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Pediatrics - Little League Syndrome, Pitcher's Elbow

Introduction
Little League Elbow, also called Pitcher’s Elbow, results from excessive throwing motions used in sports.  It most frequently occurs in baseball, but is associated with other sports that involve throwing.  Pitcher’s Elbow causes pain and interferes with motion.  Many cases of Pitcher’s Elbow respond to rest and nonoperative treatment.  If left untreated, Pitcher’s elbow can lead to significant problems that require surgery.

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Anatomy
The two bones in your child’s forearm, the ulna and radius, and your child’s upper arm bone, the humerus, form his or her elbow joints.  Muscles, nerves, tendons, and ligaments allow your child’s elbow joints to bend, straighten, and rotate.  Tendons are strong fibers that attach muscles to bones, and ligaments connect bones to each other.

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Causes
Pitcher’s Elbow occurs in players that participate in sports that require repetitive throwing.  It most frequently affects pitchers, but may also develop in outfielders, catchers, and infielders.  Pitcher’s elbow is associated with other sports as well, including tennis and football. 
 
Pitcher’s elbow is also called Little League elbow because it occurs in children and teenagers that play sports.  The condition is especially concerning for this population because their bones are growing and injuries can affect the growth process.  Additionally, their skeletal systems may not be developed enough for the demands of competitive sports.
 
Pitcher’s Elbow results when repetitive throwing puts an excessive strain on the tendons and ligaments in the elbow.  The strong movements can cause the ligaments and tendons to stretch, tear, or pull away from the bone.  If some of the bone is also torn away in the process, it can interfere with normal bone growth and cause deformity.  If the forces are great enough, the bones may slam together, causing the bones or cartilage to fracture, and resulting in a condition called osteochondrosis dissecans.

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Symptoms
Pitcher’s Elbow causes pain on the inner side of the elbow. Your child’s elbow joint may feel like it locks or gets stuck.  It may be difficult for your child to move the elbow as he or she did before, and it will affect your child’s pitching performance. 

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Diagnosis
Your doctor can diagnose Pitcher’s Elbow by reviewing your child’s medical history and examining your child’s elbow.  You should tell your doctor about your child’s sports participation, the number of throws your child typically perform, and the length of your child’s practice or playing season.  This information will help your doctor determine the magnitude of stress on your child’s elbow.  X-rays or magnetic resonance imaging (MRI) scans will be ordered to view your child’s elbow structures.

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Surgery
Arthroscopy can both diagnose and treat conditions associated with pitcher’s elbow.  Arthroscopic surgery uses an arthroscope and narrow surgical instruments that are inserted through small incisions.  An arthroscope contains a lens and lighting system that allow a surgeon to view inside of a joint.  A miniature camera allows the surgeon to view the magnified images on a video screen or take photographs and record videotape.  Arthroscopic surgery is associated with shorter recovery times and less pain and bleeding than open procedures. 
 
Arthroscopic surgery is not appropriate in every case, with some problems requiring open procedures.  Your doctor will discuss the type of surgery that is best for your child’s particular problem.

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Treatment
Your child should stop performing throwing activities and allow his or her elbow to rest if he or she experiences pain.  Ice packs may help relieve pain and swelling.  Following rest, throwing should be returned to gradually.  Physical Therapy exercises may help improve your child's strength, endurance, and coordination.  A therapist, experienced in throwing problems, can review your child's pitching motion and body posture and make recommendations to improve his or her form.
 
If your child undergoes surgery, physical therapy is helpful for regaining mobility, strength, and function after the procedure.  Your child's therapists will teach your child exercises specifically to improve the health of his or her muscles.  The therapists can help determine when your child is ready to play again and advise you on how to care for your child's elbow during sports.

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Recovery
Recovery from Pitcher’s Elbow is different for everyone.  It depends on the extent of your child’s condition and the type of treatment that your child receives.  Most players can return to play when their rehabilitation is complete.  Your doctor will let you know what to expect.

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Prevention
Your child may prevent pitcher’s elbow by taking breaks from pitching, limiting his or her amount of throwing, and altering his or her throwing motion, if necessary.  Your child should be sure to warm-up before pitching.  Your child should exercise to keep his or her arm strong and flexible. 

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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on April 13th, 2016. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.