Little League Elbow - Causes, Symptoms, Diagnosis, and Treatment

What Is Little League Elbow?

Little league elbow is a common elbow injury occurring in adolescent athletes, especially baseball players, causing pain on the inside of the elbow. It is also referred to as apophysitis, meaning chronic inflammation of the growth plate. It is mainly caused by overuse of the elbow without enough rest, but it can occur due to a single, painful injury. During overhead throwing, the cartilage (flexible connective tissue protecting the joints and bones) growth plate is put under stress and becomes irritated. This injury can be seen in baseball, tennis, softball, and golf players. Other conditions that are sometimes associated with little league elbow are:

• Medial epicondylitis (also known as medial epicondylar apophysitis).

• Medial collateral ligament injury.

• Medial epicondyle fracture.

How Is the Anatomy Related to the Little League Elbow?

The elbow is a complex joint made up of three bones: the humerus (upper arm bone) meets the end of the radius, and the ulna (two forearm bones). The humerus is connected to the radius and the ulna in the forearm by a joint working like a hinge. Many muscles, ligaments, and tendons around the elbow contribute significantly to its function, like the arms bend and stability. There are many tiny soft areas of cartilage, referred to as apophyses, at each end of the bones, and as the adolescents stop growing, these areas harden and turn into bone. But in kids and adolescents, they are very easy to injure; when athletes throw too much, these areas can get easily injured, inflamed, and sore. Pitching too much and too often, or throwing in a way that can injure the arm, can exert stress on these ligaments, tendons, and bones and cause injury.

What Are the Causes of Little League Elbow?

Little league elbow is commonly seen in adolescent pitchers, mainly because of cumulative traction stress exerted on the inside of the elbow. When the athlete throws overhand, the medial aspect of the elbow experiences traction, while the lateral aspect of the elbow experiences compression. Irritation and inflammation occur on the growth plates of the medial elbow as it is pulled due to repeated traction.

What Are the Symptoms of Little League Elbow?

• Little league elbow is commonly seen in young athletes with pain in their elbow's inner part.

• Pain begins slowly without a specific injury, but a definite painful pop may be felt occasionally.

• When the athletes continue playing, they can experience sharp, aching pain and swelling on the inside of the elbow.

• Initially, the elbow may be painful only during or right after throwing. If treatment is not provided, the elbow can start hurting all the time.

• Usually, pain starts gradually, but it can occur after one throw if the athlete often performs the same motions.

• Advanced stages may include small fractures of the growth plate, bone chips, loose bodies, bone spurs (bony lumps on the bones growing around the joints), or early arthritis.

How Is Little League Elbow Diagnosed?

Little league elbow is diagnosed by:

• Taking clear history about the sports and activities.

• Performing physical examination of the elbow for tenderness at the growth plate, checking a range of motion, and strength tests.

• In an examination of X-rays, up to 85 percent, the X-rays may be normal. It is important to evaluate the elbow on an x-ray to check for other signs of injury like injury to the growth plates, stress fractures, and bones on the lateral side of the elbow.

• It is also important to compare the affected elbow with the unaffected elbow.

What Is the Treatment for Little League Elbow?

The main treatment for little leaguer's elbow is non-surgical.

• The patient is advised to rest completely from throwing for a minimum of four to six weeks. During this period, the child is not allowed to perform any kind of throwing.

• Ice packs may be helpful in relieving pain and swelling.

• Nonsteroidal anti-inflammatory drugs will be prescribed for pain, but it will not be necessary if the athlete is not throwing.

• Following the initial four to six weeks of rest and when the patient is completely symptom-free, a throwing program should be started over the next six to eight weeks. During this time, a specialized physical therapist evaluated the child and corrected their throwing techniques. The program includes elbow range of motion, strength exercises, and strengthening of the upper arm, forearm, back, shoulder, and core. For any pain during this period, the athlete should be temporarily stopped from their program for a short period until they can perform without any pain.

Typically, little league elbow resolves with adequate rest and conservative management. But the recovery timeline for most overuse injuries will differ for every athlete. If adequate rest and treatment plan is not followed, it can lead to long-term deformity or disability, including conditions such as osteoarthritis.

Surgery:

• Most kids with little league elbow can be treated with adequate rest and physical therapy, but surgery is needed in some rare and serious cases.

• Surgery is required if the elbow problem is because of a single, painful accident. The surgery mostly depends on the child's specific problem and the injury's seriousness.

• During the surgery, the ligaments are attached back to the bone, ensuring no more loose bones.

• Recovery normally lasts two to three months and includes follow-up appointments, physical therapy, and a gradual return to throwing.

How to Prevent Little League Elbow?

Prevention is possible by teaching kids to follow these tips:

• Warm-up - It is important to warm up and start slowly with throws, which help to stretch muscles and loosen joints.

• Throw Correctly - A proper technique should be taught to the players so they do not put excess stress on their elbows.

• Limit the Number of Pitches - There is an association between the number of pitches played and elbow injuries. So, it is necessary to follow the guidelines for pitch counts at the appropriate age and take rest after the suggested period.

• No, to Fancy Stuff - Kids should not try fancy stuff like throwing curveballs or other breaking pitches till they specialize in fastballs and change-ups or are at least 13 to 14 years old.

• Year-Round Fitness - Players should follow year-round physical fitness and conditioning. A resistance program is necessary for all baseball players and should include shoulder, arm, hip, back, and trunk strengthening and aerobic conditioning.

• Slowly Back to Throwing - After the athlete's rest period from throwing, it is necessary to ease back into throwing, normally over two to three weeks after a rest period or after recovery from little league elbow.

Conclusion:

Little league elbow is a common elbow injury occurring in kids due to overuse and improper overhead throws. It can cause severe pain during practice and may also experience swelling. But the pain is minimal during rest. Adequate rest till recovery is the best treatment for this injury. In very rare cases, surgery may be advised. Following the guidelines is the best way to prevent such injuries.