements that exacerbate pain, such as throwing activities, should be avoided;
    • Ice – Reduces inflammation and diminishes pain;
    • NSAIDs and pain medication – Non-steroidal anti-inflammatory drugs reduce pain and inflammation. Additional pain medication may be required while therapeutic and strengthening exercises are performed;
    • Physical therapy – Therapy is usually recommended to strengthen and stabilize the shoulder or elbow following a period of rest and/or immobilization. It is also necessary following surgical treatment of more severe injuries in order to regain full functionality of the joint. Therapeutic exercises, neuro-muscular reeducation, manual therapy, electrical stimulation, ultrasound, cold laser therapy, and ice can be utilized to decrease pain, reduce inflammation, improve mobility, and strengthen the shoulder or elbow.

    Failure to address little league and elbow symptoms properly can lead to further elbow or shoulder problems in the future. These conditions can result in permanent damage to the growth plates, causing bone growth to be disrupted and deformity to occur.


    Prognosis

    The prognosis and speed of recovery for these conditions are dependent on a number of factors, but in the majority of cases of Little Leaguer’s shoulder and elbow, the patient can return to a regular pattern of pitching or throwing in about twelve weeks. Factors affecting the speed and completeness of recovery include the severity of the injury, the location of the injury (ligaments, growth plate, etc.), the age and activity level of the individual (younger, stronger, and more flexible people usually recover more quickly), and the individual’s commitment to rehabilitation. If a proper course of physical therapy is not followed, the patient returns to throwing too quickly, or poor throwing mechanics are not addressed, the condition may recur, resulting in further damage.


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    Page Updated on May 20, 2022 by Dr. Freeman (Pain Management Specialist) of Redefine Healthcare Dr. Eric D. Freeman

    Dr. Eric D. Freeman is a top-rated, best-in-class pain management doctor. He is a nationally recognized pain relief specialist and is among the top pain care doctors in New Jersey and the country. He is an award-winning expert and contributor to prominent media outlets.

    Dr. Eric D. Freeman has been recognized for his thoughtful, thorough, modern approach to treating chronic pain. He has been named a “top pain management doctor in New Jersey” and one of “America’s Top Physicians” for advanced sports injury treatments.

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