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Posted by Dr. Monica Wonnacott | April 30, 2017

Little Leaguer’s Elbow: What You Should Know If Your Child Pitches In Baseball

In an era where kids are specializing in sports at a young age and engaging in early competitive leagues, we are starting to see more and more sport-specific injuries at a young age. Little Leaguer’s elbow is just one of these injuries.

What is Little Leaguer’s elbow?

Little Leaguer’s elbow is an overuse injury that typically happens in young boys who do a lot of pitching in baseball. The arm motion in pitching causes repetitive stress on the on the part of the bones in the elbow that aren’t done growing (the growth plates that aren’t closed). The medical term is “medial epicondylitis.” (It’s a fancy term referring to the middle or inside part of the elbow when the arm is straight, palm up). Essentially what happens is the apophyseal cartilage gets lots of microfractures (tiny little breaks) and tons of inflammation all around.

What are the symptoms?

Kids with Little Leaguer’s elbow will have very specific point tenderness over the bony prominence on the inside edge (if the arm is extended palm up) of the elbow. There can also be pain when the child tries to fully extend/straighten the arm. Sometimes there is pain when the child bends his/her wrist back or takes a bent arm (palm down) and twists it (so the palm is up).

How is it diagnosed?

Usually the diagnosis is clinical (meaning the doctor makes the diagnosis by asking questions and doing a physical exam.) Often times an x-ray of the elbow will be normal (which does NOT rule it out), only in severe cases will you see the fractures in the elbow (or even displacement from swelling).

How do I prevent it?

Like most injuries, the key is prevention. If your coach isn’t already limiting “pitch counts” in your child, he or she should. Here are the current guidelines (noting that the number of pitches gradually increases with age, you can extrapolate for your child’s specific age if not listed):

9-10 year olds

  • 50 pitches per game
  • 75 pitches per week
  • 1,000 pitches per season
  • 2,000 pitches per year

13-14 year olds:

  • 75 pitches per game
  • 125 pitches per week
  • 1,000 pitches per season
  • 3,000 pitches per season

How do I treat it?

Treatment consists of rest. It may take 8-12 weeks for an injured player to be able to start pitching again (and then with pitch limits). Physical therapy can help with strengthening and stretching of the involved muscles. Sometimes, doctors will recommend anti-inflammatory medications to help with pain (but note that taking medications and continuing to play will only temporarily mask the symptoms and make the underlying problem worse). The key is rest.

Is Little Leaguer’s elbow the same thing as Tennis Elbow?

No. The movement/stress at the elbow is different in Tennis Elbow than Little Leaguer’s elbow. The pain in Tennis Elbow is on the other side of the elbow (the lateral or outside side of the elbow).