Jason Determann, MD (September, 2021) Fall baseball is back in swing along with elbow aches and pains for young throwers. The throwing motion creates repetitive stress that often leads to a variety of both simple and complex conditions. Understanding the disorders that lead to elbow pain in children may help explain why your little guy or girl starts holding their elbow.
First of all, don’t think you’re alone. Nearly 30% of 8-12 year old baseball players will have elbow pain. That number jumps to 45% by age 14. While tendons and ligaments may be strong, they’re still growing. Growth plates around the elbow are called a physis: cartilaginous connection of immature bone often making up the weakest link that can lead to throwing problems
Little League Elbow
Little League Elbow is one of the most common conditions that affects the pediatric growth plates. Also called medial apophysitis, the inflammatory condition stems from repetitive traction or pull from the muscles and ligaments on the inside growth plate. The inside bump on the elbow will likely be sore to the touch, but should improve with a period of rest, ice, and over the counter NSAIDs such as ibuprofen or naproxen.
Another condition is known as Osteochondritis Dissecans : fragmentation of elbow cartilage and bone due to a repetitious compressive load. Loss of motion and symptoms such as locking or catching in the elbow are usually involved. X-rays are needed to confirm the diagnosis and often MRI is used to determine the severity of cartilage injury.
As children continue to grow, the concern of ulnar collateral ligament injury (UCL) comes into play. This ligament is the primary stabilizer of the inside of the elbow and is needed in overhead athletes. This ligament can get strained, develop partial tearing, or even complete tearing in severe cases. Due to sport specialization at a young age and year-round competition, the incidence of UCL problems in pediatric throwers is rising.
Elbow Injury Prevention
Regardless of the problem, the first step is a simple one: stop throwing! Most elbow pain in children we encounter stems from overuse: the body is telling our child it needs a short break. This break can range anywhere from 2 to 6 weeks, and is often shortened with NSAIDS and physical therapy. Continuing to play or throw through the pain should be avoided to prevent even more serious injury.
In sum, the key treatment to elbow pain in children is prevention. We all share this responsibility. Emphasis should be placed on an adequate warm up and cool down. Additionally, proper throwing mechanics should be taught at a relatively early age and constantly re-evaluated. Most youth leagues, including ours here on the Eastern Shore, have pitch counts per game, week, and season. Adhering to these guidelines is critical to maximizing the health of your child’s arm.