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Little Leaguer's Elbow (Medial Apophysitis)

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KEY POINTS

  • Little Leaguer's elbow is an injury to the upper arm bone at the elbow, usually caused by too much pitching or throwing.
  • The most important treatment is resting the arm for 1 to 3 months. Your healthcare provider may recommend stretching and strengthening exercises and other types of physical therapy to help your child heal.
  • Treatment may include medicine, an elbow brace, ice, or sometimes surgery.

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What is Little Leaguer's elbow?

Little Leaguer's elbow is an injury to the upper arm bone at the elbow. It happens to young athletes who are still growing.

This problem is also called medial apophysitis.

What is the cause?

Little Leaguer's elbow is caused by overuse of the arm, usually from too much pitching or throwing. The bones of young children are still growing. Repeated throwing causes wear and tear on the new, weaker bone in the elbow. In severe cases, the growing bone may break away from the rest of the upper arm.

Children who play baseball year-round are more likely to have overuse injuries.

What are the symptoms?

The main symptom is pain at the inner side of the elbow. Your child may have swelling, and the elbow may be tender to touch.

How is it diagnosed?

Your child’s healthcare provider will ask about your child’s symptoms, medical history, and activities and examine your child's arm. Tests may include:

  • X-rays of the arm
  • CT scan, which uses X-rays and a computer to show detailed pictures of the arm
  • MRI, which uses a strong magnetic field and radio waves to show detailed pictures of the arm

How is it treated?

The most important treatment is resting of the arm. Depending on how severe the injury is, your child may need to stop throwing for 1 to 3 months, limit the number of throws, or limit playing time. During this time, your healthcare provider may recommend stretching and strengthening exercises and other types of physical therapy to help your child heal.

If there is a break in the bone, your child may need surgery.

The pain often gets better within a few weeks with self-care, but some injuries may take several months or longer to heal.

How can I help take care of my child?

Follow the full course of treatment prescribed by your healthcare provider. To keep swelling down and help relieve pain:

  • Put an ice pack, gel pack, or package of frozen vegetables wrapped in a cloth on the injured area every 3 to 4 hours for up to 20 minutes at a time for the first day or two after the injury.
  • Give your child nonprescription pain medicine, such as acetaminophen, ibuprofen, or naproxen. Read the label carefully and give your child the correct dose as directed.
    • Nonsteroidal anti-inflammatory medicines (NSAIDs), such as ibuprofen and naproxen, may cause stomach bleeding and other problems. Read the label and take as directed. Unless recommended by your healthcare provider, your child should not take the medicine for more than 10 days.
    • Check with your healthcare provider before you give any medicine that contains aspirin or salicylates to a child or teen. This includes medicines like baby aspirin, some cold medicines, and Pepto-Bismol. Children and teens who take aspirin are at risk for a serious illness called Reye's syndrome.
  • Use an elastic elbow wrap to give the elbow more support.

Follow your healthcare provider's instructions, including any exercises recommended by your provider. Ask your child’s healthcare provider:

  • How and when you will get your child’s test results
  • How long it will take for your child to recover
  • If there are activities your child should avoid and when your child can return to normal activities
  • How to take care of your child at home
  • What symptoms or problems you should watch for and what to do if your child has them

Make sure you know when your child should come back for a checkup.

How can I help prevent Little Leaguer's elbow?

Make sure your child starts stretching 4-6 weeks before the season begins.

The best way to prevent little leaguer's elbow is to limit how much your child throws. If your child is a baseball pitcher, be sure to follow the guidelines for how many pitches or innings a child can throw in a week. In general:

  • A child under the age of 14 should pitch no more than 6 innings a week and should throw no more than 85 pitches per week.
  • A child age 15-16 should pitch no more than 9 innings a week and should throw no more than 95 pitches per week.

Pitchers age 14 and under must rest as follows:

  • If a player pitches 66 or more pitches in a day, rest for 4 days.
  • If a player pitches 51-65 pitches in a day, rest for 3 days.
  • If a player pitches 36-50 pitches in a day, rest for 2 days.
  • If a player pitches 21-35 pitches in a day, rest for 1 day.
  • If a player pitches 1-20 pitches in a day, no rest is needed.

Pitchers age 15-16 must rest as follows:

  • If a player pitches 76 or more pitches in a day, rest for 4 days.
  • If a player pitches 61-75 pitches in a day, rest for 3 days.
  • If a player pitches 46-60 pitches in a day, rest for 2 days.
  • If a player pitches 31-45 pitches in a day, rest for 1 day.
  • If a player pitches 1-30 pitches in a day, no rest is needed.

Your child needs to be sure he or she is not throwing hard while playing another position such as shortstop, while practicing, or while playing other sports. It’s also very important for your child to learn proper pitching technique.

Children should not play through pain. If your child’s arm hurts, your child should stop throwing.

Developed by Change Healthcare.
Pediatric Advisor 2019.4 published by Change Healthcare.
Last modified: 2018-12-18
Last reviewed: 2018-12-18
This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.
© 2018 Change Healthcare LLC and/or one of its subsidiaries
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