Elbow
> Little League Elbow
What is Little League Elbow?
Little League elbow,
so called because it is most common among young baseball
pitchers, is a process of chronic damage to the joint
surfaces. Young pitchers's elbows are immature. They
have open growth plates with a tenuous blood supply,
which makes their elbows susceptible to ligament pulls.
The age group most affected by Little League elbow is
pre-high school, from ages 10 to 15, with the peak incidence
in the 12-to-14 age group. Little League elbow involves
an overload on the medial side of the elbow, so that
the ligament attached to the growth plate starts to
pull away. On the other side of the elbow, compression
can cause a condition called osteochondritis dissecans,
in which damage is followed by poor blood flow and small
areas of bone death. The true definition of Little League
elbow is when both these components happen together
— some elongation of the ligament structures and
changes in the growth plate on the medial side, along
with some bony debris and damage to the outer half of
the elbow. In some circumstances, the medial elbow will
suffer a several-millimeter separation. More often,
the affected elbow will become sore and show a little
extra widening of the growth plate as compared with
the unaffected, non-throwing arm.
Causes
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The problem with young pitchers is that in many cases
they are either throwing too hard too often or trying
to build up their endurance too quickly. Most of the
time, adolescent arm problems can be linked to a sudden
increase in the intensity or duration of activity. For
example, a player may decide that baseball is going
to be his preferred sport, so he goes from playing with
a high school team to playing on two summer teams in
addition to his high school team. Now he is playing
three times as often, throwing three times as much.
This affliction also happens in cases where a player
changes leagues and the pitcher's mound is
farther from home plate or the mound is elevated. Sometimes
a change of coaches causes a pitcher to end up with
a sore arm. The way baseball has taken over as a year-long
sport has resulted in an accompanying increase in arm
complaints. The overhand motion of throwing a baseball
causes the elbow to stressed at the moment of full extension
– that is, when the arm is fully cocked back,
just prior to the moment the arm and the body move forward
in the throwing motion. The medial (inside) side of
the elbow experiences tension, while the lateral (outside)
side experiences compression. This combination of forces
can stress the growth plate on the inside of the elbow.
In young people, the growth plate has not yet fully
fused with the humerus, and thus is vulnerable to irritation.
In addition, microscopic tears can result in the muscle
and lead to tendinitis. Adults don’t suffer from
Little League elbow because their growth plate has fused
with the humerus. Instead, adults are susceptible to
tears of the ulnar collateral ligament (UCL).
Considerations
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Left untreated, Little League elbow can lead to further
problems. If the ligament heals while pulled away from
the growth plate, a knob may be left, creating the potential
for tendinitis later in life. More worrisome, however,
is the prospect that the player may develop damage to
the growth plate on the outside of the elbow. Those
problems sometimes do not get better with time and will
lead to an arthritic process in the joint. Loose bodies
are the long-term result of chronically damaging that
growth plate on the outer part of the elbow.
Orthopedic Evaluation
There usually are three
parts to an orthopedic evaluation: medical history,
a physical examination, and tests that your doctor may
order.
MEDICAL HISTORY
Your physician likely will ask about your activities,
which may be causing the pain in your elbow. He or she
will probably ask when the soreness and/or pain began.
If you have had any prior elbow injuries, your physician
will ask about the treatments you have tried in the
past.
Physical Exam [top]
Your physician will feel around your elbow to look for
physical evidence of damage and to isolate the source
of pain.
Tests
X-rays often show some of the bony changes that take
place and can help your physician make a more complete
diagnosis.
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