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What is Little League elbow?

Little League elbow is a broad term that generally refers to an injury to the elbow’s tendons, ligaments and/or bones in a young, throwing athlete. Most of the time, the injury is due to overuse, but it can also be caused by a single, painful injury. Other conditions that are sometimes grouped with little league elbow are:

  • medial epicondylitis (also known as medial epicondylar apophysitis)
  • medial epicondyle fracture
  • medial collateral ligament injury.

Young athletes who play sports like baseball that require a lot of overhand throwing are more prone to getting it, and it’s usually caused by overuse or poor throwing technique. Learn more about the symptoms and causes of Little League elbow.

Your child should not be playing through elbow pain, especially if he plays on multiple teams. In most cases, Little League elbow treatment does not require surgery, but in some cases a child may have a fracture to a part of the elbow, and he/she may need surgery.

Little League Elbow | Symptoms & Causes

Elbow joints are made up of three bones — the upper arm bone is connected to the two bones in the forearm by a joint that works like a hinge. Around all these bones are muscles, ligaments, and tendons that keep the keep it all together, and help the arm bend and move.

Pitching too much and too often, or simply throwing in a way that hurts the arm, can put a lot of stress on these tendons, ligaments, and bones. There are several little soft areas of cartilage, called apophyses, at each end of most bones, and as older children stop growing, these areas turn into bone and harden. But before they harden, they are very easy to injure, and when players — mostly ages 9 to 14 — throw too much, these areas can get inflamed and sore.

This is the anatomy of an elbow.

Signs and symptoms of Little League elbow

Little League elbow symptoms may include:

  • pain in any part of the elbow
  • swelling
  • difficulty straightening the arm all the way
  • sometimes, a bump appears on the inside of the elbow
  • a locked or stiff elbow

Without treatment, the ligaments and tendons may tear away from the bone or parts of the bone can separate from each other. Continuing to play through this kind of pain can make the injury worse, and your child should stop throwing and see a doctor if he has the above symptoms.

Throwing guidelines

One of the most important things to know about Little League elbow is that it can be prevented. Just by limiting the amount your child throws, you can prevent injury from happening. Even if your child already has Little League elbow, these prevention guidelines can help him stay healthy when he returns to the sport.

USA Baseball has come up with pitch counts for young athletes. These guidelines should be applied to practices, games, and multiple leagues as well. For proper reset, pitchers should not pitch on consecutive days, and should have three months a year without pitching.

  • 9- to 10-year-old pitchers: 50 pitches per game, 75 pitches per week, 1,000 pitches per season, 2,000 pitches per year
  • 11- to 12-year-old pitchers: 75 pitches per game, 100 pitches per week, 1,000 pitches per season, 3,000 pitches per year
  • 13- to 14-year-old pitchers: 75 pitches per game, 125 pitches per week, 1,000 pitches per season, 3,000 pitches per year

More guidelines have been established in order to ensure proper rest time between pitching as well:

  • For pitchers ages 7 to 16:
    • 61 or more pitches in a day should be followed by four days of rest time
    • 41 to 60 pitches in a day should be followed by three days of rest time
    • 21 to 40 pitches in a day should be followed by two days of rest time
    • 1 to 20 pitches in a day should be followed by one day of rest time
  • For pitchers ages 17 and 18:
    • 76 or more pitches in a day should be followed by four days of rest time
    • 51 to 75 pitches in a day should be followed by three days of rest time
    • 26 to 50 pitches in a day should be followed by two days of rest time
    • 1 to 25 pitches in a day should be followed by one day of rest time

Little League Elbow | Diagnosis & Treatments

How do we diagnose Little League elbow?

Your child’s doctor will want to know all about his sports history:

  • how many sports he plays each year
  • how many leagues per sport
  • how often he throws on a weekly basis

The doctor will examine the elbow to see how well it moves around, where the pain is, and whether there is swelling. An x-ray will show any changes that might have occurred where the cartilage meets the bone and any damage to the growth plate.

When should an orthopedist or sports medicine specialist be consulted about Little League elbow?

Any persistent elbow pain in the young throwing or overhead athlete should be evaluated by an orthopedist or sports medicine specialist.

Most athletes with Little League elbow can be treated with rest and physical therapy, but in more serious cases, surgery is needed.

How do we treat Little League elbow?

Without surgery

  • The most important part of Little League elbow treatment is rest. Your child should not throw at all until his tendons, ligaments, and growth plates are fully healed.
  • Often, icing the elbow multiple times a day can help reduce inflammation until there is no pain.
  • Your doctor may also prescribe physical therapy, which can help strengthen the muscles around the elbow.

With surgery

  • If your child's elbow problem is because of a single, painful accident, then surgery may be necessary. The kind of surgery required depends on your child's specific problem and the seriousness of the injury.
  • It might involve attaching the ligaments back to the bone or making sure there are no more loose bone.
  • Recovery usually lasts two to three months, and involves follow-up appointments, physical therapy, and a very careful, gradual return to throwing.

Tommy John surgery refers to reconstruction of the ulnar collateral ligament (UCL) of the elbow.

How can parents and coaches prevent UCL injuries?

Prevention is worth a pound of cure, and this is certainly true of UCL injuries such as Little League elbow in young throwers.

Following USA Baseball's guidelines regarding pitch counts and types of pitches thrown is important. Attention to throwing mechanics and conditioning of the lower body, core, shoulder, and elbow is also important. In addition, year-round baseball participation on multiple teams increases the risk of elbow injuries like UCL tears. Finally, athletes should not throw in pain.

Learn more about preventing common baseball injuries with Boston Children’s Injury Prevention guide.

More information is also available in a Sports Illustrated feature about Boston Children's approach to Tommy John surgery.

How Boston Children’s Hospital approaches Little League elbow

At Boston Children’s Hospital, our doctors specialize not only in orthopedic care, but in pediatric orthopedic care. Our clinical experts lead the country in research and care, and have the pediatric orthopedic expertise to treat the unique needs of children and young adults' musculoskeletal systems.

You can have peace of mind knowing that the skilled experts in our Hand and Orthopedic Upper Extremity Program have treated thousands of babies and children with many arm conditions. We provide expert diagnosis, treatment and care, and we benefit from our advanced clinical and scientific research.

Each year, our orthopedic team attends to more than 100,000 patient visits and performs over 6,000 surgeries. While assessing Little League elbow, our doctors search for signs that change with age and maturity level and deliver the most precise diagnosis possible so children can get back to their lives.

Little League Elbow | Programs & Services