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Little Leaguers Elbow

Little Leaguers Elbow or Medial Epicondylar Apophysis, is a condition where lesions in the medial aspect of the elbow are produced in young athletes, particularly in baseball pitchers under the age of 10, due to repetitive throwing movement.

What is Little Leaguers Elbow?

Little Leaguers Elbow (LLE), as the name indicates, refers to a multitude of disturbing musculoskeletal symptoms that are reported in pediatric athletes. LLE is caused by chronic abuse or overuse injury to the medial aspect of the elbow joint; thereby leading to damage or injury to one or more components of medial elbow such as medial collateral ligament complex, medial epicondylar apophysis or medial epicondyle.

Little Leaguers Elbow

Signs and Symptoms of Little Leaguers Elbow

The affected pediatric athletes presents with pain (more pronounced along the medial aspect of elbow joint), popping sensation and higher propensity to experience other musculoskeletal injuries.

More specificity in symptoms can be found when taking in the various position of the injury. Medial-sided injuries, which are related to valgus overload in early and late cocking stages of throwing, can present as Apophysitis in younger children, and Epicondylar Avulsion Fraction in older children. As a result, they will have:

  • medial-sided elbow pain
  • decreased throwing speed or distance
  • point tenderness
  • effusion
  • flexion contracture
  • widening and/or fragmentation of apophysis

Lateral-sided injuries are mainly due to compressive forces during the late cocking and early acceleration stages of throwing, and also the shear forces on the radiohumeral joint during deceleration during follow-through. These can present as Panner’s disease and/or Osteochondritis Dissecans of the capitellum or radial head.

Lastly, posterior inuries can occur from the shearing forces during acceleration and deceleration phases of throwing. This is uncommon in younger athletes, and more common in older children or adolescents. This can result in injuries like Olecranon Apophysitis, Posteriormedial impingement or avulsion fractures.

Causes of Little Leaguers Elbow

This pattern of injury is often a result of repetitive/ aggressive throwing motion of upper limb in sports related activities. Certain contributing factors that may aggravates the risk of Little Leaguers Elbow are; intensive training, active participation in single sports, poor training tactics and recurrent microtrauma to the elbow joint.

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