Little League Elbow (Medial Epicondyle Apophysitis)
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Medial epicondyle apophysitis, often called "Little League elbow," is the most common injury affecting young baseball pitchers whose bones have not yet stopped growing. The medial epicondyle is the attachment site for the forearm muscles used in throwing and helps to stabilize the elbow during the throwing motion. This condition is characterized by irritation and inflammation of the growth plate (apophysis) on the inner side of the elbow (medial epicondyle).
Who Is Affected by Little League Elbow?
Pitchers ages 9-14 are most at risk for Little League elbow, but other athletes who throw overhead and play other positions in baseball are also at risk. Two to eight percent of baseball players experience overuse injuries related to the sport, but the rate jumps to 20-40 percent in children ages 9-12 and to 30-50 percent in adolescents.
What Causes Little League Elbow?
Medial epicondyle apophysitis develops when an athlete throws too much. This condition is caused by repeated overhead throwing with improper mechanics, lack of muscle strength and endurance, throwing breaking pitches too early in life, or increased pitching counts.
Repetitive pitching or throwing stresses the arm's growth plate, leading to inflammation and irritation. In severe cases, the growth plate may actually break away from the arm.
What Are the Symptoms of Little League Elbow?
Pain on the inner side of the elbow occurs while throwing a ball. Athletes may also have swelling and difficulty extending the elbow, and often report being unable to throw the ball as fast or accurately as they once did.
How is Little League Elbow Diagnosed?
Our doctors review the patient’s symptoms and pitching history and confirm the diagnosis with a physical examination. If the diagnosis is unclear or symptoms are severe, we may do an X-ray or MRI of the elbow.
What Is the Treatment for Little League Elbow?
The most important step in treating medial epicondyle apophysitis is to refrain from throwing for a few weeks and allow the growth plate to heal. Ice may help to reduce the inflammation.
Our doctors will likely recommend physical therapy to improve muscle strength and endurance, which may help decrease stress on the growth plate and reduce the risk of reinjury.
We will also test the patient's core and hip/trunk stability to ensure the elbow is not bearing more stress due to a lack of stability elsewhere in the body.
During this initial period of rest from throwing, the patient may do activities and play other sports that do not stress the elbow. A return-to-throwing program also helps gradually increase the forces and demands through the arm necessary for returning to full competitive play.