MHSAA Health & Safety

Health & Safety Resources

Little League Elbow

Little league elbow is also known as medial epicondylitis, which is the inflammation of the flexor muscles in the forearm where they attach into the elbow (inside part of the elbow). Little league elbow occurs most often in pitchers but is also seen with any other overhead activity. This injury is caused during the throwing motion by putting an increased stress load on the inside of the elbow resulting in tension. This repetitive stress leads to the breakdown of tissue faster than the body can repair it.

Little league elbow has many causes, whether it be training errors, a change in frequency, duration or intensity, or lack of preseason conditioning. It is important to address strength and flexibility imbalances early on to reduce greater risk of injury.

Some symptoms of little league elbow include pain and tenderness over the medial epicondyle (bony area at inside part of elbow). Occasionally, pain can shoot down the arm. The pain is made worse by flexing the wrist.

Initially after this injury occurs, ice and rest is reccomended. The use of anti-inflammatory medication, if prescribed by a physician, can be beneficial. Other cases using an elbow type strap helps relieve pain by spreading forces of the muscles to a larger area. In some cases complete immobilization is required. In rare cases surgery is required.

Once the initial injury has resolved physical therapy is beneficial to prevent further or repeated injury to the area. Return to play should begin once a proper rehabilitation program has been completed and should be progressed back slowly with careful monitoring. The rehabilitation program should be maintained to continue with strengthening and flexibility.

Education to parents, players and coaches is the key to prevent this overuse type injury. Considerations include:

The number of pitches is more important than the number of innings.
Participation in multiple leagues, playing other positions and practice pitching should be considered when defining and regulating rest.
Conditioning of the throwing arm and entire body can reduce a young pitcher’s risk of injury.
Improper techniques is a major factor in injury potential.
The maximum number of pitches allowed in one outing should increase with age.

The following chart shows the maximum pitch count a child is able to do for their age group (www.emedicine.com).

Maximum Pitch Counts--Game Competition (adapted from USA Baseball recommendations)
Age, y	Pitch Approved to Throw	Pitches per Game	Pitches per Week	Pitches per Season
8–10	Fastball	50	75	1000
11-12	Change-up	75	100	1000
13-14	Curve	75	125	1000
15-16	Slider, forkball, splitter, knuckleball	90	-	-
17-18	Screwball	105	-	-

For more information on this article or for priority appointments for sports injuries please contact Henry Ford Center for Athletic Medicine at 313 972-4216.

Henry Ford Health System’s Center for Athletic Medicine offers a comprehensive approach to sports medicine, including surgical and non-surgical care, sports rehabilitation, injury prevention, and performance enhancement programs. The HFHS treatment team includes sports medicine fellowship trained orthopedic surgeons, sports medicine fellowship trained primary care physicians, as well as certified athletic trainers and physical therapists. These health care professionals are supported by the HFHS nationally recognized bone and joint research facility, including the prestigious Herrick Davis Motion Analysis Lab. HFHS is proud to be health care providers to the Detroit area’s premier sports programs including professional, collegiate, and high school athletes.