Little League elbow

Little League elbow, also called medial epicondyle apophysitis, is an overuse injury from repetitive overhand throwing in kids. It mostly affects pitchers younger than sixteen. The throwing motion creates a valgus stress on the inner elbow, which can pull apart the growth plate (medial epiphyseal plate). Adults don’t get this because they lack that growth plate; instead, they tend to injure the ulnar collateral ligament.

The term was introduced by Brogdon and Crow in a 1960 article, linking it to baseball. Compared to other sports, baseball players face higher risks of overuse injuries, especially from early sports specialization. The 1960 diagnosis raised questions about how much young players should pitch. In 2007, Little League Baseball set daily pitch limits to protect against overuse.

Signs and symptoms

Signs and symptoms include aching or sharp pain on the inner elbow after pitching, sometimes with swelling. Over time, symptoms may come and go without warning, even at lower throwing speeds. Throwing velocity might drop.

Mechanism

The mechanism involves repetitive overhead throws damaging the growth plate at the elbow joint. This can appear as delayed plate closure, widening, or an acute fracture.

Diagnosis

Diagnosis is usually based on physical exam and history, though X-rays are often abnormal and may show widening, fragmentation, or avulsion of the medial epicondyle apophysis. Key clues include repetitive, high-volume overhand throwing.

The exam may show tenderness, swelling, limited elbow extension, and stiffness. X-rays can check if the growth plate is still open, reveal loose bone chips, or show early arthritis. They also help rule out other problems like a traumatic fracture of the medial epicondyle.

Prevention

To prevent Little League elbow, athletes should stay active and fit year-round, with a 3–6 month break from throwing each year. Pitchers should follow Little League pitch count guidelines, including warmup and non-pitching throws. After pitching, they need one or two days of arm rest and should avoid other high-demand throwing positions like catcher. Proper throwing form and avoiding offspeed pitches also reduce elbow stress.

Treatment requires rest, rehab, and a gradual return to throwing. Athletes must stop all overhead throwing for 4–6 weeks, using ice for pain and swelling. NSAIDs are usually unnecessary with proper rest.