Little League Elbow

What is Little League Elbow (Medial Apophysitis)?

Little League Elbow occurs in young throwing athletes and generally refers to an injury to the elbow’s tendons, ligaments and/or bones. This injury is most common in young baseball players (9-14 years old) due to overuse, such as throwing the ball too hard or too often, or poor throwing technique. Muscles of the forearm that are used to throw the ball constantly pull on the medial epicondyle of the elbow during throwing, which leads to inflammation and irritation from pulling the soft growth center apart. In severe cases, a young player may tear through the soft growth center and detach the medial epicondyle from the upper arm bone. Although this injury is most common in baseball players, other overhead athletes such as volleyball players or football quarterbacks may also be susceptible. 

What are the typical symptoms of Little League Elbow?

Symptoms include swelling and pain that typically occur on the inside (medial) part of the elbow. Range of motion may be decreased because of pain resulting in difficulty straightening the arm. Pain is aggravated by throwing and usually becomes worse with continued throwing or pitching. 

Risk factors of Little League Elbow?

  • More than 80 pitches per game
  • More than 8 months of competitive pitching per year
  • Fastball speed above 85mph
  • Continuing to throw or pitch despite arm fatigue or pain

How Is Little League Elbow Evaluated?

Plain radiographs (X-rays) of the affected joint are obtained first. These may show physeal widening, (growth plate widening) or fragmentation or avulsion of the medial epicondyle of the elbow. MRI can also be useful as a secondary study which can show increased edema of the medial epicondyle apophysis or to confirm UCL insufficiency. 

How Is Little League Elbow Treated?

Treatment for mild to moderate cases of Little League Elbow includes rest, focusing on throwing form to decrease stress on the inside of the elbow, and physical therapy to strengthen the elbow. Icing the elbow multiple times a day can help to reduce inflammation in the acute phase until there is no longer pain. Severe cases resulting either from a single painful accident or chronic injury may require surgical repair. Depending on the type of injury, surgery may entail attaching ligaments back to the bone (e.g., Tommy John Surgery: reconstruction of the ulnar collateral ligament of the elbow) or making sure there is no loose bone. Recovery may take 6 weeks to 6 months, depending on the severity of the injury. 

How Is Little League Elbow Prevented?

First of all, athletes should be instructed not to throw in pain. If pain occurs, throwing should stop to avoid further damage and injury. It is also very important to cultivate proper throwing mechanics and to condition the elbow, lower body, core, and shoulder to avoid straining the inner elbow. It is also advised to adhere to pitch count, pitch type, and recovery day recommendations from either USA Baseball or American Sports Medicine Institute.


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By Sal Liotta and Alee Vladyka