Little Leaguer's Elbow

Little Leaguer’s elbow has been used as a catch-all term for many types of elbow injuries in the skeletally immature athlete. This may lead to the under-estimation of the severity of some of these injuries. Growth plates, immature articular surfaces and lack of muscular development complicate the assessment. Due to the scope of this article, lateral and posterior elbow injuries will not be discussed.

While medial elbow pain in the skeletally mature player often suggests Ulnar collateral ligament (UCL) or flexor-pronator muscle injury, in the youth player the weakest links are the osseous (bony) structures. In the cocking and acceleration phases of throwing strong contraction of the flexor-pronator muscles and tensile forces on the UCL may result in injury to the osseous components, including the growth plate. This injury is what was originally termed Little Leaguer’s elbow. Tenderness over the medial epicondyle of the youth baseball player would warrant x-ray evaluation to rule out growth plate injury.

Prevention is the best way to deal with these injuries. Good throwing mechanics are essential. For example, side-arm throwing has been shown to be three times more likely to produce elbow injury than traditional overhand technique. Pitch counts for youth players are usually kept under 100 per day in most leagues (see below), with mandatory rest days after pitching.

Age Max Number of Pitch's
17-18 100 Pitch Max
13-16 90 Pitch Max
11-12 80 Pitch Max
9-10 70 Pitch Max

Development of fastball control should be paramount in young players. A well-located fastball can get a lot of hitters out in youth baseball. At approximately age 10, and when fastball command is well established, a pitcher can start to develop a change-up. Breaking pitches are much more harmful to the immature throwing arm so caution should be used. The following chart gives a guideline when pitches may be introduced.

Age Pitch Introduction
10  Change-Up
14 Curve Ball
When Growth Plate is Fused Slider

With good preventative measures in place, hopefully we can avoid elbow injuries including Little Leaguer’s elbow, in the youth player. 

Brent Andrews BPE, A.T.,C, Certified Level 2 Baseball Coach

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