Elbow > Little League Elbow  > Treatments

    Surgical Repair

Treatment Introduction

On the medial side of the elbow, if the growth plate gets separated by more than about four millimeters, reattaching it surgically is sometimes performed to treat Little League elbow. But it is recommended very rarely. If the patient has loose bodies in his elbow, that becomes a certain surgical situation.

Preparing for Surgery

If you and your physician have decided on surgery to treat your Achilles tendon rupture, the decisions you make and the actions you take before your surgery can be every bit as important as the procedure itself in ensuring a healthy recovery.

   Learn the potential risks and benefits of the surgery by asking your surgeon any questions that will help you better understand the procedure. It can also help to speak with someone else who has undergone the same surgery.

   Any physical problems, such as a fever or infection, should be reported to your surgeon, and you should notify your surgeon of any medication you are taking.

   Getting a second opinion from a surgeon who is as qualified as the surgeon who gave the initial diagnosis is advisable in any case.

   Make sure the orthopedist performing the surgery is board-certified, which can be determined by calling the American Board of Orthopaedic Surgery at 919-929-7103.

At most medical centers, you will go to "patient admissions" to check in for your outpatient (ambulatory) surgery. After you have checked in to the hospital or clinic, you will go to a holding area where the final preparations are made. The paperwork is completed and your elbow may be shaved, though this is not always necessary). You will wear a hospital gown and remove all of your jewelry. You will meet the anesthesiologist or anesthetist (a nurse who has done graduate training to provide anesthesia under the supervision of an anesthesiologist). Then, you will walk or ride on a stretcher to the operating room. Most patients are not sedated until they go into the operating room. Here are some important things to remember for the day of your surgery:

   You will probably be told not to eat or drink anything after midnight on the night before your surgery. This will reduce the risk of vomiting while you are under general anesthesia.

   Since you will most likely be able to go home within a few hours of surgery, and because the anesthetic and pain medications may make you drowsy, arrange for someone to drive you home when you are released.

   Wear a loose, oversized shirt that will fit comfortably over an elbow bandage when you leave the hospital.

   Take it easy. Keeping a good frame of mind can help ease any nerves or anxiety about undergoing surgery. Distractions such as reading, watching television, chatting with visitors, or talking on the telephone can also help.

Surgery to repair Little League elbow usually takes about an hour to perform.

   An incision is made on the medial side of the elbow, allowing the surgeon access to the growth plate and any loose bodies that may be have resulted from the injury.

   The growth plate and loose fragments are reattached using screws.

   The incision is sewn up with stitches and you are taken to the recovery room.

When you awaken in the recovery room following surgery, your elbow is usually wrapped in gauze, bandaged, and covered with an ice pack. Some surgeons place your arm in a posterior splint for seven to 14 days after surgery. This is a sheet of plaster wrapped in cotton and positioned along the back of your arm that keeps your elbow bent at 90 degrees. You usually stay in the recovery room for at least two hours while the anesthetic wears off. General anesthesia wears off in about an hour and regional anesthesia may take about two hours to wear off. You will be given adequate pain medicine, either orally or through an IV (intravenous) line, as well as instructions for what to do over the next couple of days. In addition, you will be given an appointment to return and a prescription for pain medicine. You may initially have significant pain in the elbow and moving your wrist also may cause pain. You should take the pain medicine as directed. Remember that it is easier to keep pain suppressed than it is to treat pain once it becomes present. Your temperature, blood pressure, and heartbeat will be monitored by a nurse, who, with the assistance of the doctor, will determine when you are ready to leave the hospital. The majority of patients leave the hospital after two or three hours. As soon as you are fully awakened, you are usually allowed to go home. You will be unable to drive a car, so be sure to have arranged a ride home.

Home Recovery

Doctors strongly recommend that you avoid any movement that strains your elbow. You should picking up heavy objects until all the pain has gone away. Here is what you can expect and how you can cope after surgery:

   You will likely feel pain or discomfort for the first few days, and you will be given pain medications as needed. Many patients may be given a narcotic painkiller.

   There may be some minor drainage on the bandage since fluid may have accumulated during the surgery. Some blood may show through the bandage during the first 24 hours.

   As much as possible, you should keep your elbow elevated above heart level to reduce swelling and pain. It often helps to sleep with pillows under your arm. Icing your elbow for 20 or 30 minutes a few times a day during the first two days after surgery also will reduce pain.

It is difficult to determine when a player with Little League elbow can start pitching again. If a young athlete has a growth plate separation or it looks like there is some damage, doctors will rely on the normal healing process, which is going to be a minimum of four to six weeks. This is based on clinical findings such as tenderness, the integrity of the ligaments, and muscular strength. Rehabilitation generally starts with a strengthening program as soon as two weeks after the injury has been diagnosed. This benefits your elbow, shoulder, forearm, and hand. Many times the exercises can be done at home after a couple of explanations, but you usually will benefit from going to a physical therapist. If you have complicated problems such as loss of movement or ligament stiffness, rehabilitation may require more extensive physical therapy. When conditions in the elbow improve, the player may begin a program in which they begin throwing again. This usually starts with a short-toss, long-toss program to allow the player to gradually rebuild arm strength. Eventually, pitchers progress to throwing from a mound, but until they complete all these steps, they should not be permitted to resume competitive pitching.

For a pitcher, prevention is the only way to keep a young arm healthy. The number one concern is to not overload the arm by having him throw too much. In Little League, there is usually one pitcher who has the best arm on the team, and the tendency is for the coach to put him out there every chance he can. Doctors recommend limiting young pitchers to no more than seven innings of competitive pitching in a week. Doctors also give young athletes pitch counts — adolescent pitchers should not throw more than 80 to 100 pitches per week. If a youngster starts a game and has a couple of rough innings and gets up to 80 or 100 pitches in five innings, well, now the seven-inning stipulation is obsolete. Moreover, doctors ask pitchers not to throw competitively in additional games. Pitchers can play at another position. They should also have an exercise routine to keep their arm strength up and build endurance. The number two concern is that throwing curve balls and sliders puts a tremendous load on the elbow. Doctors try to keep youngsters throwing just fastballs and change-ups before they get into high school. Physicians also emphasize good form. The worse a pitcher’s mechanics are, the more likely he is to have an injury. When young athletes start a sport, they are not efficient with their movements, and there is a big learning curve involved in throwing efficiently. Until pitchers learn the mechanics and build up their arm strength and endurance, there is a higher incidence of injury. If Little League elbow is caught at the early stages, it is invariably a self-limited problem. Some kids and coaches drive their bodies harder than others. If the coach is telling the kid, "You're supposed to have elbow pain; it's normal," then he is liable to get himself hurt before he realizes he is in trouble. If a youngster really has an interest in trying for a college scholarship and a major league career, he has to keep in mind that he cannot go from playing weekend baseball to practicing every day with two teams without risking injury. Parents definitely have a major role in prevention. Some parents push too hard. If they see some talent in their child, sometimes the dad will try to teach him a curve ball and have him throwing too much at home.