Little League Elbow

Anatomy & Background

Little Leaguer’s elbow is a condition that compromises the structures in the medial (inside) area of the elbow, typically due to overuse and stress placed on the elbow joint by repetitive athletic movements. It most often occurs in adolescent baseball or softball players, and is most commonly seen in baseball pitchers due to the repetitive overhand motion involved in throwing the ball.

Affected Areas

The elbow joint connects three bones in the arm, the humerus (upper arm bone) and the radium and ulna (forearm bones).  Within the joint, there are strong, fibrous connective tissue 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 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.

Causes

Little Leaguer’s elbow is typically a result of repetitive movement and overuse of the elbow by adolescent aged baseball and softball players, particularly pitchers. Stress and strain on the medial structures in the elbow can result due to the repeated cocking and following 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. Inflammation of the growth plate in the elbow can also occur.

Causes that lead to Little Leaguer’s 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 curve balls, 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’s Elbow

Symptoms can vary based on how severe the condition is, but generally include:

• Pain, which is usually moderate to severe in nature. The pain may increase when attempting to throw a ball or when throwing more than the recommended number of pitches in a game.
• Tenderness on the inside of the elbow, closer to the upper arm. This is the location of the growth plate.
• Weakness of the elbow, accompanied by possible loss of motion of the elbow joint, although this is not typical unless severe damage has occurred.
• Stiffness of the elbow.
• Redness, bruising or other discoloration where the injury occurs. A noticeable deformity over the medial epicondyle may also be seen.

Treating Little League Elbow

Treatment of Little Leaguer’s elbow is typically conservative in nature, unless severe damage to the ligaments 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 – To reduce 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 the patient can perform the 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 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 medial structures or ligaments in the elbow is severe enough, surgery may be needed to repair or 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 elbow can be performed arthroscopically.

Medicine Intervenes and Managing Your Pain

Initial treatment of Little Leaguer’s elbow typically focuses on temporarily resting the joint, as well as reducing pain and inflammation. This then allows the patient to proceed through a course of physical therapy to strengthen and stabilize the elbow. Pain management is achieved through interventions such as:

• Rest and/or immobilization – Use of the elbow may be temporarily limited and movements that exacerbate pain, such as throwing activities, should be avoided.
• Ice – To reduce inflammation and diminish 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 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 elbow 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 elbow.

Prognosis

The prognosis and speed of recovery for this condition is dependent on a number of factors, but in the majority of cases of Little Leaguer’s elbow, the individual 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 individual returns to throwing too quickly, or poor throwing mechanics are not addressed, the condition may recur, resulting in further damage.