Coach My Elbow Hurts

Posted by Dr. Podesta on February 17, 2011 with 96 Comments

Elbow pain is the most common complaint I am asked to evaluate in young throwing athletes in my practice. Unfortunately, the number of little leaguers I am evaluating for elbow pain has risen tremendously over the last few years. I attribute this to a number of problems. First, these young athletes are asked to throw more than their maturing muscles and bones can handle. Second, they do not get adequate rest after throwing to allow their muscles, ligaments and bones to recover. Third, they are either taught, or on their own, try to throw pitches that their bodies are not developed enough to throw properly. One or a combination of all these factors can contribute to the development of elbow problem in young throwers.

There are a number of problems that can occur in the young throwers elbow. The most common injury to the young elbow and the first I will discuss is Little Leaguer’s Elbow. Little Leaguer’s Elbow is actually an injury to a growth plate on the inside (medial) portion of the humerus bone in a skeletally immature child. Little Leaguer’s Elbow results from either a chronic stress to the growth plate or from a sudden pull on the growth plate by the muscles and tendons that attach to it (Figure 1).

Figure 1. Flexor forearm muscles pulling away the medial humeral growth plate.

These young athletes will frequently present with complaints of elbow pain and swelling localized to the inside or medial portion of the elbow. They will often complain of loss of elbow motion, numbness, tingling, pins and needles sensation in the hand. When they attempt to throw, they will find they have a loss of velocity of their throws and they have lost control of their throws.

The diagnosis of Little Leaguer’s Elbow is usually quite easy. The young prepubescent (skeletally immature) athlete will have tenderness at the medial humeral growth plate. This can be made worse with stretching the muscles that attach there.

Evaluating, and comparing, radiographs of both the injured and non-injured elbows confirm the diagnosis of Little Leaguer’s Elbow. Radiographs will show a separation of the medial humeral epicondyle (Figure 2).

Figure 2 Separation of the medial humeral epicondyle (arrow)

The treatment of Little Leaguer’s Elbow requires the athlete to stop all throwing activity, allowing the bone to heal. Since this is actually a fracture of the growth plate, treatment is similar to the treatment for most other fractures. Treatment initially will involve immobilizing the elbow for 10 to 14 days in a splint. After this short period of immobilization, range of motion exercises for the elbow can begin. Throwing does not begin until the fracture has healed. A progressive interval-throwing program is not started until the elbow is pain free, range of motion is complete and radiographs reveal a healed fracture, usually 6 to 8 weeks after the injury occurs.

Occasionally surgical treatment is necessary to repair the fracture. Surgery is indicated when the growth plate is significantly separated from the humerus bone.

When elbow pain develops in the young throwing athlete, it is extremely important to have the elbow evaluated. It is not sufficient to take a wait and see approach hoping the elbow pain will disappear. The majority of the time it is NOT just a sprain. If the underlying cause of the injury is not discovered or corrected, the risk of re-injury or permanent damage to the growth center is significant. Remember Kids Don’t Sprain They Break!

There are a number of warning signs of elbow injury that must be recognized:

  1. Pain in the elbow
  2. Loss of elbow motion
  3. Loss of control
  4. Loss of velocity
  5. Swelling of the elbow
  6. Inability to warm up
  7. Numbness, tingling, pins and needles sensation in the hand

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