Injuries in the Young Thrower’s Elbow – Part III

This is the third and final installment in a series on injuries in the young thrower’s elbow. In the first two installments, (Part I, Part 2) we explained how the elbow works and discussed some common diagnoses in a young thrower’s elbow: Little Leaguer’s Elbow, avulsion fracture of the medial epicondyle, Osteochondritis dissecans (OCD) and Olecranon apophysitis.

In this article, we will discuss ulnar collateral ligament (UCL) injuries. There is a misperception that a UCL injury is caused by a single forceful throw. Read on to learn about how the UCL is at risk of overuse injuries and the signs and symptoms that are present long before a tear that leads to surgery.

Ulnar collateral ligament (UCL) injuries are more commonly seen in the older adolescent but may occur in the younger athletes as well. Elbow stability is crucial for a throwing athlete. The UCL is the most important stabilizer for the inside of the elbow. With repetitive throwing, the UCL becomes stretched and has small tears. This is painful and ultimately leads to instability in the elbow. These injuries rarely occur with a single event or throw. When asked, athletes who believe they injured their elbow in a single event will acknowledge a history of elbow pain with throwing.

Typically, the pain is on the inside of the elbow a just below the bony bump where medial epicondyle apophysitis can occur. Because the injury is to the soft tissue, X-rays are often normal. To better evaluate this problem and determine the best course of treatment, an MRI with contrast injected in the joint is used.

Symptom summary

• Pain over the inside of the elbow with throwing • Gradually increasing pain • May feel unstable or “give way” • Rarely popping

With proper rest, an early injury to the UCL can heal. Rest and removal of the repetitive stress may allow early changes of stress in the ligament to resolve. Unfortunately, there is a perception that a period of rest can be detrimental to the career of the young athlete. The reality is that continuing to throw can result in major complications and may ultimately lead to a complete injury of the ligament, for which surgery may be the only option. This requires significant recovery and rehabilitation time out of sport and does not guarantee return to play. Early prevention of over-stress is the best way to avoid this negative effect on the performance and the psychological well-being of the young athlete.

The well-known surgical reconstruction of the UCL is named after Tommy John. He was a baseball player who successfully returned to major league pitching after having this procedure. While some more mature athletes return to play after this procedure, a large number do not and surgery at an early age is felt to be problematic for a long throwing career. There is no arguing that preventing the injury is ideal.

Treatment summary

• Rest for at least 6-12 weeks • Immobilization with a hinged elbow brace may be recommended to improve compliance with rest • Anti-inflammatory medication may be needed • Therapy to focus on flexibility, strength, trunk and scapular stabilization • Surgery is typically needed for complete tears, or if the elbow is unstable • Focused training to improve throwing form is needed

Elbow Injury Prevention in Young Athletes

Throwing elbow injuries in our youth are PREVENTABLE. Parents and coaches are advocates for their young athletes. We’ve covered many tips in previous installments, but here are the top tips for avoiding a UCL injury.

Top Tips to avoid throwing related injuries:

• Recognize and respond early to signs and symptoms of an overuse injury • Stop pitching when the arm becomes tired or form becomes worse • Never pitch with pain • Training should focus on form, not quantity of throws

Find many more tips on elbow injury prevention in throwing athletes on our website.

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 on our North Campus, now in Plano.

Call: 469-515-7100

Visit Website

Editor's Pick:

Experts who work with professional & Olympic athletes share information for your youth athlete!

Watch The Athlete's Parent featured

on Fit Fueled & Fabulous

The information on this website is intended to provide users with resources and information which they may find useful and of interest.  We take all reasonable steps to keep this information current and accurate, but errors can occur.  The information on this site is therefore provided as is with no guarantee of accuracy, completeness or timeliness. The Athlete's Parent reserves the right to make changes to any information or services on this site without notice to the user.

The Athlete's Parent may include hyperlinks to third-party content, advertising, or websites, provided to our visitors for the sake of convenience. By using our website, you acknowledge and agree that The Athlete's Parent is not responsible for and does not endorse any advertising, products, or resources available from such outside resources or websites. The Athlete's Parent shall not be liable to any party as a result of any information, services, or resources made available through this website.