Medial Epicondyle Apophysitis / Little League Elbow (Pediatric)

What is medial epicondyle apophysitis?

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 medial epicondyle apophysitis?

Pitchers ages 9-14 years old are most affected by medial epicondyle apophysitis. Other athletes who throw overhead and play other positions in baseball are also at risk for developing this condition. Two to eight percent of baseball players experience overuse injuries related to the sport, but the number jumps to 20-40 percent in children ages 9-12 years old and to 30-50 percent in adolescents.

What causes medial epicondyle apophysitis?

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, causing it to become inflamed and irritated. In severe cases, the growth plate may actually break away from the arm.

What are the symptoms of medial epicondyle apophysitis?

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 say they are unable to throw the ball as fast or as accurately as they once did.

How is medial epicondyle apophysitis diagnosed?

Our doctors review the patient’s symptoms and pitching history and confirm diagnosis with a physical examination. If diagnosis is unclear or symptoms are severe, we may do an X-ray or MRI of the elbow.

What is the treatment for medial epicondyle apophysitis?

The most important step in treatment of medial epicondyle apophysitis is to refrain from throwing for a few weeks and let the growth plate heal. Ice may help to reduce the inflammation. Our doctors will likely recommend physical therapy to improve muscle strength and endurance, which may help to decrease the stress on the growth plate and reduce the risk for re-injury. We will also test the patient for core and hip/trunk stability to ensure the elbow is not taking on 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 to slowly increase the forces and demands through the arm that are necessary for returning to full competitive play.