Little League Elbow Is a Term That Describes a Number of Chronic Overuse Conditions Associated

Read the info below on Little Leaguer's Elbow, then think about the questions listed at the end.

Little Leaguer's Elbow is a term that describes any number of chronic overuse conditions associated with repetitive throwing that affect the skeletally immature elbow. Repetitive valgus & extension forces can lead to irritation/injury of the 1) medial epicondyle (aphophysitis or avulsion), 2) medial collateral ligament secondary to traction, 3) osteochondritis of the capitellum or radial head, 4) premature closure of the proximal radial epiphysis secondary to compression.

The young athlete who presents with this condition is frequently a pitcher who has pain during the acceleration phase of throwing. Poor technique or side-arm style may be associated. Treatment begins with rest and is dependent on the radiographic findings. Loose bodies should be removed, and avulsed bone should be repaired. Intact osteochondrotic lesions should be left in place, since the prognosis for healing is good in skeletally immature athletes. When the pain is resolved, a careful progressive return to throwing can be instituted. Proper technique should be monitored. Total number of throws and innings pitched per week should be limited.

1)There's no mention of the role a PT might play in the care / mgmt / prevention / treatment of this condition. Speculate on what you believe a PT might be able to offer.

2) Assume for a minute that you have an interest in working in a clinical area in which you might treat patients with these types of problems, or at least interact with people at risk for these pathologies. Do you think a PT practicing in this area should have a good knowledge of any of the following? (Why or why not):  proper throwing technique  types of pitches that put the skeletally immature elbow at risk of injury  a progressive throwing program for return to pre-injury level of function  appropriate limits to place on number of pitches and innings-pitched per week for prevention of injury.

Additional Information:

Am J Sports Med 2001 Jan-Feb;29(1):15-7 Nonoperative treatment of ulnar collateral ligament injuries in throwing athletes.

Rettig AC, Sherrill C, Snead DS, Mendler JC, Mieling P.

Methodist Sports Medicine Center, Thomas A. Brady Clinic, Indianapolis, Indiana 46280, USA.

Ulnar collateral ligament injury of the elbow in throwing athletes is a common occurrence, and either operative or nonoperative treatment is an option. The results of operative repairs and reconstructions have been well documented in the literature; however, little information has been reported on the outcome of nonoperative treatment. From 1994 to 1997, we evaluated 31 throwing athletes with ulnar collateral ligament injuries. The purpose of this study was to determine what percentage of athletes could return to their sport without surgical intervention and to identify factors that would predict return to full competition by an athlete treated nonoperatively. The factors studied included acute versus insidious onset of symptoms, the duration of symptoms before treatment, and age. Nonoperative treatment, which included a minimum of 3 months' rest with rehabilitation exercises, allowed 42% of the athletes in our study (N = 13) to return to their previous level of competition. Those who did return did so at an average of 24.5 weeks after diagnosis. No predictive findings obtained either through the patient's history or physical examination were found that would assist the clinician or athlete in predicting the success of nonoperative treatment.