Injuries in the Young Thrower's Elbow – Part I


[if gte vml 1]><v:shapetype id="_x0000_t75" coordsize="21600,21600" o:spt="75" o:preferrelative="t" path="m@4@5l@4@11@9@11@9@5xe" filled="f" stroked="f"> <v:stroke joinstyle="miter"></v:stroke> <v:formulas> <v:f eqn="if lineDrawn pixelLineWidth 0"></v:f> <v:f eqn="sum @0 1 0"></v:f> <v:f eqn="sum 0 0 @1"></v:f> <v:f eqn="prod @2 1 2"></v:f> <v:f eqn="prod @3 21600 pixelWidth"></v:f> <v:f eqn="prod @3 21600 pixelHeight"></v:f> <v:f eqn="sum @0 0 1"></v:f> <v:f eqn="prod @6 1 2"></v:f> <v:f eqn="prod @7 21600 pixelWidth"></v:f> <v:f eqn="sum @8 21600 0"></v:f> <v:f eqn="prod @7 21600 pixelHeight"></v:f> <v:f eqn="sum @10 21600 0"></v:f> </v:formulas> <v:path o:extrusionok="f" gradientshapeok="t" o:connecttype="rect"></v:path> <o:lock v:ext="edit" aspectratio="t"></o:lock> </v:shapetype><v:shape id="Picture_x0020_3" o:spid="_x0000_s1026" type="#_x0000_t75" style='position:absolute;margin-left:288.7pt;margin-top:13.95pt;width:170.5pt; height:208.9pt;z-index:251663360;visibility:visible;mso-wrap-style:square; mso-width-percent:0;mso-height-percent:0;mso-wrap-distance-left:9pt; mso-wrap-distance-top:0;mso-wrap-distance-right:9pt; mso-wrap-distance-bottom:0;mso-position-horizontal:absolute; mso-position-horizontal-relative:text;mso-position-vertical:absolute; mso-position-vertical-relative:text;mso-width-percent:0;mso-height-percent:0; mso-width-relative:page;mso-height-relative:page'> <v:imagedata src="file:///C:/Users/M/AppData/Local/Temp/msohtmlclip1/01/clip_image001.jpg" o:title="Jagger Luce - Baseball_071" croptop="9359f" cropbottom="2923f"></v:imagedata> <w:wrap type="square"></w:wrap> </v:shape><![endif][if !vml][endif]There is an increasing concern about overuse injuries in young athletes, particularly young throwers. These injuries occur gradually over time with repetitive motions like running, throwing and jumping. Athletes who specialize in a sport too early or don’t take rests, during the week or between seasons, are at risk of overuse injuries.

In this series, we are going to discuss these common elbow injuries:

[if !supportLists]· [endif]“Little Leaguer’s elbow” or medial epicondyle apophysitis

[if !supportLists]· [endif]Avulsion fracture of the medial epicondyle

[if !supportLists]· [endif]Osteochondritis dissecans (OCD)

[if !supportLists]· [endif]Olecranon apophysitis

[if !supportLists]· [endif]Ulnar collateral ligament (UCL) injuries

The elbow joint is made up of three bones: one bone in the upper arm bone (humerus) and two bones in the forearm (radius and ulna). Muscles, ligaments and tendons hold the elbow joint together. Cartilage is soft tissue found on bony surfaces inside the joint and in areas of young bones that are still growing.

The elbow joint has two motions. The hinge motion allows the arm to bend like the hinge of a door; the pivot motion helps the lower arm twist and rotate. The bones and soft tissues in a young athlete’s elbow are all at risk of injury.

Overuse injuries are preventable. Knowing more about them can help reduce the progression of the symptoms and in many cases prevent the onset of the symptoms. With early recognition, proper rest and treatment, most do not need surgery.

In this first installment, we will explain the most common diagnoses in a young thrower’s elbow: Little Leaguer’s Elbow and avulsion fractures of the medical epicondyle. In the rest of the series, we will talk about other conditions. [if !supportLineBreakNewLine]

Medial epicondyle apophysitis, commonly called Little Leaguer’s elbow, is typically caused by excessive throwing or insufficient rest between throwing activities. In certain positions, the tendons and ligaments pull on the growing bone on the middle side of the elbow. Repeated pulling can tear ligaments and tendons away from the bone. The tearing may pull tiny bone fragments with it in the same way a plant takes soil with it when it is uprooted. This can cause pain and instability with throwing. Oftentimes, the first sign of injury is that the athlete complains of pain on the inside “bump” of the elbow during or after activity like throwing. [endif]

Symptoms may include
  • Elbow pain with throwing or after activity

  • Pain and tenderness on the inside of the elbow (on the bump)

  • Soreness lasting days to weeks

  • Worsening control with throwing

  • Inability to throw desired distance

  • In later stages, may have difficulty fully straightening or bending the elbow

  • In later stages, may have locking of the elbow.

Treatment may include
  • Rest – continuing to throw may lead to major complications and jeopardize a child’s ability to remain active in a throwing sport

  • Ice for swelling

  • Proper stretching and strengthening

  • May require a cast or splint if the pain does not resolve with rest

  • Therapy for flexibility, strength, and core stabilization

  • Focused training to improve throwing form

  • Surgery to stabilize the medial epicondyle may be needed in cases of complete fracture

An avulsion fracture of the medial epicondyle occurs when the muscles and tendons pull off a piece of bone that is connected by cartilage to the main bone. A strong pull of the forearm muscles, during a pitch for example, can cause an avulsion fracture of the medial epicondyle on the inside of the elbow. This is different from Little Leaguer’s elbow because there is a distinct injury, usually a “pop” and immediate pain. However, many have a history of elbow pain prior to this injury. Symptoms may include

  • A pop or giving way

  • Immediate pain on inside of the throwing elbow

  • Immediate swelling and bruising is seen

  • Pain with wrist movement

  • Numbness or tingling in the ring finger and small finger

  • Inability to bend the elbow or pick up heavy objects

Treatment may include
  • Ice and anti-inflammatory medication for pain and swelling

  • For fractures that are in good position, a splint is recommended for 2-3 weeks

  • Surgery may be needed with a complete separation

  • In all cases, aggressive range of motion early in healing stages (within 2-3 weeks) is recommended

  • Therapy for flexibility, strength, and core stabilization

  • Strengthening and proper throwing progression is recommended 8-12 weeks following injury

  • Focused training to improve throwing form

Elbow Injury Prevention in Young Throwing Athletes

Throwing elbow injuries in our youth are preventable. Parents and coaches are advocates for their young athletes and can follow these tips to help avoid throwing related injuries:

  • Recognize and respond early to signs and symptoms of an overuse injury

  • Include fast or “hot” throws from non-pitching positions including middle infielders in pitch counts

  • Schedule rest weekly and seasonally

  • Encourage multiple sports until after the age of 12 years

Continue to: Injuries in the Young Thrower's Elbow - Part 2

Find many more tips on elbow injury prevention in throwing athletes on our website, scottishritehospital.org/sports.

Philip L. Wilson, M.D., is a board certified orthopedic surgeon fellowship-trained in pediatric orthopedics and sports medicine. He is Assistant Chief of Staff at Texas Scottish Rite Hospital for Children and he leads the Sports Medicine Center. Dr. Wilson holds an appointment as Associate Professor of Orthopaedics and Pediatrics at the University of Texas Southwestern Medical School. He sees patients for sports injuries including bone, muscle and ligament injuries at Scottish Rite Hospital’s North Campus in Plano.

Call: 469-515-7100

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