eMedicine Specialties > Sports Medicine > Upper Limb

Little League Elbow Syndrome: Follow-up

Author: Holly J Benjamin, MD, FACSM, FAAP, Assistant Professor of Clinical Pediatrics and Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, The University of Chicago and The University of Chicago Physicians Group; Appointed Director of Primary Care Sports Medicine, The University of Chicago
Coauthor(s): Igor Boyarsky, DO, Director of Triage, Assistant Professor, Department of Emergency Medicine, King-Drew Medical Center, University of California at Los Angeles; Christian Rank, MD, Staff Physician, Department of Emergency Medicine, Martin Luther King/Charles R Drew Medical Center; Eleby R Washington III, MD, FACS, Associate Professor, Department of Surgery, Division of Orthopedics, Charles R Drew University of Medicine and Science
Contributor Information and Disclosures

Updated: Jan 5, 2009

Follow-up

Return to Play

Return to throwing activities in individuals with little league elbow syndrome should be carefully monitored by the patient and his or her family in conjunction with an educated trainer, the coach, and a pediatric sports medicine or orthopedic specialist. The return to competitive pitching should begin when an athlete has fully completed his or her rehabilitation program. As the athlete returns to competition, careful attention to pitch types, pitch counts, a proper rotation schedule, and maintenance of core strength and flexibility is necessary.21

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Table

Maximum Pitch Counts — Game Competition 
(Adapted From USA Baseball Recommendations) 11

Age, y
Pitch Approved to Throw
Pitches per Game
Pitches per Week
Pitches per Season
Pitches per Year
9–10
Fastball
50
75
1000
2000
11-12
Change-up
75
100
1000
3000
13-14
Curveball
75
125
1000
3000
15-16
Slider, forkball, splitter, knuckleball
90
-
-
 
17-18
Screwball
105
-
-
 

Maximum Pitch Counts — Game Competition 
(Adapted From USA Baseball Recommendations) 11

Age, y
Pitch Approved to Throw
Pitches per Game
Pitches per Week
Pitches per Season
Pitches per Year
9–10
Fastball
50
75
1000
2000
11-12
Change-up
75
100
1000
3000
13-14
Curveball
75
125
1000
3000
15-16
Slider, forkball, splitter, knuckleball
90
-
-
 
17-18
Screwball
105
-
-
 

Complications

Even with a reasonable long-term maintenance program, complications such as posttraumatic arthritis, permanent flexion contractures, and growth or angular deformities may occur following little league elbow syndrome.

Prevention

Prevention can be accomplished by educating parents, players, and coaches about the symptoms and sequelae of little league elbow syndrome. Emphasis should be placed on proper throwing techniques during practices and games. Pitch counts, pitch types, and a proper rotation schedule should be followed. The number of competitive pitches thrown in practice and the number of innings per week, per season, and per year should be monitored. The prescreening physical examination affords an excellent opportunity for the physician to provide this information.

Proper warm-up time and proper strength and flexibility exercises should be maintained during the off-season or initiated at least 6 weeks before the first practice. Pitching should be limited to 9 months per year maximum, and an off-season interval throwing program is important. Proper biomechanics should be emphasized at all times. Athletes should be encouraged to seek medical care when symptoms of throwing-related elbow pain develop.

Prognosis

Prognosis for recovery from little league elbow syndrome is guarded and depends on the specific pathologic process. In general, disorders that affect the articular surfaces of the elbow, such as the capitellum and radial head, as well as those that affect the normal growth and development of the elbow have the worst long-term prognosis. Over the short term, most cases of little league elbow syndrome resolve with rest and conservative management. Osteoarthritis is a potential long-term complication. Functional disability and permanent deformity can result from proper or improper management.

Education

Little league elbow syndrome, as well as other sports-related injuries, can be discussed with parents and players during the preparticipation physical examination. This is an excellent opportunity for physicians to educate their patients about causes, symptoms, and prevention of sports injuries.21

Miscellaneous

Medicolegal Pitfalls

  • Medicolegal issues can arise in conjunction with making the diagnosis of little league elbow syndrome. Initially, at the time of diagnosis, the issues of causation are not usually arguable. The issues of responsibility can be argued, especially when the child has been participating in an organized and adult-supervised baseball or football league. The question arises as to whether the child is responsible for his or her own elbow, whether the parents are responsible for the child's injury, or whether the league is legally responsible when these injuries occur.
  • After treatment has been initiated and the patient enters the maintenance phase of rehabilitation, the issue of whether the child can return to organized sports activity can have legal implications. If the physician allows a child with radiographic or physical evidence of a continued problem to return to the sport, even with the absence of symptoms, then the physician can potentially be held liable for the progression of pathology (eg, loose body formation from osteochondritis dissecans). Therefore, all of the potential risks of resuming activity should be explained before the child returns to sports competition.Documentation in the medical chart of a detailed discussion regarding guidelines for the patient's return to play and appropriate limitations for pitching should occur, as should documentation of the parents’ understanding and acceptance of the risks.
 


More on Little League Elbow Syndrome

Overview: Little League Elbow Syndrome
Differential Diagnoses & Workup: Little League Elbow Syndrome
Treatment & Medication: Little League Elbow Syndrome
Follow-up: Little League Elbow Syndrome
References
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References

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  18. Cain EL Jr, Dugas JR. History and examination of the thrower's elbow. Clin Sports Med. Oct 2004;23(4):553-66, viii. [Medline].

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  21. Ronai J. Eight essentials of post-pitching recovery. USA Baseball.com. Available at http://mlb.mlb.com/usa_baseball/article.jsp?story=medsafety2. Accessed July 17, 2008.

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Further Reading

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Keywords

little league elbow syndrome, little league elbow, medial epicondylitis, valgus elbow extension overload syndrome, medial elbow apophysitis, ulnar collateral ligament injuries, lateral elbow compression injuries, overuse elbow injuries, Panner’s disease, Panner disease, LLE syndrome, LLE, elbow injury, baseball injury, pitcher’s elbow, pitching injury

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Contributor Information and Disclosures

Author

Holly J Benjamin, MD, FACSM, FAAP, Assistant Professor of Clinical Pediatrics and Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, The University of Chicago and The University of Chicago Physicians Group; Appointed Director of Primary Care Sports Medicine, The University of Chicago
Holly J Benjamin, MD, FACSM, FAAP is a member of the following medical societies: American Academy of Pediatrics, American College of Sports Medicine, and American Medical Society for Sports Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Igor Boyarsky, DO, Director of Triage, Assistant Professor, Department of Emergency Medicine, King-Drew Medical Center, University of California at Los Angeles
Igor Boyarsky, DO is a member of the following medical societies: American Medical Association, American Medical Student Association/Foundation, American Osteopathic Association, American Society of Addiction Medicine, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Christian Rank, MD, Staff Physician, Department of Emergency Medicine, Martin Luther King/Charles R Drew Medical Center
Christian Rank, MD is a member of the following medical societies: American College of Emergency Physicians
Disclosure: Nothing to disclose.

Eleby R Washington III, MD, FACS, Associate Professor, Department of Surgery, Division of Orthopedics, Charles R Drew University of Medicine and Science
Eleby R Washington III, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Medical Association, International College of Surgeons, and National Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Andrew D Perron, MD, Residency Director, Department of Emergency Medicine, Maine Medical Center
Andrew D Perron, MD is a member of the following medical societies: American College of Emergency Physicians, American College of Sports Medicine, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

CME Editor

Jon B Whitehurst, MD, Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner and Executive Board Member, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital
Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

Chief Editor

Sherwin SW Ho, MD, Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago
Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

 
 
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