What is it?
Medial Epicondylitis, the medical term for “Little League” elbow, is inflammation of the wrist flexor muscles that attach to the elbow. It is a tendonitis condition of the elbow usually caused by forceful, repetitive and excessive forward bending of the wrist (like after releasing a baseball). However, in the younger population, the weaker structure within the elbow complex can be the growth plates of the elbow. Injury to these growth plates (apophyses) can be compression, distraction, or torsion related during the mechanics of the throwing motion. Growth plate injuries that are not treated properly can cause life-long limitations and should be avoided at all cost.
An injury that is far more encompassing than epicondylitis, is an ulnar collateral ligament rupture. This ligament takes an abundance of stress/strain during the throwing motion and a tear to this structure will result in “Tommy John” surgery to repair the ligament to return to a pain-free throwing motion.
What are the symptoms?
Symptoms of “Little League” elbow typically begin with pain during activity and can progress toward a more constant pain, with or without activity. It is usually a generalized ache with sharp point tenderness to the inside of the elbow. Sharp twinges of pain occur with use of the flexor muscles. It is not uncommon for a moderate to severe case to produce a “squeaky gate” type feeling to the elbow known as crepitus. This is caused by inflammation and excessive deposition of scar tissue into the tendon, known as tendonosis.
*Note – at any time, if there is a limitation of elbow motion, or symptoms persist for longer than 4 weeks, see your doctor immediately.
How can I treat “Little League” elbow?
Step 1- Prevent the injury by limiting the repetition of throws and gradually build up the strength, speed and frequency of throwing, always avoiding throwing through discomfort.
*Utilize a preseason throwing conditioning program.
Step 2- Recognize the problem, don’t try to ignore the pain.
Step 3- If there is pain…Begin a course of over-the-counter anti-inflammatories (ibuprofen or naproxen) on a consistent basis (ibuprofen-400mg 3x’s/day for 2 wks or naproxen-200mg every 12 hours for 2 wks). Note – if you have any stomach, liver or kidney issues, please discuss the medications with your PCP (primary care physician).
Step 4 – Avoid or significantly reduce the aggravating activities.
Step 5 – Stretch the wrist flexors as demonstrated in the attached picture. As with any stretching, it should be done 5-6x-s per day with each stretch being held for 10 seconds-each session should last 3-4 mins.
Step 6 – Contrast Ice-Heat-Ice-Heat-Ice applications to the medial elbow changing every 3 minutes (a total of 15 mins.) a minimum of 3 times daily.
Directions-Little League Elbow Stretch
- Extend your affected arm in front of you, elbow straight with your palm up.
- Using the uninvolved hand, press the affected wrist downward and gently twist the wrist to turn the thumb in a downward direction (supination).
- Hold this position for a minimum of 10 seconds and repeat for a 3-5 minute timeframe.
Dr. Custer is the chiropractor at Better Care Chiropractic & Physical Therapy. He is a doctor of chiropractic as well as a former certified Athletic Trainer with previous work duties working as the Gettysburg Area High School Head Trainer/Health Teacher, Philadelphia Eagles Football Club Seasonal Assistant Trainer, and athletic trainer for Bryn Mawr Sports Medicine Center.
If you have questions/comments/suggestions, please feel free to contact Dr. Custer at [email protected]