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445 Pleasant Valley Way, Suite 100, West Orange, NJ 07052
862.520.4027
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Background & Etiology

The elbow joint is a connection point between the humerus (arm bone) and the radius and ulna (forearm bones.) Ligaments are strong, fibrous connective tissues made of collagen that attach bone to bone. These structures are a key component of a strong joint, providing stability and strength that allows the elbow to move with precision.

Ligaments can be stretched by an injury, excess strain on the joint, or through improper stretching techniques that weaken the elbow joint because stretched-out ligaments can cause joint instability. Ligaments can be highly susceptible to injury, and can lead to complications in the function of the joint. These injuries can range from sprains, which are typically mild, to tears that may require interventions like surgery to heal properly.

Little Leaguer’s Elbow

Injuries referred to as Little Leaguer’s Elbow are injuries that occur to the structures of the medial area of the elbow (the medial epicondyle, the medial epicondylar apophysis and the medial collateral ligament.) These conditions are typically the result of overuse and excess stress placed on the elbow joint, particularly by year-round athletic training.

As the name implies, this injury typically occurs in young or adolescent baseball or softball players, most often pitchers. The stress and strain that occurs during the “follow through” (throwing) phase and “cocking” (wind up and hold) phase of throwing a ball can lead to ligament laxity, and sprains or tears of the medial structures of the elbow.

Symptoms of Little Leaguer’s Elbow will vary depending on the severity of the injury, but they may include some or all of the following:

  • Moderate to severe pain
  • Loss of motion and weakness of the elbow
  • Redness, discoloration or bruising over the injured area
  • Stiffness
  • Acute elbow pain when attempting to throw a ball.
  • Possible deformity over the medial epicondyle.

Treatment for elbow ligament injuries may require resting the joint to allow pain and inflammation to subside. For severe injuries, like ligament tears surgery to reattach or repair the ligaments may be needed. How much movement should be restricted following the injury will depend on the severity of the ligament damage. Once cleared by the physician, a physical therapy program should be initiated to reverse the effects of immobilization and restore elbow motion.

  • Manual Therapeutic Technique (MTT): hands on care including soft tissue massage, and joint mobilization by a physical therapist to modulate pain and reduce any soft tissue or tendon irritation and restore normal joint mechanics and range of motion.
  • Therapeutic Exercises (TE) including exercises to improve strength and performance of the elbow and related muscles.
  • Neuromuscular Reeducation (NMR) to restore stability, begin retraining the upper extremity, improve proximal joint stability and improve movement technique and mechanics (for example: throwing) in use of the involved upper extremity in daily activities especially overhead activities.
  • Modalities that can include the use of ultrasound, electrical stimulation, ice, cold and laser to decrease pain, improve mobility and reduce inflammation of the elbow joint and surrounding muscles and tendons.
  • Home program development should include strengthening, stretching and stabilization exercises as well as instructions to help the person perform daily tasks and advance to the next functional level.

Post surgery immobilization can have detrimental effects that can be improved through physical therapy including:

  • Joint articular cartilage softening
  • Shortening and atrophy of musculotendinous units
  • Decreased mobility of the joint and connective tissues
  • Decreased circulation
  • Loss of active and passive motion
  • Progressing to strengthening
  • Analysis and correction of poor throwing mechanics

 

Goals for physical therapy post surgery immobilization are optimal loading and restoration of normal tissue relationships to improve motion, strength and ability to perform functional activities of daily living.

Physical therapy interventions can help improve range of motion, strength, coordination, proprioception and endurance. Formal therapy and compliance with an extensive home program is the mainstay to restoring function of the elbow

The use of pain medications, immobilization, rest and ice are the first line of treatment. A course of physical therapy will help reduce inflammation, pain, and restore motion and strength. In severe case arthroscopic surgery may be indicated.

Prognosis

Rate of recovery and the prognosis for Little Leaguer’s Elbow will depend on a number of factors:

  • Age- Younger individuals recover faster and are less likely to have residual deficits. Younger individuals heal quicker, have better circulation, are stronger and usually their pre-injury tissue integrity is better.
  • Prior activity level plays an important role in post-injury recovery. Those who exercise regularly are stronger and more flexible, and generally have an easier and more complete recovery.
  • Compliance- Patients that are committed to their rehabilitation program and are compliant with their home program are more successful in returning to full function.

Prevention

  • Discourage athlete from pitching at home during and after the season
  • Restrict or eliminate the throwing of curveballs, sliders, and other breaking balls
  • Shorten playing season
  • Provide three to four rest days between pitching
  • Allow for proper conditioning and warm-up
  • Instruct throwing athlete in proper throwing mechanics
  • Educate coaches and parents of the risk and prevention of this injury

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Real People, Real Testimonials.

"Eric was an excellent physical therapist. I made tremendous improvement during my time there. Rachel & Brittany were always smiling and creating a positive environment. Highly recommend using twinboro EHT!!!"

Ella G.

The Bridgewater Location is excellent! Every single staff person is on point. From day one when I called to schedule my first appointment and throughout my treatment staff were helpful, professional, and overall a caring and compassionate team. Their professionalism and caring was evident not only in my treatment, also in the treatment of other patients. Being in a room with multiple treatment stations you cannot help but notice the care received by other patients. My ankle is 100% better and if I ever need PT again I would not hesitate to return. I was always a part of the therapy process, if I had questions they were answered. If I wanted to improve my ankle health at home I was provided clear instructions for exercises. Staff were skilled and knowledgeable. I highly recommend this location to family and friends.

Constance C.

"I feel that the physical therapy at the Union office is above and beyond the best that I have ever received. They helped me so much and I hope to return as a visitor and utilize their equipment when I am fully recovered from surgery. Thank you Nicole, Elaine and the entire staff for always going the extra mile to make sure I received treatment. Never had a problem with billing either. I have been to a few PT facilities and highly recommend Twin Boro!"

Linda R.

“Never having experienced physical therapy before, I had no idea what to expect. I feel so fortunate that my experience has been totally positive. Everyone helped me feel so welcome and comfortable. I feel that I am being challenged, but not too much. I feel that I make an improvement at each session.”

Tora

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