Little Leaguer’s Elbow (Medial Epicondylar Apophysitis)

Little Leaguer’s Elbow (Medial Epicondylar Apophysitis)



Description


Little leaguer’s elbow is characterized by inflammation of the growth plate of the inner elbow. The medial epicondylar growth plate of the elbow becomes inflamed because of repetitive injury from muscular contraction. The muscles that bend the wrist attach to the medial epicondyle, and the growth plate is an area of relative weakness; injury to it occurs as a result of repeated stress or vigorous exercise. This is a temporary condition of the medial epicondyle that is uncommon after age 16.



Common signs and symptoms



• A slightly swollen, warm, and tender bump on the inner elbow

• Pain with activity, especially bending the wrist against force (curls, lifting, throwing) or after an extended period of vigorous exercise in an adolescent

• In more severe cases, pain during less vigorous activity

• Inability to throw at full speed

• Inability to fully straighten the elbow


Causes


Little leaguer’s elbow is caused by stress or injury, usually from overuse or fall, to the medial epicondyle growth plate, which is still developing during adolescence. Repeated stress or injury causes inflammation and interferes with development.



Factors that increase risk



• Throwing sports, such as baseball

• Overzealous conditioning routines, such as weightlifting

• Being overweight

• Male gender, between 11 and 18 years of age

• Rapid skeletal growth

• Poor physical conditioning (strength, flexibility)


Preventive measures



• Appropriately warm up and stretch before practice and competition.

• Maintain appropriate conditioning that includes arm, forearm, and wrist strength, along with flexibility, endurance, and cardiovascular fitness training.

• Exercise moderately, and avoid extremes.

• Rest appropriately after vigorous exercise.

• Use proper technique.


Expected outcome


Mild cases of little leaguer’s elbow can be resolved with a slight reduction of activity level, whereas moderate to severe cases may require significantly reduced activity for 3 to 4 months.



Possible complications



• Bone infection

• Growth plate may pull off the arm bone, resulting in a fracture

• Inability to fully straighten the elbow


General treatment considerations


Initial treatment consists of medications and ice to relieve pain; stretching and strengthening exercises, particularly the muscles that bend the wrist; and modification of activities. Specifically, throwing and heavy lifting should be avoided. These exercises can all be carried out at home for acute cases, but chronic cases often require referral to a physical therapist or athletic trainer for further evaluation or treatment. The affected elbow may occasionally need to be immobilized for a few weeks with a brace, cast, or splint, and a counterforce brace (tennis elbow brace) may help relieve symptoms. In the growing patient, surgery is rarely needed, and only if conservative treatment fails; however, surgery is necessary if the growth plate separates completely and moves away from where it should be.

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Jul 18, 2016 | Posted by in SPORT MEDICINE | Comments Off on Little Leaguer’s Elbow (Medial Epicondylar Apophysitis)

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