Medial Apophysitis

Little Leaguer’s Elbow Doctor in Dallas, TX



-Medial epicondyle apophysitis, often known as Little League Elbow, is an injury that occurs typically in young baseball pitchers, most often ages 9-14. Though it is most common in pitchers, it can also occur in outfielders, infielders, catchers, or anyone who engages in repeated throwing motions.

Medial Apophysitis Anatomy

The medial epicondyle is the place on the inside of the elbow where the forearm muscles used for throwing are attached and stabilizes the elbow during the throwing motion. Medial apophysitis is the irritation or inflammation of the growth plate on the inside of the elbow.

Little Leaguer’s Elbow Causes

This condition develops due to simple overuse. Often, these young pitchers’ bones and muscles are still growing, and high pitching numbers too early in life can lead to irritation of the growth plate on the inside of the elbow. There is a direct link between a young athlete’s pitch count (number of pitches thrown) and elbow pain. This is why many leagues have rules limiting the number of pitches a young athlete is permitted to throw.

The greatest stress occurs during the acceleration of the arm, just before the ball is thrown. A type of pitch known as a “breaking” pitch, which is thrown with topspin and drops just as it reaches the plate, puts the most stress on the medial epicondyle area. For this reason, it is not recommended that pitchers throw breaking pitches until 14 at the youngest.

Growing bones are easily injured, due to the fact that the growth plate is weaker than the muscles and ligaments surrounding it. Once the growth plate fuses, it is more likely the athlete will injure the tendons and ligaments.

In some severe cases of Little League Elbow, this growth plate could potentially break away from the arm completely.

Little Leaguer’s Elbow Symptoms

If there is inflammation in the growth plate on the inside of the elbow, a young pitcher could experience:

  • Pain while pitching or throwing
  • Swelling on the elbow
  • Difficulty extending the elbow and decreased accuracy and speed when pitching
  • A distinct, painful pop felt while pitching or throwing 

Oftentimes these symptoms may only be visible while the athlete is engaged in pitching or throwing, but it will eventually advance to the point where any overhead movement of the arm is painful. If this condition goes untreated, it can lead to early arthiritis or bone spurs.

Medial Apophysitis Diagnosis 

A doctor will likely review a patient’s symptoms, pitch count, and medical history when attempting to diagnose Little League Elbow. An X-ray or MRI can provide a more accurate view of the growth plate to confirm a diagnosis.

Little Leaguer’s Elbow Treatment

Treating Little League Elbow generally comes in 3 phases:

    • Rest. Athletes must take a complete break from pitching. Ice can be used to relieve any pain or swelling, as well as non-steroidal anti-inflammatory medications.
    • Rehab. A physician will work with a physical therapist to come up with a treatment plan that will strengthen the elbow, as well as the forearm, upper arm, shoulder, back, and core.
    • Return to pitching. Once players regain a full range of motion and are pain-free, they are free to return to pitching. Doctors may advise that athletes progress from a non-throwing position to a less effort throwing position, and then to a full effort throwing position. 

The vast majority of cases of Little League Elbow will resolve themselves through a combination of rest and physical therapy. The timeline for recovery will be different for every athlete, and not following the treatment plan or returning to pitching too early could result in further damage down the line, such as osteoarthritis. 

Medial Apophysitis Prevention

As with all overuse injuries, active prevention is always best. Methods for preventing Little League Elbow include:

  • Year-round fitness. Year-round fitness and conditioning will help keep the elbow strong and prevent possible injury due to overuse. 
  • Active rest. Baseball players often need a period of rest where they engage in strength and resistant training but do not do any pitching or throwing. This should be at least 3 to 6 months out of the year.
  • Pitching guidelines. Pitching guidelines exist for a reason, and have been established through extensive research by doctors. Pay attention to them.
  • Control, command, and speed. Pitchers should first master control and command of the ball before they work on increasing their pitch speed. Pitchers younger than 14 should only throw fastballs and change-ups. Curve-balls can be added after fourteen, and sliders after 16.
  • Avoiding maximum effort throws. On days they have pitched, young pitchers should avoid other high-demand throwing positions like a catcher. Pitchers should also take a break from pitching for several days after pitching a game.
  • Avoiding further injury. Pitching through pain will not make you a better pitcher. It will only further injure your elbow or shoulder. If a young athlete experiences painful popping in the elbow or shoulder, they should not pitch at all until they are pain-free.
  • Proper mechanics. Proper form and appropriate throwing mechanics when pitching can prevent injury, while poor form and mechanics can cause it.

At SPORT, we will identify the source of your pain and then utilize state-of-the-art therapeutic techniques that focus on restoring your range of motion.

Depending on the specific condition and its severity, these treatment options may include physical therapy, over-the-counter anti-inflammatory medication, slings and supports, cortisone shots, or shoulder or elbow surgery.

If you have an acute or chronic shoulder or elbow injury that needs medical attention, call SPORT at (469) 200-2832 to arrange a consultation or you can request one online. Hurt today? We can arrange a same-day urgent care visit to ensure you get fast, effective relief.

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