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Pediatrics - Little League Syndrome, Pitcher's Elbow

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Introduction

Little League elbow, also called Pitcher’s elbow, results from excessive throwing motions used in sports.  It most frequently occurs in baseball, but is associated with other sports that involve throwing.  Pitcher’s elbow causes pain and interferes with motion.  Many cases of pitcher’s elbow respond to rest and nonoperative treatment.  If left untreated, Pitcher’s elbow can lead to significant problems that require surgery.
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Anatomy

 
The two bones in your child’s forearm, the ulna and radius, and your child’s upper arm bone, the humerus, form his or her elbow joints.  Muscles, nerves, tendons, and ligaments allow your child’s elbow joints to bend, straighten, and rotate.  Tendons are strong fibers that attach muscles to bones, and ligaments connect bones to each other.
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Causes

Pitcher’s elbow occurs in players that participate in sports that require repetitive throwing.  It most frequently affects pitchers, but may also develop in outfielders, catchers, and infielders.  Pitcher’s elbow is associated with other sports as well, including tennis and football. 
 
Pitcher’s elbow, also called Little League elbow because it occurs in children and teenagers that play sports, is especially concerning for this population because their bones are growing and injuries can affect the growth process.  Additionally, their skeletal systems may not be developed enough for the demands of competitive sports.
 
Pitcher’s elbow results when repetitive throwing puts an excessive strain on the tendons and ligaments in the elbow.  The strong movements can cause the ligaments and tendons to stretch, tear, or pull away from the bone.  If some of the bone is also torn away in the process, it can interfere with normal bone growth and cause deformity.  If the forces are great enough, the bones may slam together, causing the bones or cartilage to fracture, and resulting in a condition called osteochondrosis dissecans.
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Symptoms

Pitcher’s elbow causes pain on the inner side of the elbow.  Your child’s elbow joint may feel like it locks or gets stuck.  It may be difficult for your child to move the elbow as he or she did before, and it will affect your child’s pitching performance.
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Diagnosis

Your doctor can diagnose pitcher’s elbow by reviewing your child’s medical history and examining your child’s elbow.  You should tell your doctor about your child’s sports participation, the number of throws your child typically perform, and the length of your child’s practice or playing season.  This information will help your doctor determine the magnitude of stress on your child’s elbow.  X-rays or magnetic resonance imaging (MRI) scans will be ordered to view your child’s elbow structures.
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Treatment

Your child should stop performing throwing activities and allow his or her elbow to rest if your child experiences pain.  Ice packs may help relieve pain and swelling.  Following rest, throwing should be returned to gradually.  Therapy can be helpful, and sometimes a review of your child’s pitching motion may be beneficial.  If your child’s pain persists or recurs with throwing activities, you should consult your doctor.
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Surgery

Arthroscopy can both diagnose and treat conditions associated with pitcher’s elbow.  Arthroscopic surgery uses an arthroscope and narrow surgical instruments that are inserted through small incisions.  An arthroscope contains a lens and lighting system that allow a surgeon to view inside of a joint.  A miniature camera allows the surgeon to view the magnified images on a video screen or take photographs and record videotape.  Arthroscopic surgery is associated with shorter recovery times and less pain and bleeding than open procedures.  Following surgery, physical or occupational therapy is helpful for regaining mobility, strength, and function.
 
Arthroscopic surgery is not appropriate in every case, with some problems requiring open procedures.  Your doctor will discuss the type of surgery that is best for your child’s particular problem.
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Recovery

Recovery from pitcher’s elbow is different for everyone.  It depends on the extent of your child’s condition and the type of treatment that your child receives.  Most players can return to play when their rehabilitation is complete.  Your doctor will let you know what to expect.
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Prevention

Your child may prevent pitcher’s elbow by taking breaks from pitching, limiting his or her amount of throwing, and altering his or her throwing motion, if necessary.  Your child should be sure to warm-up before pitching.  Your child should exercise to keep his or her arm strong and flexible. 
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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on February 16, 2022. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.

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Lisa R. Reznick MD, PA

Board Certified Orthopedic and Hand Surgeon

4100 Fairway Court, Suite 120
Carrollton, TX 75010
Phone: (972) 395-9000
Fax: (972) 395-9002

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In Carrollton, TX, board-certified orthopedic surgeon Dr. Lisa Reznick offers conservative treatment options for all types of general orthopedic issues, while specializing in surgeries of the hand, wrist, and elbow.