Pediatric Elbow Pain
(Little Leaguer's Elbow)

CONDITION

Little Leaguer's elbow occurs when the growth plate on the inside of the elbow is injured by the forceful pulling of tendons, usually with throwing. A growth plate is specialized cartilage that eventually matures into bone. Sometimes the growth plate is pulled away from the bone to which it normally attaches (Figure 1).

Figure 1.

CAUSES

Repetitive and forceful throwing, and sometimes a single lifting event, can cause injury to the growth plate. Other risk factors include:

• being 8 to 13 years old
• using poor throwing technique
• throwing breaking balls, such as curves and sliders
• pitching
• increasing the amount of throwing or pitching too quickly
• lack of flexibility in the arm and forearm muscles and tendons
• weak arm and forearm muscles.

SYMPTOMS AND SIGNS

• You will have aching and sometimes sharp pain over the inside of the elbow.
• Sometimes the pain can go down the inside of the upper forearm.
• Pain is worse during and shortly after activities that cause the problem, especially throwing a baseball and pitching.
• Pain is worse when you push on the inside of the elbow.
• Sometimes there is swelling over the inside of the elbow.
• If you have weakness and numbness or problems feeling your forearm or hand, you may have a pinched nerve instead of Little Leaguer's elbow.
• If you have a lot of swelling and pain on the outside of your elbow and if you can't bend or straighten your elbow completely, especially after a fall on an outstretched hand, you may have an elbow fracture.

WHEN TO CALL YOUR DOCTOR

Call your doctor right away (day or night) if:

• If you have severe pain, swelling and/or numbness over your elbow and forearm after a fall or injury.
• If you can't fully straighten or bend your arm after a fall or injury.

Call your doctor during regular office hours:

• If you have mild to moderate pain after a fall or injury, but don't have problems feeling your forearm or hand, and can bend and straighten your elbow completely.
• If you have had pain and swelling that have been getting worse over time.

SELF-CARE AT HOME

• Rest your arm and hand from activities that cause pain.
  • Avoid bending the wrist if it hurts the elbow.
  • Avoid picking up heavy objects that cause pain.
  • Rest from throwing sports until all of your symptoms resolve.
  • Pick things up with your palm down to avoid stress on the growth plate.
• For swelling and pain control, ice your elbow or apply a cold pack held in place with plastic wrap or an elastic bandage. Do this three times daily for 20 minutes or up to 20 minutes an hour.
  • Ice massage can help. Freeze water in a paper cup, peel the top of the cup back so the ice is sticking out, then rub the ice over the painful area for a few minutes at a time. Let your elbow get warm between massages.
  • You can use ice massage any time you are having pain or after arm activities that will probably cause pain.
• Avoid stretching and strengthening exercises until you see your doctor, who will coach you about what to do.
• Because injuries to growth plates can be serious, see your doctor if your pain persists longer than a week or recurs after returning to throwing.
• Your doctor may ask you to rest completely for three to four weeks, and you may not be able to throw for six to eight weeks.
• If you have severe pain, problems bending your arm or numbness in your forearm or elbow, do not do any exercises or use any braces. Place your arm in a sling and see your doctor.