Little Leaguer’s Elbow

With baseball season in full swing we begin to see an increase in upper extremity injuries in young athletes. One of the most common injuries we treat is a throwing injury known as medial apophysitis, or “Little Leaguer’s Elbow.”

This condition occurs when the repetitive stress of frequent throwing places excessive strain on the tendons, ligaments and cartilage of the elbow joint.  In the young player and immature elbow this is particularly concerning because of the damage it can cause to the growth plate.

The two “phases” of throwing which impact the elbow joint include the early acceleration phase (a pulling force on the growth plate of the inner elbow) and the throwing/release phase (strong inward and downward snap of the wrist).  A hinge and pivot joint, the elbow allows a broad range of motion.  The growth plate in the elbow, though, is comprised of growth cartilage – a soft substance that is not as strong as bone.  With repetitive stress, this growth cartilage can weaken, develop small fissures and in more severe cases pull apart from the bone. The repeated pulling can also tear ligaments and tendons away from the bone – possibly pulling tiny bone fragments with it.  In a young player, this could potentially disrupt normal bone growth and result in deformity.

Another less common though more serious throwing injury, known as Osteochondritis Dissecans, can occur in young athletes and involves the loosening and fragmenting of immature bone and cartilage. The pain associated with this condition is usually felt on the outside of the elbow.

Both prevention and early treatment of Little Leaguer’s Elbow are key for young players.

Symptoms of Little Leaguer’s Elbow

The most common symptom associated with Little Leaguer’s Elbow is pain on the inside of the elbow, which may be severe and occur abruptly, or mild – increasing in intensity, gradually over time.  Other symptoms may include swelling, redness and warmth over the inner elbow.  Range of motion may be restricted in some players, with an inability to straighten the elbow.

Diagnosis and Treatment

A physical examination and pain assessment will help diagnose Little Leaguer’s Elbow.  An X-ray or MRI may be indicated to assess irregularities in the elbow joint and growth plate damage.

When diagnosed early, nonsurgical treatment can effectively resolve the problem and may entail rest (refraining from throwing activity), as well as icing to reduce swelling.  Sports rehabilitation specialists may also be able to help young players refine their throwing technique to reduce stress on the elbow joint.

In more severe cases, surgery may be required to reattach a ligament and/or the bone or growth plate  – stabilizing the elbow joint.

Preventing Throwing Injuries in Little League Baseball

Understanding the impact of throwing injuries on the immature elbow is key for coaches, parents and players.  Risk of injury can be reduced by properly warming up and ensuring proper throwing technique.  And adequate rest is as equally important as practice for optimal performance.

The American Academy of Orthopaedic Surgeons (AAOS) recommends that young pitchers play no more than three to four innings each game, to prevent throwing injuries.

Pitch Count Guidelines and Little League Regulations

As competition in youth sports intensify and seasons extend to include tournaments and World Series games, we are seeing an alarming increase in throwing injuries in the young player.  This has prompted the American Sports Medicine Institute, together with USA Baseball, Little League Baseball and Major League Baseball to examine the impact of excessive throwing on the young, skeletally immature athlete.  Their findings have translated into new regulations, pitch count guidelines and educational initiatives in Little League Baseball.

Next month we’ll talk about pitch count guidelines and its role in protecting young baseball players.