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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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.

Young athletes should avoid breaking pitches, such as a curveball or slider, until after they are 14 years old. The skeletally immature elbow and shoulder cannot handle the repetitive forces and torque produced by these pitches. Nonsurgical treatments include rest and applying ice to the painful or swollen area of the elbow for a few days, as well as over-the-counter medications for pain and physical therapy. Once the condition clears, changing or refining throwing techniques may help prevent future injury.

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

diagnosis: Differential diagnosis is a list of possible conditions that may explain symptoms. সহজ বাংলা: একই লক্ষণের সম্ভাব্য রোগের তালিকা।" data-rx-term="differential diagnosis" data-rx-definition="Differential diagnosis is a list of possible conditions that may explain symptoms. সহজ বাংলা: একই লক্ষণের সম্ভাব্য রোগের তালিকা।">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 stiffness, or reduced movement. সহজ বাংলা: জয়েন্টের প্রদাহ।" data-rx-term="arthritis" data-rx-definition="Arthritis means joint inflammation causing pain, swelling, stiffness, or reduced movement. সহজ বাংলা: জয়েন্টের প্রদাহ।">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
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