Injuries in the Young Thrower’s Elbow – Part 2
This is the second part of a three part series on injuries in the young thrower’s elbow. In this series, we are discussing these common elbow injuries:
“Little Leaguer’s elbow” or medial epicondyle apophysitis
Avulsion fracture of the medial epicondyle
Osteochondritis dissecans (OCD)
Ulnar collateral ligament (UCL) injuries
In the first installment, we explained how the elbow works and the most common diagnoses in a young thrower’s elbow: Little Leaguer’s Elbow and avulsion fractures of the medical epicondyle. Now, we will discuss conditions that occur when early signs and symptoms of overuse progress to different problems.
Young throwers are at an increased risk of throwing-related overuse injuries because they tend to repeat the same motion over and over in practice, coaching sessions, tournaments and games. Additionally, throwing athletes often play their sport year-round. Many do not take a break from their sport during the week or between seasons. We know that these behaviors are related to increased risk for overuse injuries.
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.
Osteochondritis dissecans (OCD) of the elbow is a less common condition that can be caused by excessive throwing. Little Leaguer’s elbow often precedes OCD in the throwing population (other populations, such as gymnasts, can get it through direct impact from landing on extended arms).
In OCD, the muscles on the inside of the elbow are pulled, which is then absorbed as compression on the outside of the elbow. With each throw, compression of the radial head on the capitellum occurs (see above figure). Over time, the pressure on the immature bones can loosen a piece of the bone and cartilage.
The problem is much like a pot-hole: the undersurface of the bone becomes weak, and the outer layer and soft tissue covering then crack and move. In some cases, the loose piece can cause locking of the elbow motions in addition to pain. The loose pieces may need to be removed surgically.
Dull achiness on the outside of the elbow
Pain that is worse with activity and improved with rest
Pain that gradually worsens over time
Unable to completely straighten the arm
Popping and locking can be common
Rest - continuing to throw may lead to major complications and jeopardize a child’s ability to remain active in a throwing sport
Strict activity restrictions to protect the elbow from further injury with throwing
Immobilization may be necessary in severe cases, or if restrictions are not followed
Surgical treatment may be indicated if it does not heal or the tissue becomes unstable or loose
Therapy to focus on flexibility, strength, trunk and scapular stabilization
Resume throwing at a minimum of 6-12 months
Focused training to improve throwing form is needed
Olecranon Apophysitis can occur with repeated throwing when inflammation of the cartilage on the back of the elbow develops. This causes the growth area of the upper arm bone to become inflamed and painful. When this occurs, a growing athlete may complain of pain during follow-through or when straightening the elbow. In older adolescents, bone spurs and stress fractures can also occur in this area.
Pain in the back of the elbow during follow-through and when straightening arm
Pain in the back of the elbow that becomes gradually worse over time
Unable to completely straighten the arm
Locking and popping, rarely
Rest - continuing to throw may lead to major complications and jeopardize a child’s ability to remain active in a throwing sport.
Ice and anti-inflammatory medication for pain and swelling
Therapy for flexibility, strength and core stabilization
Focused training to improve throwing form
Surgery is rarely needed and only in severe cases
Elbow Injury Prevention in Young Athletes
Throwing elbow injuries in our youth are preventable. Here are more tips parents and coaches can follow to help young throwers avoid these 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
Stop pitching when the arm becomes tired or form becomes worse.
Never pitch with pain
Never pitch on consecutive days
Serious pitchers should consider using a pitching coach
Find 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 Orthopedics and Pediatrics at the University of Texas Southwestern Medical School. He sees patients for sports injuries including bone, muscle, and ligament injuries on our North Campus, now in Plano.
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