Little League Elbow

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.