Little League Elbow (Medial Apophysitis)

Definition

Little League elbow is pain in the elbow joint 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 (eg, 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. This could lead to the athlete trying to pitch, which would further damage the elbow. 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 running in place.
• 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 a maximum of 4-10 innings per week.
  
  • While there is no concrete guideline, it is reasonable to aim for no more than 80-100 pitches per game, or 30-40 pitches per practice
  • More specific guidelines are normally laid out by individual baseball leagues
• Learn and practice the mechanics of good pitching techniques.
• Do not throw curve balls and sliders until high school when the growth plate in your elbow is fused with the bone.