Little Leaguer's Elbow (Medial Epicondylar Apophysitis)

with Rehab

Medial epicondylar apophysitis is also called Little Leaguer's elbow. The condition involves inflammation of the growth plate of the inner elbow (medial epicondyle) that causes elbow pain. The medial epicondyle is the site of attachment for the forearm muscles that are responsible for bending the wrist. Growth plates are a weaker area of bone, and are highly vulnerable to injury in skeletally immature individuals. Little Leaguer's elbow is an overuse injury that often lasts temporarily. It is uncommon after age 16.

SYMPTOMS

  • Slightly swollen, warm, and tender bump of the inner elbow.

  • Elbow pain with use of the elbow and wrist.

  • Pain that gets worse when bending the wrist against force (curls, lifting, throwing), or following 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 repeated stress to the medial epicondylar growth plate. This stress causes inflammation, which results in pain.

RISK INCREASES WITH:

  • Throwing sports (baseball, softball).

  • Conditioning routines that are too intense, such as weight lifting.

  • Being overweight.

  • Boys between 11 and 16 years of age.

  • Rapid skeletal growth.

  • Poor strength and flexibility.

PREVENTION

  • Warm up and stretch properly before activity.

  • Allow for adequate recovery between workouts.

  • Maintain physical fitness:

  • Strength, flexibility, and endurance.

  • Cardiovascular fitness.

  • Avoid extremes (too light or too heavy) in training.

  • Learn and use proper exercise technique.

PROGNOSIS

The course of the condition depends on the severity of the injury. Mild cases usually resolve with slight reduction of activity level. However, moderate to severe cases often require significantly reduced activity for 3 to 4 months.

RELATED COMPLICATIONS

  • Bone infection.

  • Growth plate pulling off the arm bone, resulting in a fracture.

  • Ongoing inability to fully straighten the elbow.

TREATMENT

Treatment first involves the use of ice and medicine, to reduce pain and inflammation. The use of strengthening and stretching exercises may help reduce pain with activity. These exercises may be performed at home or with a therapist. Certain activities (throwing or lifting greater than 10 pounds) should be avoided, until symptoms go away. Individuals who suffer from chronic Little Leaguer's elbow are often referred to a therapist for further evaluation and treatment. Your caregiver may advise wearing a sling or brace to restrain the elbow. Surgery is rarely needed to treat this condition.

MEDICATION

  • If pain medicine is needed, nonsteroidal anti-inflammatory medicines (aspirin and ibuprofen), or other minor pain relievers (acetaminophen), are often advised.

  • Do not take pain medicine for 7 days before surgery.

  • Prescription pain relievers may be given, if your caregiver thinks they are needed. Use only as directed and only as much as you need.

  • Corticosteroid injections may be given by your caregiver. These injections should be reserved for the most serious cases, because they may only be given a certain number of times.

HEAT AND COLD

  • Cold treatment (icing) should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain, and immediately after activity that aggravates your symptoms. Use ice packs or an ice massage.

  • Heat treatment may be used before performing stretching and strengthening activities prescribed by your caregiver, physical therapist, or athletic trainer. Use a heat pack or a warm water soak.

SEEK MEDICAL CARE IF:

  • Symptoms get worse or do not improve in 4 weeks, despite treatment.

  • You develop a fever greater than 101°F.

EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Little Leaguer's Elbow

These exercises may help you when beginning to rehabilitate your injury. Your symptoms may resolve with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Restoring tissue flexibility helps normal motion to return to the joints. This allows healthier, less painful movement and activity.

  • An effective stretch should be held for at least 30 seconds.

  • A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched tissue.

RANGE OF MOTION – Wrist Extension, Active-Assisted

  • Extend your right / left elbow and turn your palm upwards.*

  • Gently pull your palm and fingertips back, so your wrist extends and your fingers point more toward the ground.

  • You should feel a gentle stretch on the inside of your forearm.

  • Hold this position for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

*If directed by your physician, physical therapist or athletic trainer, complete this stretch with your elbow bent, rather than extended.

STRETCH – Wrist Extension

  • Place your right / left fingertips on a tabletop, leaving your elbow slightly bent. Your fingers should point backwards.

  • Gently press your fingers and palm down onto the table by straightening your elbow. You should feel a stretch on the inside of your forearm.

  • Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

STRENGTHENING EXERCISES - Little Leaguer's Elbow

These exercises may help you when beginning to rehabilitate your injury. They may resolve your symptoms with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Muscles can gain both the endurance and the strength needed for everyday activities through controlled exercises.

  • Complete these exercises as instructed by your physician, physical therapist or athletic trainer. Increase the resistance and repetitions only as guided.

STRENGTH – Wrist Flexors

  • Sit with your right / left forearm palm-up and fully supported. Your elbow should be resting below the height of your shoulder. Allow your wrist to extend over the edge of the surface.

  • Loosely holding a __________ weight, or a piece of rubber exercise band or tubing, slowly curl your hand up toward your forearm.

  • Hold this position for __________ seconds. Slowly lower the wrist back to the starting position in a controlled manner.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Ulnar Deviators

  • Stand with a ____________________ weight in your right / left hand, or sit while holding a rubber exercise band or tubing, with your healthy arm supported.

  • Move your wrist so that your pinkie travels toward your forearm and your thumb moves away from your forearm.

  • Hold this position for __________ seconds and then slowly lower the wrist back to the starting position.

Repeat __________ times. Complete this exercise __________ times per day

STRENGTH – Forearm Pronators

  • Sit with your right / left forearm supported on a table, keeping your elbow below shoulder height. Rest your hand over the edge, palm up.

  • Gently grip a hammer or a soup ladle.

  • Without moving your elbow, slowly turn your palm and hand upward to a "thumbs-up" position.

  • Hold this position for __________ seconds. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

STRENGTH - Grip

  • Grasp a tennis ball, a dense sponge, or a large, rolled sock in your hand.

  • Squeeze as hard as you can, without increasing any pain.

  • Hold this position for __________ seconds. Release your grip slowly.

Repeat __________ times. Complete this exercise __________ times per day.