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Understanding Little League Elbow: Causes, Symptoms, and Treatment Options

Kathy Ryan-Ceisel, PT MHS

Athletic Edge and Wellness

Overhead Throwing Specialist

Little League Elbow is a prevalent condition among young athletes, particularly those engaged in repetitive throwing or overhead activities, such as baseball pitching. This condition, akin to Little League Shoulder, primarily affects children and adolescents aged 11 to 16. This age group corresponds to the range of young athletes who are actively involved in sports that require repetitive overhead throwing motions, such as baseball pitching.  


The medial epicondyle, a bony prominence on the inner side of the elbow, has its own growth center, separate from the main humeral bone. This growth center typically develops around age 6-7 and fuses by age 15. The ulnar collateral ligament (UCL) and flexor-pronator muscles, originating from the medial epicondyle, stabilize the elbow against stress.


Frequent repetitive strain results in a gapping-type injury and may cause widening and inflammation of the growth plate or even an avulsion fracture. Risk factors for developing little league elbow with baseball players include a high number of pitches per game, pitch velocity, continued throwing despite arm fatigue, and frequent participation in throwing.  Catching may also be associated with little league elbow.  During this critical period of growth and development, the growth plates in the elbow joint are still open and vulnerable to injury due to repetitive stress and strain.


The overall risk of injury increased by 15% between 2011 and 2016, and the proportion of baseball injuries associated with the elbow nearly doubled in the same time frame. The prevalence of medial epicondyle peaks between the ages of 11 to 12, with a rate of about 30 percent.


In patients whose medial epicondyle apophysitis is complicated by an avulsion fracture, they may describe acute pain with a “pop” sensation at the time of avulsion injury.


Common signs to watch for in Little League Elbow:


Pain: The athlete may experience pain on the inner side of the elbow, specifically around the bony prominence called the medial epicondyle.


Tenderness: The area around the inside of the elbow (medial epicondyle) may be tender to touch.


Swelling: There may be swelling around the inner side of the elbow, which can be visually noticeable.


Difficulty in throwing: The athlete may have difficulty in throwing or experience pain and discomfort while throwing.


Limited range of motion: Little league elbow can result in a decreased range of motion in the elbow joint, making it difficult to fully straighten or bend the arm.


Weakness or grip problems: The athlete may experience weakness in the affected arm or have difficulty gripping objects firmly.


It is important to note that these symptoms may vary in severity depending on the individual and the stage of the condition. If you or someone you know is experiencing these symptoms, it is advisable to seek immediate medical attention for a proper diagnosis and treatment.




*Pain during throwing motion:  Pain can be aggravated during the throwing motion, making it uncomfortable and challenging for the athlete to throw with the same force and accuracy as before.


*Decreased throwing distance: The pain and limited range of motion can result in a decreased throwing distance. Athletes may find it difficult to generate enough power in their throws, leading to reduced velocity and a shorter distance covered by the ball.


*Altered throwing mechanics: To compensate for the pain and limitations, athletes with little league elbow may unknowingly alter their throwing mechanics. These changes can negatively impact their throwing technique, accuracy, and overall performance. Improper mechanics can also put additional stress on other parts of the arm and lead to further injuries.


*Difficulty with follow-through: Little league elbow can affect an athlete's ability to complete the full throwing motion and follow-through. This can result in a less fluid and natural throwing motion, affecting the overall efficiency and effectiveness of their throw.


* Decreased control and accuracy: Pain and limitations in the elbow joint can make it challenging for athletes to maintain control and accuracy in their throws. The lack of stability and discomfort can lead to erratic and inconsistent throws, affecting their ability to hit their intended targets.



Diagnosis of Little League Elbow:


Consulting a sports medicine physician is necessary. X-rays and other imaging tests like MRI may be necessary to assess the condition accurately. Diagnostic findings on X-rays may include:


1.      Medial Epicondyle Apophysitis: This is a condition where the growth plate on the inner side of the elbow becomes inflamed and irritated. X-rays may show widening or irregularity of the growth plate.


2.      Osteochondritis Dissecans (OCD): OCD is a condition where a small piece of bone and cartilage becomes detached from the joint surface. X-rays may show loose bodies or fragments in the joint space.


3.      Joint Space Narrowing: Overuse and repetitive stress on the elbow joint can cause narrowing of the joint space. This can be seen on X-rays as a decrease in the space between the bones of the elbow.


4.      Bone Spurs: Chronic irritation and stress on the elbow joint can lead to the formation of bone spurs. These are bony outgrowths that can be seen on X-rays.


5.      Elbow Dislocation: In severe cases, repetitive stress on the elbow can result in a dislocation. X-rays can help determine the extent of the dislocation and any associated fractures.


It's important to note that X-ray findings alone may not provide a complete picture of the extent of the injury. Accurate diagnosis of medial epicondyle apophysitis requires bilateral radiographs to compare the patient’s anatomy and evaluation for an avulsion fracture. Other imaging tests, such as MRI, may be necessary to evaluate soft tissue structures, such as ligaments and tendons, which cannot be seen on X-rays.  CT and MRI are only indicated for medial epicondyle avulsion fractures or symptoms not responding to therapy. They are helpful in more accurately determining the degree of epicondylar displacement and the need for operative versus non-operative management.  In older athletes with near closure of the growth plate, an MRI may be indicated to evaluate for concurrent UCL tear. Additionally, the clinical presentation and symptoms of the individual should also be taken into consideration for accurate diagnosis and treatment.

Treatment for Little League Elbow


  • Rest and activity modification: The first step in treating little league elbow is to rest the affected elbow and avoid activities that exacerbate the pain. This may involve a temporary break from throwing or participating in overhead sports. This may extend from 4-8 weeks.


  • Casting/Bracing: May be indicated for 4-6 weeks with avoidance of activity. After refraining from activity and if the athlete is pain-free, physical therapy may be initiated; focusing on elbow and shoulder strengthening exercises with a gradual return to a throwing program over the subsequent 6 weeks. Limitations on throws/pitching may be indicated. Avulsion fractures of the medial epicondyle responds well to nonoperative treatment.


  • Surgery:  If the patient develops elbow laxity, instability, or greater than 75% displacement, the patient may require surgical management with open reduction and internal fixation (ORIF).


  • Physical therapy:  can provide exercises to stretch and strengthen the shoulder-elbow muscles, improve range of motion and strength and promote proper shoulder-elbow mechanics. They may also use modalities such as heat or ice to reduce pain and inflammation.


  • Gradual return to activity: Once the pain has subsided and the shoulder -elbow has regained strength and flexibility, a gradual return to throwing or overhead activities is recommended. This should be done under the guidance of a healthcare professional or physical therapist to prevent re-injury.


  • Technique correction: Athletes may need to modify their throwing or overhead technique to reduce stress on the elbow joint. Proper mechanics and throwing form can help prevent future episodes of little league elbow.


  • Prevention strategies: Coaches, parents, and athletes should prioritize injury prevention strategies such as proper warm-up and cool-down exercises, regular strength training, and monitoring workload to avoid overuse injuries.

Athletes experiencing symptoms of Little League Elbow should consult a healthcare professional for an accurate diagnosis and personalized treatment plan. Early intervention and proper management are crucial for promoting healing, preventing further damage, and ensuring a safe return to sports.

Athletic Edge and Wellness, Illinois Baseball Edge, and 1Top Prospect in Algonquin IL are your professional throwing partners in elite baseball/softball performance and arm care through the continuum of ages and competition levels.  We offer team and hyper-personalized private instruction to help players move better, maximize training progressions, and more efficiently navigate the college recruitment process.  Our services include player centric training on elements such as velocity, command, secondary pitch, arm care, recovery (including Normatec), physical therapy, performance therapy, strength and mobility, and consulting that provides personal attention to student-athletes on their collegiate recruiting journey.  These services are offered under one roof.  Come experience the difference with a professional staff that is world class, tightly aligned, and able to collaborate for superior results.

Located at 1213 S. Main St. Algonquin, IL @ 224-505-3343






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