Little League Elbow

Last updated: February 8, 2026Reviewed date: February 8, 2026Reading time: 4 min read

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Article Summary

Little League elbow is the result of repetitive stress to the growth plate on the inside of the elbow. The greatest stress occurs during the acceleration phase of throwing a baseball. Growing bones are easily injured because the growth plate is much weaker than the ligaments and muscles that attach to it. Kids with Little League elbow must take a break from all throwing for about 6...

Key Takeaways

This article explains Other Names in simple medical language.
This article explains Pathophysiology in simple medical language.
This article explains Causes in simple medical language.
This article explains Differential Diagnosis in simple medical language.

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Start here Choose the right pathway for symptoms, reports, medicines, or urgent warning signs. Disease article roadmap Read this topic step by step: meaning, symptoms, warning signs, diagnosis, treatment, prevention, and follow-up. Treatment planner Prepare questions about treatment choices, benefits, risks, side effects, and follow-up. Family & caregiver guide Organize symptoms, reports, medicines, questions, and follow-up safely. Nutrition & diet guide Prepare food, hydration, supplement, and medicine-timing questions safely. Prevention guide Organize risk factors, protective habits, screening, and warning signs. Recovery guide Prepare a safe plan for activity, rehabilitation, warning signs, and follow-up.

Educational health guideWritten for patient understanding and clinical awareness.

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Emergency safety firstUrgent warning signs are highlighted below.

Definition

Little League elbow is the result of repetitive stress to the growth plate on the inside of the elbow. The greatest stress occurs during the acceleration phase of throwing a baseball. Growing bones are easily injured because the growth plate is much weaker than the ligaments and muscles that attach to it. Kids with Little League elbow must take a break from all throwing for about 6 weeks. For pain and swelling, they can: Put ice or a cold pack on the elbow every 1–2 hours for 20 minutes at a time. This injury most often affects pitchers ages 9-14, though baseball players in other positions, as well as other overhead athletes such as volleyball players and football quarterbacks, may also be susceptible to little league elbow.

Other Names

Little League Elbow
Medial Epicondyle Apophysitis
Medial Epicondyle Stress Fracture

Pathophysiology

By definition occurs in skeletally immature pediatric patients
- In these patients, avulsion or physical injuries more common than ligamentous or tendon injuries
- As growth plates fuse, these athletes develop other causes of medial elbow pain
- The injury pattern depends on the developmental stage of the elbow
Occurs as a result of overuse or repetitive valgus stress placed upon the elbow
- Causes a tension force to overload the medial structures
- Produces tension along the medial elbow, shearing at the posterior elbow, and compression along the lateral elbow^[4]

Causes

Sports
- Overhead athletes
- Throwing athletes
Seen during cocking, acceleration phases of pitching
Overuse can be classified into 4 stages:
- Pain in the affected area after physical activity
- Pain during activity without restricting performance
- Pain during the activity that restricts performance
- Chronic unremitting pain even at rest
Factors that contribute to overuse
- Pitching mechanics
- Pitch volume (>80 per game)
- Pitch type (especially fastball)
- Pitch duration (> 8 months per year)
- Pitching when fatigued
- Physical conditioning

Associated Conditions

Can occur if the disease progresses
- Ulnar Collateral Ligament Injury
- Medial Epicondylitis

Pathoanatomy

Osseous structures
- Medial Epicondyle including medial epicondyle apophysis, of distal Humerus
- Proximal Ulna
- Humeroulnar Joint
Static stabilizers
- Ulnar Collateral Ligament
Dynamic stabilizers
- Common Flexor Tendon

Differential Diagnosis

Fractures
- Adult
  - Radial Head Fracture
  - Olecranon Fracture
  - Capitellum Fracture
  - Coronoid Fracture
  - Terrible Triad of Elbow
- Pediatric
  - Nursemaids Elbow
  - Supracondylar Fracture
  - Lateral Condyle Fracture (Peds)
  - Medial Condyle Fracture (Peds)
  - Olecranon Fracture (Peds)
  - Radial Head Fracture (Peds)
  - Medial Epicondyle Fracture (Peds)
  - Salter Harris Fracture
Dislocations & Instability
- Elbow Dislocation
- Proximal Radioulnar Joint Instability
Tendinopathies
- Lateral Epicondylitis
- Medial Epicondylitis
- Distal Biceps Tendon Injury
- Triceps Tendon Injury
Bursopathies
- Olecranon Bursitis
Ligament Injuries
- Lateral Collateral Ligament Injury (Elbow)
- Ulnar Collateral Ligament Injury
Neuropathies
- Cubital Tunnel Syndrome
- Radial Tunnel Syndrome
Arthropathies
- Elbow Arthritis
Other
- Valgus Extension Overload
- Posteromedial Rotatory Instability
- Posterolateral Rotatory Instability
- Osteochondral Defect
Pediatric Considerations
- Little League Elbow
- Panners Disease (Avascular Necrosis of the Capitellum)
- Nursemaids Elbow (Radial Head Subluxation)

Diagnosis

History
- Typically in 9-12-year-old males
- Almost universally insidious in nature with no acute trauma
- Important to clarify sport, position, frequency, etc
- Will complain of pain in throwing arm and loss of speed, accuracy, and/or distance
- Pain is at the medial elbow
- Sometimes stiffness, swelling, limited elbow extension, mechanical symptoms
Physical: Physical Exam Elbow
- Tenderness to medial elbow
- Swelling and effusion can be present
Special Tests
- Elbow Valgus Stress Test: Should be painful, instability suggests more significant injury

Radiographs

Standard Radiographs Elbow
- Diagnosis is primarily clinical
- Often normal early on in disease process
Findings
- Apophysitis: physeal widening, sclerosis, cortical irregularity
- Epiphysiolysis: fragmentation or avulsion of the medial epicondyle

MRI

Findings
- Edema across the medial epicondyle physis
- If suspected UCL injury will be best viewed
- Increased T1 and T2 uptake in UCL can be physiologic

Ultrasound

Findings unknown (needs to be updated

Treatment

Nonoperative

Indications
- First-line therapy in virtually all cases
Relative rest
- Discontinue offending activity, typically throwing until pain and tenderness resolve
- Usually about 4-6 weeks
Physical Therapy
- Begin when pain-free
- Strengthen dynamic stabilizers of core, shoulder
- Eventually throwing program as the athlete approaches RTP
Medications including
- NSAIDS
- Acetaminophen
Activity modification
- Pitchers may require biomechanical correction
Prevention
- Follow pitch count guidelines
- Education of athlete, parents and coaches
- Correct biomechanics
- Improve core strength and cardiovascular fitness

Operative

Indications
- Failure of conservative measures
Technique
- Avulsion fracture: ORIF of medial epicondyle
- UCL Injury: UCL reconstruction

Safety note: This is not a prescription or diagnosis. For severe symptoms, pregnancy danger signs, children with serious illness, chest pain, breathing difficulty, stroke-like weakness, or major injury, seek urgent care.

Which doctor may help?

Orthopedic doctor, rheumatologist, or physiotherapist depending on cause.

What to tell the doctor

Write which joints hurt, swelling, morning stiffness duration, fever, injury, and walking difficulty.
Bring X-ray, uric acid, ESR/CRP, rheumatoid factor, or previous reports if available.

Questions to ask

Is this injury, osteoarthritis, rheumatoid arthritis, gout, infection, or another cause?
Which exercises, supports, or lifestyle changes are safe?
Do I need blood tests or X-ray?

Tests to discuss

Joint examination and range of motion
X-ray when chronic arthritis or injury is suspected
ESR/CRP, uric acid, rheumatoid tests when inflammatory arthritis is suspected

Avoid these mistakes

Do not ignore hot swollen joint with fever.
Avoid repeated steroid injections/tablets without a clear diagnosis and follow-up.

Medicine safety and first-aid guide

This section is for patient education only. It does not replace a doctor, pharmacist, or emergency care.

Safe first steps

Avoid heavy lifting, sudden bending, and prolonged bed rest.
Use comfortable posture and gentle movement as tolerated.
Discuss physiotherapy, X-ray, or MRI only when clinically needed.

OTC medicine safety

For mild back pain, pain-relief medicine may be discussed with a doctor or pharmacist.
Avoid repeated painkiller use if you have kidney disease, stomach ulcer, uncontrolled blood pressure, or are taking blood thinners.

Avoid these mistakes

Do not start antibiotics without a proper medical decision.
Do not use steroid tablets or injections casually for quick relief.
Do not delay emergency care because of home remedies.

Get urgent help if

Back pain with leg weakness, numbness around private area, loss of urine/stool control, fever, cancer history, or major injury needs urgent care.

Medicine names, dose, and timing must be decided by a qualified clinician or pharmacist after checking age, pregnancy, allergy, other diseases, and current medicines.

For rural patients and family caregivers

Patient health record and symptom diary

Write your symptoms, medicines already taken, test results, and questions before visiting a doctor. This note stays on your device unless you print or copy it.

Doctor to discuss: Doctor / qualified healthcare provider

Tests to discuss with doctor

Basic vital signs: temperature, pulse, blood pressure, oxygen level if needed
Relevant blood, urine, imaging, or specialist tests only after clinical assessment

Questions to ask

What is the most likely cause of my symptoms?
Which warning signs mean I should go to emergency care?
Which tests are really needed now?
Which medicines are safe for my age, pregnancy status, allergy, kidney/liver/stomach condition, and current medicines?

Emergency warning signs such as chest pain, severe breathing difficulty, sudden weakness, confusion, severe dehydration, major injury, or loss of bladder/bowel control need urgent medical care. Do not wait for online information.

Go to emergency care if you notice:

Severe or rapidly worsening symptoms
Breathing difficulty, chest pain, fainting, confusion, severe weakness, major injury, or severe dehydration

Doctor / service to discuss: Qualified healthcare provider; specialist depends on symptoms and examination.

Step 1
Check danger signs first

If danger signs are present, seek emergency care and do not wait for online information.
Step 2
Record the symptom story

Write when symptoms started, severity, medicines already taken, allergies, pregnancy status, and test results.
Step 3
Visit a qualified clinician

A doctor, nurse, or qualified healthcare provider can examine you and decide which tests or treatment are needed.
Step 4
Do only useful tests

Do tests after clinical assessment. Avoid unnecessary tests, random antibiotics, or repeated medicines without diagnosis.
Step 5
Follow up and return early if worse

If symptoms worsen, new warning signs appear, or treatment is not helping, return for review quickly.

Rural patient practical tips

Take a written symptom diary and all previous prescriptions/test reports.
Do not hide medicines already taken, even herbal or over-the-counter medicines.
Ask which warning signs mean urgent referral to hospital.

This roadmap is for education. A real diagnosis and treatment plan requires history, examination, and clinical judgment.