Little League Elbow

Diagnostic Techniques

All young throwers with elbow pain should see a doctor since X-rays may be needed to determine the extent of the growth plate injury. A full examination is performed assessing range of motion, strength, flexibility, and neurologic evaluation that includes ulnar nerve and C8/T1 assessment.

Common Treatments - Non-Orthotic

If caught early, there is minimal separation of the growth plate and it can be treated with rest, ice and compression wraps. The period of non-throwing may take 4 to 6 weeks to allow proper healing. If the injury to the growth plate is more severe, or there is significant separation of the growth plate from the bone, casting may be necessary. On rare occasions, the injury is severe enough that surgical pinning is necessary to re-attach the growth plate fragment.

Common Treatments - Orthotic

If pain is significant, immobilization can be accomplished with a long-arm posterior splint or a hinged orthosis but the duration of immobilization should be brief.

Clinical Presentation

The most "striking" symptom little league elbow is pain at the inner elbow. The pain may be severe and occur abruptly after one hard throw, or it may occur gradually over the course of a season. There may also be swelling, redness and warmth over the inner elbow.

Etiology

• Little league elbow is a growth plate injury on the medial aspect of the elbow due to a valgus stress. • The growth plate, also called the medial epicondylar apophysis, is the attachment site for the group of muscles that flex the wrist and rotate the forearm palm down. • It occurs in children and teens involved in sports that require repetitive throwing motions. • With repetitive throwing, and not enough rest between throwing activities, the growth cartilage weakens, begins to develop very small cracks and may actually pull apart from the arm bone, like a screw pulling out of a plaster wall.