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Little League Elbow & Shoulder

What is Little League Elbow?

Little league elbow is an injury to the growth plate on the inner (medial) aspect of the elbow. The growth plate connects the medial epicondyle to the elbow, which is the attachment site for the muscles that flex the wrist and rotate the forearm palm down. The condition tends to occur in young athletes involved in sports that require over-head throwing activities.

What is Little League Shoulder?

Little league shoulder is an injury to the growth plate at the upper end of the humerus, at the shoulder. The growth plate connects the humeral head to the shaft of the humerus. The muscles of the shoulder cross over the growth plate and place stress across the area when the shoulder is taken through a range of motion. The condition also tends to occur in young over-head throwing athletes.

What causes Little League Shoulder and Elbow?

The conditions are caused by repetitive throwing and over-head exercises. As the arm is taken through the throwing motion, the forceful contraction of the muscles crossing the growth plate put stress on them. Since the growth plate is made of cartilage, it is softer than the surrounding bone, and is susceptible to injury. With repetitive activities, small injuries in the growth plate, which can result in disruption of the plate or fracture.

Is this a problem?

It can be. If left untreated, the growth plate may become damaged and stop growing properly. Your doctor will let you know if the x-rays show signs of damage to the growth plate.

What are the treatment options?

Treatment will depend on the extent of the growth plate injury. Often if the condition is caught early, it can be treated with rest, medication, ice and compression wraps. Occasionally, when caught early, the athlete can return to limit activities, often at a different position. The rest period off of activities will usually last 4 to 6 weeks to allow complete healing of the growth plate. If the injury to the growth plate is more severe, or there is significant separation of the growth plate, casting or surgery may be needed. After healing, a gradual return to throwing activities is initiated.

FAQs about Little League Shoulder and Elbow:

What are the symptoms?

The most significant symptom is pain at the inner elbow or shoulder. The pain can be severe or described as achy. It can occur abruptly after a single hard throw or it may occur gradually over the course of a game or season. The pain may also be associated with swelling, redness and/or increased warmth. Often there is an associated decreased control or speed of the athlete’s pitches.

What should I do if I begin to have symptoms?

The first and most important thing to do when symptoms occur is to stop throwing. Anti-inflammatories (Ibuprofen, Naprosyn) and ice can help with symptoms. If the symptoms continue, the athlete should not return to activities and should be evaluate by a physician.

How can the conditions be prevented?

The risk of the conditions can be decreased by following several straight-forward practices:

  1. Following the recommendations for pitch counts created by Little League Baseball (see below).
  2. Warm up and stretch before throwing activities.
  3. No curve balls or breaking pitches until age 14.
  4. See a physician at the onset of symptoms in the elbow or shoulder of the patient’s dominant hand.

Little League Baseball Recommendations

A pitcher once removed from the mound cannot return as a pitcher. A pitcher remaining in the game, but moved to a different position, can return to the mound, only once per game.

The coach must remove a pitcher once the pitcher reaches the limit for his/her age as noted below. The pitcher may remain in the game at another position, though he/she is not allowed to play catcher if they have reached 41 or more pitches.

Age

Maximum Pitches Allowed

7-8

50 per day

9-10

75 per day

11-12

85 per day

13-16

95 per day

17-18

105 per day


The amount of rest between days when pitching is allowed will depend on the age of the athlete and the number of pitches thrown.

Pitchers ages 14 and under

 

Pitchers ages 15 to 18

Pitches Thrown

Days rest from pitching

 

Pitches Thrown

Days rest from pitching

66 or more

4 days

 

66 or more

4 days

51-65

3 days

 

51-65

3 days

36-50

2 days

 

36-50

2 days

21-35

1 day

 

21-35

1 day

1-20

0 days

 

1-20

0 days

 

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