Pitcher’s Elbow (Medial Epicondyle Apophysitis)

Pitcher's Elbow (Medial Epicondyle Apophysitis)

Being informed about potential conditions that can occur, as well as how to treat them, is an essential part of playing a sport. In addition to other sports-related conditions like tennis elbow or golf hand injuries, it’s important to recognize the signs of pitcher’s elbow, a common condition in young baseball players.

Here’s everything you need to know about pitcher’s elbow, including common causes, little leaguer’s elbow symptoms and how to go about treatment.


What Is Little Leaguer’s Elbow?

Pitcher’s elbow — also known as medial epicondyle apophysitis or “little leaguer’s elbow” — occurs when the bony bump on the inside of the elbow becomes painful and inflamed. The affected area is the attachment site where the tendons of the muscles that bend the fingers and wrist are located.

Little leaguer’s elbow is a common injury in young athletes, specifically baseball or softball pitchers aged 9 to 14 whose bones are still developing. Little leaguer’s elbow results from repetitive motion and overuse and can limit the arm’s range of motion, reducing or preventing the ability to throw a ball.

What Causes Pitcher’s Elbow?

Pitcher’s elbow occurs from overuse of the elbow and forearm muscles, as well as insufficient rest and recovery between activities. While throwing a ball too hard and too often tends to be the most common cause, pitcher’s elbow may also result from sports like swimming, golfing, wrestling, cheerleading and gymnastics.

Pitcher’s Elbow Signs and Symptoms

Most elbow injuries cause pain during or after throwing, limiting the ability to throw or decreasing throwing velocity. Your or your athlete’s coach may also notice pitches starting to sail high. Here are some other signs and symptoms associated with pitcher’s elbow:

  • Difficulty straightening the arm all the way
  • A bump or swelling on the inside of the elbow
  • Pain in the inner elbow extending along the forearm
  • A stiff or locked elbow
  • Painful or weak grip strength

In some cases, an athlete with pitcher’s elbow may experience ulnar neuritis, a tingling sensation or numbness in the elbow, forearm, hand or fingertips.

Why This Occurs in All Ages — Especially Children

Why This Occurs in All Ages — Especially Children

While pitcher’s elbow can occur at any age, it’s most common in adolescents, as we briefly touched on earlier. Up to 74% of baseball players aged 8 to 18 report some level of arm pain while throwing, with 23% of these injuries resulting from arm overuse.

When adolescents begin playing a new sport, they often use improper techniques and overuse the elbow. This can stress the arm’s growth plate, or the medial epicondyle, causing irritation and inflammation over time. In more severe cases, the growth plate can actually break away from the arm.

Certain maneuvers like breaking pitches and curveballs put additional stress on the growth plate, contributing to pitcher’s elbow. It’s important to limit these types of pitches as much as possible, especially for younger players.

How to Treat Pitcher’s Elbow

Now that we’ve covered the basic signs and symptoms of little leaguer’s elbow, what can you do to treat this condition? Here are some of the most common remedies for pitcher’s elbow, some that you can do at home and some that require professional treatment.

1. Rest

While it can be difficult for many athletes, resting and taking a break from the sport is one of the simplest yet most vital treatment methods. It’s a necessary part of the healing process and allows ample time to reduce swelling and inflammation.

2. Ice

Icing the affected area can also help reduce inflammation and swelling. It’s a low-tech recovery method that generally shows good results. Ice the inflamed area for 15-20 minutes every four to six hours. Remember to put a cloth or towel between the skin and the ice pack.

3. Compression

Compression is a treatment method that involves wrapping the elbow with an elastic or ACE™ bandage to help reduce swelling.

4. Elevation

Try elevating or raising the injured elbow on a pillow or another soft surface above the heart while sitting or lying down. Elevation may help decrease the throbbing or swelling caused by the pain.

5. Anti-Inflammatory Medication

Non-steroidal prescription or over-the-counter medications, such as ibuprofen, Advil or Motrin, can help reduce inflammation, swelling and pain.

6. Surgery

Surgery may be recommended or required in more severe cases. Ulnar collateral ligament (UCL) reconstruction, also known as Tommy John surgery, is a procedure used to correct pitcher’s elbow by replacing the injured UCL with a tendon retrieved from somewhere else in the patient’s body. If surgery is necessary, the doctor will likely recommend physical therapy afterward to help the athlete regain strength, mobility and function.

7. Physical Therapy

Physical therapy typically begins with treating elbow pain, followed by a series of little leaguer’s elbow exercises or training therapies to increase the range of mobility and strength of the affected area.

In addition to aiding recovery, physical therapy may also reduce the likelihood of reinjury when you or your child resumes playing. Increased mobility and strength can also improve performance when the time comes to return to the game.

8. Shockwave Therapy

Extracorporeal pulse activation technology (EPAT) shockwave therapy is a regenerative, non-invasive treatment method that delivers impulse pressure waves to damaged soft tissue, reducing pain and accelerating healing. Deep muscle stimulation breaks down scar tissue in the injured elbow joint, stimulating blood flow and reducing inflammation with each treatment session.

Shockwave therapy doesn’t require any surgery or risk infection, allowing for a quicker return to sports practices and activities. Some athletes can even undergo shockwave therapy sessions while maintaining some activity levels, depending on the severity of the injury.

When Should You See a Medical Professional?

Without proper treatment, the tendons and ligaments could eventually tear away from the bone or parts of the bone may separate from one another. To avoid worsening the pain and injury, you or your child should stop throwing and see a doctor when displaying the symptoms mentioned above. You should also see a medical professional if you’re uncertain of the severity of the condition or if ice and rest aren’t improving it.

Request an Appointment With the Hand Center

Request an Appointment With the Hand Center

Recognizing the signs and symptoms of a pitcher’s elbow injury is essential to ensure you or your young athlete receives the care and treatment necessary. At the Hand Center of Louisiana, our comprehensive services entail everything, including clinical evaluation and diagnosis, medical treatment, surgical intervention and therapeutic rehabilitation to address injuries of the hand, wrist, forearm, elbow and shoulder.

If you believe you or your athlete may have pitcher’s elbow, we encourage you to meet with one of our highly trained physicians, who can evaluate the condition and determine the proper treatment approach. Request an appointment at the Hand Center of Louisiana today.