What is Little League Elbow: Causes, Symptoms, Non-Surgical & Surgical Treatment, Recovery, Prevention, Diagnosis

Little league elbow is an overuse injury or condition caused by stress to the elbow leading to irritation and inflammation to the growth plates particularly in youths⁽¹⁾. In individuals who are skeletally immature, such as the teens, the growth plates are more prone to injury than the tendons and ligaments surrounding the elbow^{(2, 7)}. The Little League Elbow is generally noticed in youth overhand pitchers, but it can also be seen in players involved in tennis, baseball and softball games⁽²⁾. Any persistent elbow pain in the young throwing people should be referred to sports medicine specialist or an orthopedist.The specialist would want to know the sports history of the child, the types of sports the child plays and how often he/she is involved in pitching and throwing. The doctor then may take up physical examination of the elbow to ensure whether the elbow is freely moving around or not. He would try to pinpoint where the pain is exactly and try to observe if there is any swelling. Depending upon the need, an X-ray may be recommended to observe any changes that may have occurred at the point of meeting of cartilage with bones and damage, if any, to the growth plate.⁽²⁾

The elbow is a complex joint where the three bones (humerus, radius and ulna) come together and converge⁽³⁾. The radius is on the outer side of the elbow; whereas, the ulna is on the inner side of the elbow and it also includes the olecranon, the tip of the elbow that one can feel. Many ligaments and muscles around the elbow significantly contribute to its stability and function. Many growth plates can be seen in the elbow; and in younger adults all their elbow growth plates do not reach skeletal maturity. Excessive elbow stress during certain movements, such as throwing, leads to increased compressive forces on the inner side of the elbow leading to the condition known as little league elbow in young adults and ulnar collateral ligament injuries in mature adults.

Repeated overhead throwing without proper rest, pitching too much, adopting improper mechanics while pitching and throwing, throwing with lack of muscle strength in shoulder are some of the factors contributing to the Little League Elbow Injury.⁽⁵⁾ When any such condition is noticed, then it should be immediately brought to the notice of medical sports specialist, else the condition can worsen resulting in damage to the bone and sometimes it may damage both bone and ligament. The chances for premature closure of the growth plate or fracture of the growth plate might be there in the patient requiring casting or surgery. With proper rest and dedicated rehabilitation program, the child can get complete relief from Little League Elbow, but in serious cases surgery may be needed^.(7)

• Pain caused by pitching or throwing on the inside of the elbow.^{(6, 7)}
• Difficulty in extending the elbow completely.
• Swelling to the inner elbow accompanied by stiffness.⁽⁶⁾
• Decreased throwing speed and/or accuracy.⁽⁷⁾
• Development of a bump on the elbow side.
• Increase in intensity of pain while throwing and usually becoming worse with continued throwing or pitching.⁽⁶⁾
• Stiff or a locked elbow.

The orthopedician or sports medical specialist after carrying out a complete physical exam may order certain imaging tests like X-ray and MRI.

X-ray: It is the most common test for an elbow injury. It reveals whether there is any bone damage, fracture, dead bone or irregularities in the growth plate and hence helps with the diagnosis of Little League Elbow.

Magnetic Resonance Imaging (MRI): Compared to X-Ray, it provides more detailed image of the bones and soft tissues. Tendons and ligaments can be seen in MRI leading to accurate diagnosis.

Once the diagnosis of Little League Elbow is made, then the best possible treatment plan can be designed by the doctor.

Rest⁽⁶⁾: Little league elbow can be treated by giving rest to the elbow. Care should be taken not to throw at all until the complete healing of ligaments, tendons and growth plates is achieved.

Cold Application: Applying ice to the inflamed or swollen part of the elbow multiple times a day can help in reduction of inflammation until the pain is relieved.

Physical Therapy: Physical therapy is also recommended by a few doctors and helps in strengthening of muscles around the elbow, arms and shoulders.

Surgery may be required if the elbow problem is caused by a painful accident. Seriousness of the injury and young one’s specific problems will decide the type of surgery to be undertaken. The surgery might involve attaching of the ligaments back to the elbow bone or ensuring that there are no more loose bones.

Recovery from surgery for Little League Elbow might take two to four months involving follow-up appointments, physical therapy and well planned gradual return to throwing.

Certain institutes conduct a video throwing analysis where they are able to perform a two-dimensional video analysis of throwing motion of the child. Trained therapists in this field are able to break down the phases of throwing motion to find out if any deficiencies.

Once cleared to return to throwing by the doctor, the athlete undergoes a progressive throwing program slowly increasing the forces and demands of the arms and shoulders.

Normally it may take around 2 to 4 months time for an injured person to return to competitive throwing. Immediately upon recovery, care should be taken to ensure excessive number of pitches is not done by the pitcher. The number of pitches may be gradually increased over a period of time. It is advisable to avoid higher stress pitches like a breaking ball or curve ball until the pitcher attains appropriate age. The shoulder and core strengthening program should be continued round the year for maintaining and further development of strength and muscle control.

Less Pitching^{(1, 4)}: Pitching involves speed and strength of the elbow motion, which leads to overuse injury and results in Little League Elbow. So, there should be a limit to the pitch count, which has been set by USA Baseball for different age groups restricting the number of pitches followed by proper rest and is an excellent strategy to prevent Little League Elbow.

Modifications in Pitching Mechanics^{(1, 4)}: Pitching has no perfect from; however, there are many ways to better the movements used when pitching to prevent Little League Elbow. For example, a side-arm delivery pitch puts more strain on the elbow and causes shoulder or elbow pain in majority of the pitchers who pitch in this manner, i.e. in a horizontal way. While pitchers who use overhead delivery, i.e. more vertical movement, have less issues with elbow and shoulder pain. So, to prevent Little League Elbow, the pitchers should be trained to ditch the side-arm and throw more overhead pitches.

Weakness and stiffness in some parts of your body leads to inefficient movement of your body and hence causes stress to your elbow. So, these issues should be tackled and the weak areas should be strengthened so that when you pitch, the movement is effortless and puts less stress on your elbow and thus prevent Little League Elbow. The shoulder, thoracic and hip muscles should be strengthened and their flexibility should be increased to prevent stress while pitching.

While it is to understand one cannot completely prevent sports injury or accidents, practice of rest, use of the correct mechanics and strengthening of arms and shoulders can reduce chances of injury to a considerable extent.

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