Elbow > Little League Elbow

What is Little League Elbow?                                                                                     

Little League elbow, so called because it is most common among young baseball pitchers, is a process of chronic damage to the joint surfaces. Young pitchers's elbows are immature. They have open growth plates with a tenuous blood supply, which makes their elbows susceptible to ligament pulls. The age group most affected by Little League elbow is pre-high school, from ages 10 to 15, with the peak incidence in the 12-to-14 age group. Little League elbow involves an overload on the medial side of the elbow, so that the ligament attached to the growth plate starts to pull away. On the other side of the elbow, compression can cause a condition called osteochondritis dissecans, in which damage is followed by poor blood flow and small areas of bone death. The true definition of Little League elbow is when both these components happen together — some elongation of the ligament structures and changes in the growth plate on the medial side, along with some bony debris and damage to the outer half of the elbow. In some circumstances, the medial elbow will suffer a several-millimeter separation. More often, the affected elbow will become sore and show a little extra widening of the growth plate as compared with the unaffected, non-throwing arm.

Causes                                                                                                                              [top]

The problem with young pitchers is that in many cases they are either throwing too hard too often or trying to build up their endurance too quickly. Most of the time, adolescent arm problems can be linked to a sudden increase in the intensity or duration of activity. For example, a player may decide that baseball is going to be his preferred sport, so he goes from playing with a high school team to playing on two summer teams in addition to his high school team. Now he is playing three times as often, throwing three times as much. This affliction also happens in cases where a player changes leagues and the pitcher's mound is farther from home plate or the mound is elevated. Sometimes a change of coaches causes a pitcher to end up with a sore arm. The way baseball has taken over as a year-long sport has resulted in an accompanying increase in arm complaints. The overhand motion of throwing a baseball causes the elbow to stressed at the moment of full extension – that is, when the arm is fully cocked back, just prior to the moment the arm and the body move forward in the throwing motion. The medial (inside) side of the elbow experiences tension, while the lateral (outside) side experiences compression. This combination of forces can stress the growth plate on the inside of the elbow. In young people, the growth plate has not yet fully fused with the humerus, and thus is vulnerable to irritation. In addition, microscopic tears can result in the muscle and lead to tendinitis. Adults don’t suffer from Little League elbow because their growth plate has fused with the humerus. Instead, adults are susceptible to tears of the ulnar collateral ligament (UCL).

Considerations                                                                                                                [top]

Left untreated, Little League elbow can lead to further problems. If the ligament heals while pulled away from the growth plate, a knob may be left, creating the potential for tendinitis later in life. More worrisome, however, is the prospect that the player may develop damage to the growth plate on the outside of the elbow. Those problems sometimes do not get better with time and will lead to an arthritic process in the joint. Loose bodies are the long-term result of chronically damaging that growth plate on the outer part of the elbow.

Orthopedic Evaluation

There usually are three parts to an orthopedic evaluation: medical history, a physical examination, and tests that your doctor may order.

MEDICAL HISTORY

Your physician likely will ask about your activities, which may be causing the pain in your elbow. He or she will probably ask when the soreness and/or pain began. If you have had any prior elbow injuries, your physician will ask about the treatments you have tried in the past.

Physical Exam                                                                                                                 [top]

Your physician will feel around your elbow to look for physical evidence of damage and to isolate the source of pain.

Tests

X-rays often show some of the bony changes that take place and can help your physician make a more complete diagnosis.