By Brad Bernardini, MD, Orthopedic Surgeon—Virtua Sports Medicine 

Most people have heard of professional baseball players sustaining elbow and shoulder injuries caused by repetitive throwing. But, many people don’t realize that young children can be susceptible to throwing injuries as well, including an overuse injury called Little League elbow. 

What is Little League elbow?

Little League elbow, or medial epicondyle apophysitis, is an injury that causes irritation and inflammation of the growth plate on the inside of the elbow. If left untreated, this inflammation can progress to a full fracture of the growth plate. 

It's most common among baseball pitchers who are between ages 11 to 13. It usually occurs in the dominant, or “throwing,” hand. 

Although the injury is most common in pitchers, children who play other high-demand throwing positions such as catcher, outfield or shortstop, also can develop Little League elbow.

The risk for developing this condition increases in players in the following situations:

• Those who participate in intense, highly competitive baseball programs. 
• Those who pitch for more than one team. 
• Those who pitch on consecutive days or play baseball year-round. 

What causes Little League elbow?

Throwing places a great deal of stress on the elbow, especially when the arm is cocked. Studies on repetitive throwing injuries show that there’s a link between Little League elbow, pitch counts, and the number of games pitched. As the number of pitches increases and muscles begin to fatigue, the pitcher’s form begins to break down. Poor form causes increased stress on the bone. 

Little League-age children have a growth plate on the inside of the elbow that’s not fully hardened, or calcified. As the arm comes forward in the throwing motion, children are especially prone to injuries to this growth plate because it’s the weakest link in the bone. 

Little League elbow often begins gradually and results in aching, sharp pain or swelling on the inside of the elbow. Sometimes the symptoms only occur when the child is pitching, but they may eventually occur during any type of throwing. 

How is Little League elbow treated?

Treatment for Little League elbow typically involves refraining from throwing for 3 weeks. After that, physical therapy with a throwing specialist usually is recommended. Because much of the power behind the throwing motion comes from the core of the pitcher’s body, physical therapy focuses on improving core strength, increasing mobility, and promoting proper body mechanics. 

After 6 weeks, if the child has full range of motion and is pain-free, he can start a progressive throwing program and eventually return to the field with permission from the doctor. To ensure that they stay in good throwing shape, children should continue to perform strength training and conditioning exercises 3 times per week for as long as they’re participating in a throwing sport. 

How can you prevent Little League elbow?

Raising awareness of Little League elbow is critical to prevention. If children experience pain on the inside of their elbow, they should immediately bring it to the attention of a coach or parent and should be removed from the game. The child should be examined by a sports medicine or pediatric orthopedic specialist as soon as possible. 

Coaches should follow age-appropriate pitching guidelines. Children ages 11-12 should be throwing no more than 65 pitches per game and pitching no more than 2 games per week. 

Children also should avoid overspecialization in one sport by taking at least 2 to 3 consecutive months off from throwing sports each year. Because studies show that single-sport athletes break down faster, it’s a good idea to try other sports during the off-season. 

Until children reach skeletal maturity (age 16 in boys; age 15 in girls), they should avoid throwing specialty pitches such as curveballs and sliders. Strength-training exercises that use body weight are a safe way for young baseball players to improve mobility, develop core strength, and increase muscle tone. 

Ignoring the signs of Little League elbow can cause serious problems with growth and, in severe cases, result in fractures, early arthritis, and bone spurs. Raising awareness of Little League elbow among players, parents and coaches is crucial to ensuring that young ball players can have fun safely and develop a love of the game. 

Get back in the game

Virtua sports medicine specialists offer a full range of nonsurgical services for everyone from high-performing athletes to active adults to children having fun on the pitch, field and court. Click here to schedule an appointment online.