What Is Pitcher’s Elbow (Little Leaguer’s Elbow)?

What Pitcher’s Elbow really is something called Little Leaguer’s which encompasses two kinds of elbow pain. When you’re talking about elbow pain and people who play baseball they’re either younger athletes whose growth plates aren’t closed or older athletes.

The older athletes who get elbow pain from pitching are adults and their growth plates (or the physis where the bone grows) are closed. So when you’re talking about a Little Leaguer’s Elbow this is in the elbow of a young thrower.

This is an issue affecting prepubescents (your 10, 11, 12 year old kids) having to do with the growth plate on the inside of the elbow where the tendons attach that help to flex your wrist. It’s also where a ligament attaches called the ulnar collateral ligament. And the ligament itself at this point, is stronger than the attachment of this area of bone.

And so what you get is an inflammation of the growth plate on the inside of the elbow. The reason you have this is because there’s a lot of torque that goes through the elbow when you’re throwing, especially pitching.

Unfortunately, the pitchers who throw the hardest are at the highest risk for this injury. Also continued repetitive throwing over and over again, puts you at risk as well. So now that we know the diagnostic, the question is how do we treat it?

Prevention and Pitch Count

The most important part of treating Little Leaguer’s Elbow is prevention which is based on a few things including pitch count, parents, and pain.

#1 Most importantly, limiting the amount of throwing a pitcher or a thrower does.

So the way that we try to do this most commonly is a pitch count. The younger you are the less you could pitch especially on consecutive days.

For example a 13 year old thrower at any given time throwing cannot throw more than 95 pitches. And if they do throw, they cannot throw within the next four to six days depending on which league they’re in.

Now the problems that we run into is when these baseball players are playing for both their school team and with a travel team and nobody’s watching or caring about when they’re throwing.

#2 Parents are the most important people to education about Little Leaguer’s Elbow prevention.

Parents really are the most important people to educate about this.

We’re not advocating for this because we just don’t want people to get hurt, we’re doing this based on studies that have been done following pitchers and young throwers with how much they pitch, showing that the more you pitch, the more risk there is for injury.

#3 Do not play through pain. You’re not getting paid for it.

Next, what we do is try to prevent kids from playing through pain. If anybody has elbow pain and they’re trying to throw through it, that’s a big problem.

What we’ve also found in baseball players in any age is that there’s a 3o times risk of needing a surgery on your elbow or your shoulder if you’re throwing with elbow or shoulder pain.

So you should not be throwing through pain, especially if nobody’s paying you for it. And at this level nobody is.

Rest, Physical Therapy, and Interval Throwing Program

When I have somebody come into my office with Pitcher’s Elbow or Little Leaguer’s Elbow, the first treatment is rest.

Every young thrower hates to hear that. There are many young guys in tears because the first treatment is no throwing anything; not a baseball, not a basketball, and not a football for a six weeks.

During that time we also start physical therapy which works not just the elbow but mostly on the shoulder.

We work on shoulder range of motion, shoulder dynamics and kinematics. Once we’ve completed that therapy and the thrower is pain free, after that six week period, then we start what’s called an interval throwing program which is a slow return to pitching or slow return to throwing depending upon what the player’s position is.

Continued Repetitive Throwing and Overspecialization Injuries

The good news is, in the Northeast we have winter. So a lot of kids are aren’t able to specialize as much. Usually young baseball players are able to take a season off but in the South continued repetitive throwing and overspecialization injuries are an epidemic because those kids are playing baseball four seasons in a row.

Do I Need Surgery?

The worst thing that can happen with a pitcher with a little leaguer’s elbow  (and this only really happens in kids who throw very hard) is that medial epicondyle, or the medial part of the elbow where the growth plate is, actually “avuls” or pulls off of the rest of the bottom of the arm bone or the humerus bone. If that happens we have to reattach it with a screw.

Risks?

Most of the kids will return to full activity and be able to throw. Of course, they go back with a better knowledge of what the risks are of overuse of their elbow during throwing.

The hope is we get them back to 100% but anytime there’s surgery done on the elbow or shoulder, especially young players, really the risk is that they’ll have another surgery later on.

Strengthening the Surrounding Muscles

Elbow therapy focuses on your shoulder and your core because most of the power that you generate pitching is from your lower body and your core musculature, not your elbow.

Elbow problems come from a lot of the forces going through it.  What you have to do to decrease some of that force is make sure that your range of motion of your shoulder, your core, trunk and lower extremities are as good as they can be to limit the amount of force that your elbow sees.

 

 

Dr. Michael Gott is a Westchester orthopedic surgeon who is fellowship trained in sports medicine. He has also been an active member of the National Ski Patrol as well as a Member of the Windham Mountain Ski Patrol for 18 years.