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Elbow Pain in Little League Pitchers

Condition: “Little League elbow”, which is referred to by the medical term medial epicondyle apophysitis, causes elbow pain in young overhead-throwing athlete, such as Little League baseball pitchers.

Background: During the overhead throwing motion, stress occurs at the medial elbow joint, and over time, this can lead to damage of the growth plate at this location.

Risk Factors: This injury is most often diagnosed in athletes under the age of 16. Repetitive pitching is associated with an increased risk of injury; thus, youth baseball leagues have adopted pitch count limits and mandated rest days to protect the young players. Athletes are also recommended to not play a single sport year-round without a rest or break.

History and Symptoms: Young athletes typically experience medial elbow pain and decreased throwing speed and distance. Information regarding position played, training schedule, number of teams, estimate of innings/pitches per week, prior injuries, participation in other sports, and pain at night is critical.

Physical Exam: The physician will examine the elbow for structural problems and swelling. Pain is typical upon touch at the medial elbow. Range of motion, strength, and nerve function in the affected elbow should be assessed. Special tests that create stress of the medial elbow can cause pain. A full assessment of the throwing motion is helpful to figure out a potential cause for the injury.

Diagnostic Process:  X-rays of the elbow are commonly ordered first to determine the injury. Ultrasound and MRI can also be ordered to provide a more detailed assessment.

Rehab Management: It is recommended for “Little League Elbow” the patient be seen by a physical medicine and rehabilitation (PM&R) physician for treatment due to their expertise in sports injuries. Initial management includes approximately 4-6 weeks of rest from all throwing activities. Ice and anti-inflammatory medications are useful to ease symptoms. When motion becomes pain-free, strengthening exercises will be initiated followed by re-introduction of throwing. Athletes are typically allowed to return to participation after approximately 12 weeks. Surgery may be required for severe injuries.

Other Resources for Patients and Families: The patient and family should receive counseling on prevention strategies. The USA Baseball Medical and Safety Advisory Committee has published recommendations for youth pitch counts. Coaches, parents, and players should work together with medical specialists to ensure that the player completes rehabilitation before returning to play.

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