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Little Leaguer’s Elbow

Overview

Most people in baseball have heard the term “Little Leaguer’s Elbow” but don’t understand what it truly is. Little Leaguer’s Elbow is a term first coined in 1960 that describes a condition caused by repetitive throwing motions, especially in children who play sports that involve throwing.  

MECHANISM OF INJURY

The pitching motion that causes a valgus stress to the inside elbow joint is resisted by the UCL. The UCL is attached to the bone in a location that includes a growth plate called the medial apophysis. This is also the location where the forearm muscles attach, which adds additional stress to the growth plate. The growth plate is intrinsically weaker than adult bone that has matured and stopped growing. For kids, the growth plate is the weak link in the chain. Adult pitchers do not experience the same injury because they do not have the relatively weak open growth plate in the elbow. Instead, a more common injury in adult athletes is direct injury to the UCL, an injury that often requires Tommy John Surgery for the athlete to resume high-level competitive throwing. (Click this link to learn more on Tommy John Surgery)

PLAYER EVALUATION & DIAGNOSIS

Team Ahmad will perform a very brief history for patients who present to the office for evaluation of their elbow pain. They obtain the patient’s demographic information, such as what sport they play, how many teams they play on, what position they play, and what and where it hurts and for how long. Sometimes, the most important piece of information is simply what the patient’s age is. If the patient’s age is between twelve and fourteen, the sport is baseball, and the location of pain is the elbow, the issue is most likely to be a condition called Little Leaguer’s Elbow.
There is a very unique situation where there is an overlap between a young athlete who’s developing increased height/weight/body mass and strength with increasing throwing velocity. This overlaps with persistent skeletal growth in the growing child. The area where the bone grows is weaker than tendons and ligaments; therefore, the twelve- to fourteen-yearold has a perfect window where he or she is throwing harder and generating more force on the elbow, but the elbow is still vulnerable at the growth plate and becomes injured.

SIGNS & SYMPTOMS OF LITTLE LEAGUER’S ELBOW

Patients often present to the office for evaluation of pain because it stops their ability to play. They explain that they’ve been throwing and, after some detective work, I usually discover a history of excessive throwing and a sense that the throwing is becoming harder with more velocity. The patient can easily point to the location of pain on the inside part of the elbow. It only hurts with throwing and, typically, doesn’t hurt with routine activities such as carrying books, or other activities such as homework.
The examination is specific for two things: There is usually no ecchymosis or bruising and swelling, and no limitations in motion, but there’s simply direct tenderness when pushing on the area of bone at the growth plate and pain when stressing the elbow that puts tension on the growth plate
X-rays reveal that the area of the growth plate, which is usually one to two mm in thickness, has increased in size and may be double the normal width. MRI scans are usually not necessary as the diagnosis is made simply from the history, physical exam, and X-rays.

NON-OPERATIVE TREATMENT

Treatment can be frustrating for the player, the family, coaches, and even for the doctor.
The treatment is to stop throwing for four to six weeks while working on core and leg strengthening, and shoulder and elbow strengthening. Then, at four to six weeks, if the examination shows a return to normal, a progressive throwing program with optimized throwing mechanics is initiated. It can be an additional six weeks before the athlete can be game-ready; therefore, the non-operative treatment can take three months and, unfortunately, in some situations, well over nine months, and sometimes even twelve.

OPERATIVE TREATMENT

In some situations, although it’s much less common than standard Little Leaguer’s Elbow, the growth plate bone can actually be ripped off and fractured from the attachment site. The muscles, which also attach to the bone, tend to displace the fractured bone. If this occurs, then it creates an instability problem at the elbow where getting back to throwing can be very challenging without pain. In addition, there are situations where the bone may actually not heal, and that, also, can be a very painful situation and a difficult surgical challenge. Therefore, if the bone is fractured, surgery is recommended. The bone is put back to its normal position and fixed with a screw that holds it in place while it heals and allows early and aggressive range of motion.
Unfortunately, once or twice a year, I take care of a throwing athlete who had a fracture of this growth plate that was not treated surgically and failed to heal on its own. To correct this unhealed bone fracture, I have to surgically remove extensive scar tissue to get the bone fragment back into its normal position. The bone fragment is often deformed and fragile and requires a delicate balance of placing forceful screws to ensure it heals while avoiding too much screw pressure that will simply crush and fragment the bone.

Dr. Ahmad performed 2 different surgeries on my daughter at 2 different times. She had excellent outcomes both times. She is a high level gymnast and needed to be seen by the best. Dr. Ahmad is the best.

Mary Louise Lea

Dr Ahmad is extremely knowledgeable and professional! I highly recommend him and his staff. They were very supportive throughout my son’s recovery from UCL surgery!

Anonymous

Dr Ahmad came into each appointment up to date on my file, ready to discuss how treatment was progressing and fully engaged on my rehabilitation. He listened attentively to my feedback and was efficient without being rushed. Thanks to his medical care, I’m in better shape than I was before injury.

Anonymous

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