Little Leaguer's Elbow
Aka: Little Leaguer's Elbow, Apophysitis of the Medial Epicondyle

  1. Definition
    1. Medial epicondyle Apophysitis in child pitchers
  2. Epidemiology
    1. Most common in ages 9 to 12
  3. Mechanism
    1. High risk injury in child pitchers
  4. Pathophysiology
    1. Medial elbow
      1. Ulnar ligament avulsed
      2. Pulls medial epicondyle from physis
    2. Lateral elbow (secondary to changes at medial elbow)
      1. Capitellum compresses into radial head
  5. Symptoms
    1. Medial elbow pain with throwing a ball
    2. May effect pitch speed and accuracy
  6. Signs
    1. Decreased elbow range of motion
    2. Localized swelling and tenderness
  7. Imaging: XRay elbow with comparison view of opposite side
    1. Often normal
    2. Findings suggestive of Apophysitis
      1. Medial epicondyl hypertrophy
      2. Widening or avulsion at apophysis
  8. Diagnosis
    1. Clinical diagnosis based on suspicion despite XRay
  9. Management
    1. No throwing for 4-6 weeks
    2. Gradually advance throwing after 4-6 weeks of rest
  10. Prevention
    1. Allow for adequate recovery between outings
    2. Consider throwing mechanics evaluation
    3. Limit number of pitches per week and per outing
      1. Guidelines adjusted for age and pitch type
      2. AAP: 200 pitches/week and 90 pitches/outing
      3. USA-BMSAC: 125 pitches/week and 75 pitches/outing
  11. Orthopedic referral indications
    1. Osteochondritis dissecans
    2. Avulsion Fractures
  12. Complications
    1. Results in chronic injury and decreased function

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