Little league elbow
Generic adolescent term for medial elbow injury
can refer to a continuous spectrum of injuries to medial side of the elbow including
medial epicondyle stress fractures
ulnar collateral ligament (UCL) injuries
flexor-pronator mass strains
Epidemiology
younger patients are more likely to have apophysitis or avulsion injuries, rather than UCL sprains
Pathophysiology
due to repetitive valgus loading with throwing causing repetitive microtrauma to the immature skeleton causes tension overload of the medial structures
Risk factors
Greater than 80 pitches per game
More than 8 months of competitive pitching per year
Fastball speed > 85mph
Continued pitching despite arm fatigue/pain
Participating in showcases
Symptoms
elbow pain in throwing arm
decreased throwing speed, accuracy, and distance
Physical exam
tenderness to palpation about medial elbow
pain with valgus stress
instability with valgus stress notes more severe involvement should be checked in varying degrees of elbow flexion to extension
Nonoperative
rest, activity modifications, PT
indication
is the mainstay of treatment
technique
coach and parent education is critical to limit number of innings pitched per week
use minimal immobilization to maintain elbow ROM
Operative
-ORIF of medial epicondyle
for medial epicondyle avulsion fractures
-UCL reconstruction
for UCL disruption and insufficiency
Complications
Ulnar nerve neuropathy
Continued pain and instability
Loss of motion
Inability to return to same level of play
