Little League elbow | |
---|---|
Repetitive overhead throwing motions, like those in baseball, can lead to this medical condition. | |
Causes | Repetitive throwing movements |
Little League elbow, technically termed medial epicondyle apophysitis, is a condition that is caused by repetitive overhand throwing motions in children. "Little Leaguer's elbow" was coined by Brogdon and Crow in an eponymous 1960 article in the American Journal of Radiology. [1]
The name of the condition is derived from the game of baseball. Compared to athletes who play other sports, baseball players are at higher risk of overuse injuries and injuries caused by early sports specialization by children and teenagers. [2]
Little League elbow is most often seen in young pitchers under the age of sixteen. The pitching motion causes a valgus stress to be placed on the inside of the elbow joint which can cause damage to the structures of the elbow, resulting in an avulsion (separation) of the medial epiphyseal plate (growth plate). [3]
The first diagnosis of the injury in 1960 set off a firestorm of controversy regarding how much youth baseball players can and should be asked to pitch. The ailment even appeared in the comic strip Peanuts in 1963 when Charlie Brown received a diagnosis. [4] In 2007, in order to protect against overuse injuries, Little League Baseball began limiting the number of pitches a player could throw per day. [5]
Adult pitchers do not experience the same injury because they do not have an open growth plate in the elbow. Instead, adult athletes have a fused growth plate, meaning that ligaments and tendons must bear the stress of the repeated throwing motion. A more common injury in adults is to the ulnar collateral ligament of the elbow, an injury that often requires Tommy John surgery in order for the athlete to resume high-level competitive throwing. [6]
Little League elbow, or apophysitis of the elbow causes children to feel aching, sharp pain, with or without swelling of the inside of their elbow after pitching. Over time, these symptoms can appear and reappear without warning, even when restricting the athlete to lower velocity pitching. [7] Decreased throwing velocity may also be noted. [8]
Repetitive overhead throws damage the epiphyseal plate at the boney elbow joint. It presents the same whether due to of delayed plate closure, widening, or acute fracture. [9]
Doctors usually notice Little League elbow based on physical exam and history, as X-rays are typically normal. The patient's history will reveal repetitive, high volume, overhand throwing. Patients may have tenderness, swelling, limited extension, and stiffness of the elbow on exam. [3] X-rays may be helpful to check if the growth plate is open, see if loose bone chips are present, and see if there are signs of early arthritis. [8] X-rays can also rule out other elbow issues, such as fractures of the medial epicondyle from a trauma. [3] [7] [8]
In order to prevent Little League elbow, athletes should stay active and fit all year, with at least a 3-6 month break from throwing per year. For pitchers, Little League Pitch Count guidelines should be followed, with warmup and non-pitching throws taken into consideration. [10] Following a pitching outing, athletes should rest their arms for a day or two, and should avoid other high-demand throwing positions on the field (eg. catcher). Another key of prevention is proper throwing form and avoidance of "offspeed pitches" to minimize stress on the elbow. [7]
An athlete with Little League elbow must rest, rehab, and then gradually return to throwing. Athletes should stop all overhead throwing activities for 4–6 weeks, and use ice to relieve pain and swelling. [3] NSAIDSs are often unnecessary when resting properly. Rehab consists of focused physical therapy to increase elbow range of motion and build muscle groups for throwing (arm, shoulder, back, and core). Athletes can resume throwing once they have regained full range of motion and strength without pain. Initially throwing should begin at a low volume and low intensity, before progressing through a pitching program to get them back to full speed. [3] [7] Timelines of recovery vary, but athletes usually return to full strength in 8–12 weeks. [3] A lack of treatment can leave patients susceptible to long term issues. [7]
Without timely activity changes, children may get small fractures in the growth plate, loose bodies or bone chips, and they are more susceptible to early arthritis and bone spurs. [7] [8]
Little League elbow happens to children 8–16 years old who perform repetitive overhand throwing, most often baseball pitchers. The disorder is most common in athletes under age 10 who play year-round and throw excessive amounts. [3] [10] Due to the varying degrees of stress placed on the elbow by different pitches, it is recommended to avoid "offspeed" pitches (curveballs and sliders) until high school age. [7] [8]
The humerus is a long bone in the arm that runs from the shoulder to the elbow. It connects the scapula and the two bones of the lower arm, the radius and ulna, and consists of three sections. The humeral upper extremity consists of a rounded head, a narrow neck, and two short processes. The body is cylindrical in its upper portion, and more prismatic below. The lower extremity consists of 2 epicondyles, 2 processes, and 3 fossae. As well as its true anatomical neck, the constriction below the greater and lesser tubercles of the humerus is referred to as its surgical neck due to its tendency to fracture, thus often becoming the focus of surgeons.
Ulnar collateral ligament reconstruction, colloquially known as Tommy John surgery, is a surgical graft procedure where the ulnar collateral ligament in the medial elbow is replaced with either a tendon from elsewhere in the patient's body, or with one from a deceased donor. The procedure is common among collegiate and professional athletes in several sports, particularly in baseball. The surgery is performed to restore optimal function for repetitive elbow movements or specifically throwing ability, often extending the careers of professional athletes. In many athletes, the surgery is done more than once during their careers.
In baseball, the pitcher is the player who throws ("pitches") the baseball from the pitcher's mound toward the catcher to begin each play, with the goal of retiring a batter, who attempts to either make contact with the pitched ball or draw a walk. In the numbering system used to record defensive plays, the pitcher is assigned the number 1. The pitcher is often considered the most important player on the defensive side of the game, and as such is situated at the right end of the defensive spectrum. There are many different types of pitchers, such as the starting pitcher, relief pitcher, middle reliever, lefty specialist, setup man, and the closer.
In baseball and softball, the curveball is a type of pitch thrown with a characteristic grip and hand movement that imparts forward spin to the ball, causing it to dive as it approaches the plate. Varieties of curveball include the 12–6 curveball, power curveball, and the knuckle curve. Its close relatives are the slider and the slurve. The "curve" of the ball varies from pitcher to pitcher.
The ulnar collateral ligament (UCL) or internal lateral ligament is a thick triangular ligament at the medial aspect of the elbow uniting the distal aspect of the humerus to the proximal aspect of the ulna.
Epicondylitis is the inflammation of an epicondyle or of adjacent tissues. Epicondyles are on the medial and lateral aspects of the elbow, consisting of the two bony prominences at the distal end of the humerus. These bony projections serve as the attachment point for the forearm musculature. Inflammation to the tendons and muscles at these attachment points can lead to medial and/or lateral epicondylitis. This can occur through a range of factors that overuse the muscles that attach to the epicondyles, such as sports or job-related duties that increase the workload of the forearm musculature and place stress on the elbow. Lateral epicondylitis is also known as “Tennis Elbow” due to its sports related association to tennis athletes, while medial epicondylitis is often referred to as “golfer's elbow.”
The lateral epicondyle of the humerus is a large, tuberculated eminence, curved a little forward, and giving attachment to the radial collateral ligament of the elbow joint, and to a tendon common to the origin of the supinator and some of the extensor muscles. Specifically, these extensor muscles include the anconeus muscle, the supinator, extensor carpi radialis brevis, extensor digitorum, extensor digiti minimi, and extensor carpi ulnaris. In birds, where the arm is somewhat rotated compared to other tetrapods, it is termed dorsal epicondyle of the humerus. In comparative anatomy, the term ectepicondyle is sometimes used.
The knee examination, in medicine and physiotherapy, is performed as part of a physical examination, or when a patient presents with knee pain or a history that suggests a pathology of the knee joint.
The lateral collateral ligament is an extrinsic ligament of the knee located on the lateral side of the knee. Its superior attachment is at the lateral epicondyle of the femur ; its inferior attachment is at the lateral aspect of the head of fibula. The LCL is not fused with the joint capsule. Inferiorly, the LCL splits the tendon of insertion of the biceps femoris muscle.
In baseball, sidearm is a motion for throwing a ball along a low, approximately horizontal plane rather than a high, mostly vertical plane (overhand).
Golfer's elbow, or medial epicondylitis, is tendinosis of the medial common flexor tendon on the inside of the elbow. It is similar to tennis elbow, which affects the outside of the elbow at the lateral epicondyle. The tendinopathy results from overload or repetitive use of the arm, causing an injury similar to ulnar collateral ligament injury of the elbow in "pitcher's elbow".
The unhappy triad, also known as a blown knee among other names, is an injury to the anterior cruciate ligament, medial collateral ligament, and meniscus. Analysis during the 1990s indicated that this 'classic' O'Donoghue triad is actually an unusual clinical entity among athletes with knee injuries. Some authors mistakenly believe that in this type of injury, "combined anterior cruciate and medial collateral ligament disruptions that were incurred during athletic endeavors" always present with concomitant medial meniscus injury. However, the 1990 analysis showed that lateral meniscus tears are more common than medial meniscus tears in conjunction with sprains of the ACL.
The elbow is the region between the upper arm and the forearm that surrounds the elbow joint. The elbow includes prominent landmarks such as the olecranon, the cubital fossa, and the lateral and the medial epicondyles of the humerus. The elbow joint is a hinge joint between the arm and the forearm; more specifically between the humerus in the upper arm and the radius and ulna in the forearm which allows the forearm and hand to be moved towards and away from the body. The term elbow is specifically used for humans and other primates, and in other vertebrates it is not used. In those cases, forelimb plus joint is used.
A supracondylar humerus fracture is a fracture of the distal humerus just above the elbow joint. The fracture is usually transverse or oblique and above the medial and lateral condyles and epicondyles. This fracture pattern is relatively rare in adults, but is the most common type of elbow fracture in children. In children, many of these fractures are non-displaced and can be treated with casting. Some are angulated or displaced and are best treated with surgery. In children, most of these fractures can be treated effectively with expectation for full recovery. Some of these injuries can be complicated by poor healing or by associated blood vessel or nerve injuries with serious complications.
The overhandthrow is a single-handed throw of a projectile where the object is thrown above the shoulder.
Ulnar collateral ligament injuries can occur during certain activities such as overhead baseball pitching. Acute or chronic disruption of the ulnar collateral ligament result in medial elbow pain, valgus instability, and impaired throwing performance. There are both non-surgical and surgical treatment options.
Medial knee injuries are the most common type of knee injury. The medial ligament complex of the knee consists of:
Dr. Jeremy Bruce is an Orthopaedic Surgeon at Erlanger Hospital in Chattanooga, Tennessee. He is also a Program Director and Director of Sports Medicine for the Orthopedic Residency program at The University of Tennessee College of Medicine in Chattanooga. He is a ringside physician that has covered UFC fights, Bellator fights, Ringside World Boxing championship, USA Boxing events and is a member of the USA Boxing Medical Commission. Dr. Bruce was a member of the USA Bobsled and Skeleton Team and competed alongside future Olympic gold medalist Jim Shea in the North American Skeleton Championship in Calgary, AL (1994).
A medial epicondyle fracture is an avulsion injury to the medial epicondyle of the humerus; the prominence of bone on the inside of the elbow. Medial epicondyle fractures account for 10% elbow fractures in children. 25% of injuries are associated with a dislocation of the elbow.
Early sports specialization is the phenomenon of a child or teenaged athlete intensively pursuing a single sport or athletic activity year-round, instead of participating in a wide variety of activities. Premature emphasis on a single sport is associated with physical injuries, mental health problems, and psychosocial harm to young athletes. Many young athletes who are pushed to excel in a single sport quit playing prematurely, or are forced to stop because of injuries.