Little League Elbow

May 2nd, 2007

Elbow injuries occur frequently in pitchers. The valgus stress placed on the elbow during pitching causes distraction of the medial side of the elbow and compression of the lateral side. In the child, this leads to inflammation of the medial epicondyle with microtears of the flexor tendons (Little League elbow). In the adolescent, with increasing strength, there may be avulsion fractures through the epiphysis or growth plate. On the lateral side, osteochondritis dissecans can occur, where a fragment of bone from the capitellum loses its blood supply, loosens, and becomes a loose body in the joint. Surgery is often needed to correct the problem. The best way to prevent this is to learn proper pitching technique, as well as limiting the number of pitches allowed in Little League baseball. Studies suggest that a young pitcher should not exceed 350 throws a week.

Pitcher’s shoulder (or Little League shoulder) is from repeated stress on the head of the humerus in young pitchers, causing a stress fracture of the proximal humeral epiphysis. When diagnosed, rest is essential for healing and to prevent further damage. Another form of Little league shoulder is due to impingement syndrome, from overuse of the rotator cuff tendons leading to stretching and proximal migration of the humeral head and impingement against the acromion and coracoacromial ligament.

The most important part of treatment for LLE is physical therapy. Rehabilitation in general follows a logical and sequential progression to quickly and safely return the athlete to a preinjury level of function. The initial phase involves limiting immobilization as much as possible with initiation of range-of-motion exercises and joint mobilizations as necessary to prevent joint contractures. For athletes with hypermobility, joint stabilization exercises may be beneficial. Treatment of pain and inflammation with icing regularly 20 minutes 1-2 times per day is important. Anti-inflammatory medications may used as needed to treat pain and may also help treat inflammation when present. Appropriate upper extremity stretching and strengthening exercises can be initiated as tolerated using dumbbells or light resistance bands. Elbow braces are of limited benefit but may be used for comfort or to promote active full range of motion. A core strengthening program should also be initiated immediately. Athletes should be able to start core exercises prior to the ability to perform specific elbow strengthening exercises.

During the recovery phase of treatment, the athlete should begin a progressive throwing program. Usually, this phase occurs at approximately week 4-8 of treatment. The criteria to progress to the more advanced recovery phases include full, nonpainful range of motion, no tenderness to palpation, normal symmetric upper extremity strength, good core stabilization, and good balance.

Related Photos:

AP xray shows widening of the apophysis of the medial epicondlye ans calcification along the Medial collateral ligament

MRI image shows that the MCL(medial collateral ligament) is intact