Little League Shoulder and Elbow

The elbow joint connects three bones in the arm, the humerus (upper arm bone) and the radius and ulna (forearm bones). There are ligaments (strong, fibrous connective tissue) within the joint that attach bones to one another. They allow the elbow to move properly and provide strength and stability to the joint. When ligaments are stretched, strained, sprained, or torn, it results in pain and instability in the joint.

Little Leaguer’s elbow results in damage to the medial section of the elbow (the inside of the elbow), including the medial collateral ligament, as well as the medial epicondyle and the medial epicondylar aphophysis. The medial epicondyle is the growth plate on the inside end of the elbow, and this often becomes inflamed in adolescents experiencing Little Leaguer’s elbow.

The shoulder joint is a ball and socket joint that connects the scapula (shoulder blade) to the humerus (upper arm bone). The physis, or growth plate, is the weak point of the proximal humerus (the upper part of your humerus). Stress to the shoulder blade and arm bone causes widening of the growth plate, resulting in a shear or stress injury. Little League shoulder only affects athletes whose growth plates have not yet closed.

Little Leaguer’s shoulder and elbow are typically a result of repetitive movement and overuse by adolescent-aged baseball and softball players, particularly pitchers. Stress and strain on the medial structures in the elbow and twisting of the shoulder can result due to the repeated cocking and follow-through motions involved in pitching a ball. This can lead to ligament laxity (looseness), which can result in sprains or tears of the ligaments in the elbow and shoulder. Inflammation of the growth plate in the elbow and shoulder can also occur.

Causes leading to Little Leaguer’s shoulder and elbow include:

• Year-round playing of baseball or softball, especially pitching, as well as continuous athletic training involving overhand throwing motions;
• Pitching more than the recommended number of pitches per game or per week for an individual’s age;
• Some pitches place more strain on the ligaments in the elbow, including curveballs, sliders, and “breaking balls.”;
• Lack of adequate rest between pitching;
• Improper warm-up prior to pitching or improper conditioning;
• Poor throwing mechanics.

Symptoms of Little Leaguer’s shoulder and elbow can vary based on how severe the condition is, but generally include:

• Pain, which is usually moderate to severe in nature. Pain may increase when attempting to throw a ball or when throwing an increasing number of pitches;
• Tenderness on the inside of the elbow or near the shoulder;
• Weakness, accompanied by the possible loss of motion of the shoulder or elbow joint, although this is not typical unless severe damage has occurred;
• Stiffness of the elbow or shoulder;
• Redness, bruising, or discoloration where the injury occurs. A noticeable deformity over the medial epicondyle or an angular deformity at the shoulder may also be seen.

To properly diagnose shoulder and elbow injuries, our specialist will conduct a thorough physical examination and review the patient’s sports history as well as personal and family medical history. Sometimes, testing such as an X-ray or an MRI may be required to look for any changes where the cartilage meets the bone and any damage to the growth plate. After confirming a diagnosis, your doctor will address the pain level.

The prognosis and speed of recovery for these conditions are dependent on a number of factors, but in the majority of cases of Little Leaguer’s shoulder and elbow, the patient can return to a regular pattern of pitching or throwing in about twelve weeks. Factors affecting the speed and completeness of recovery include the severity of the injury, the location of the injury (ligaments, growth plate, etc.), the age and activity level of the individual (younger, stronger, and more flexible people usually recover more quickly), and the individual’s commitment to rehabilitation. If a proper course of physical therapy is not followed, the patient returns to throwing too quickly, or poor throwing mechanics are not addressed, the condition may recur, resulting in further damage.