What is it?
“Little League Elbow” is a disorder of the inside portion of the elbow in young athletes. Repetitive stress on the elbow joint, often from throwing, results in irritation of the growth plate, leading to pain and, possibly, even pulling a portion of the growth plate away from the bone. Most injuries can be treated conservatively; however, some do require surgery.

Causes
Repetitive stress on the elbow from throwing too many pitches or utilizing improper technique, especially while throwing curve balls, can all lead to “Little League Elbow.”

Risk Factors
• Often, the position the athlete plays makes them more vulnerable to this type of injury. Most commonly, pitchers are affected but catchers, infielders and outfielders can also develop this problem. • High pitch count and type of pitch • Year-round pitching or multiple leagues • Improper technique • Inadequate rest between outings

Symptoms
• Pain in the inside portion of the elbow • Pain is usually the worst during the back or cocking phase of throwing • Sometimes, there will be a decrease in the velocity of throws, or the distance that can be thrown

Diagnosis
After a careful history and physical examination, often, a sports medicine physician will obtain x-rays, sometimes of the unaffected arm also, for comparison.

Treatment
• Usually the first line of treatment involves 4-6 weeks of rest • Anti-inflammatory medications and ice may be recommended • Once the rest period is complete, a gradual progression of throwing can be resumed • A throwing coach or throwing program can help correct improper technique • If a fragment of the growth plate is pulled too far off the bone, then surgical intervention may be required.

Injury Prevention
• Proper technique • No curve or breaking balls until the age of 14 • Pitching in more than one league should be discouraged • Proper rest between outings should be encouraged • Return to Sport Enforcement of pitch or throw count recommendations: • Athletes 7-8 years old: 50 pitches per day • Athletes 9-10 years old: 75 pitches per day • Athletes 11-12 years old: 85 pitches per day • Athletes 13-16 years old: 95 pitches per day • Athletes 17-18 years old: 105 pitches per day

Return to Play
Often, after 4-6 weeks of rest and non-painful rehabilitation, the patient may begin a graduated throwing program over several weeks, leading to a full return to sports participation.

AMSSM Member Authors
Dustin W. Lash, DO, Tracy Ray, MD

References
Shanley E, Thigpen C. Throwing injuries in the adolescent athlete. Int J Sports Phys Ther. 2013 Oct;8(5):630-40

Zaremski JL, Krabak BJ. Shoulder injuries in the skeletally immature baseball pitcher and recommendations for the prevention of injury. PM R. 2012 Jul;4(7):509-16.