University Park, Pa. -- Without simple but necessary precautions, "Little League elbow" can leave teenage pitchers with a permanently deformed arm, notes the May issue of the Penn State Sports Medicine Newsletter.
"Parents, coaches and players can take four measures to prevent `Little League elbow,' a generic term for a variety of potentially serious elbow injuries," says Gary A. Levengood, M.D., an orthopedic surgeon at the Hughston Clinic in Atlanta. "The first is to have the player warm up prior to pitching. All players should throw the ball at short distances for at least 15 minutes before the start of a practice session or a game.
"Second, pitchers should not be allowed to throw curves until late adolescence (15-16 years old)," Levengood notes. "Third, the amount of pitching should be limited. Rules established by various youth baseball groups regarding the number of innings pitched per week, the number of pitches thrown, and the pitching rotation are designed to prevent elbow and shoulder injuries."
Fourth, pitchers should wear a neoprene (synthetic rubber) sleeve to keep the elbow warm and muscles loose. This may make muscle and tendon tears less likely, although it will not prevent severe injuries.
"Whenever young ballplayers develop pain in the elbow, they should get medical attention early to prevent further damage," Levengood says. "A young player, especially a pitcher, should see a physician if elbow pain lasts longer than several hours, if there is swelling, or if the player is unable to move the elbow. Untreated elbow injuries may hinder growth and development of the elbow."
Levengood points out that there are three phases of pitching that can cause injury.
"The cocking phase is the time during which the arm is brought back to its farthest point prior to forward motion," he says. "During this time, tension is placed on the inner side of the elbow, stretching the ulnar collateral ligament, the major stabilizer of the elbow. Repeated motions can cause injury through further stretching or tearing of the ligament.
"If these ligaments or muscles become stretched or torn, increased forces are loaded onto the opposite side of the joint, possibly resulting in growth plate injuries to the head of the radius, one of the bones in the lower part of the arm," says Levengood. "If forearm muscles that allow the wrist to flex are also stretched, repeated motion can cause an injury where the tendon attaches at the elbow. The condition is called medial epicondylitis, popularly known as `pitcher's elbow.' "
The acceleration phase, according to Levengood, is the point at which the arm begins its forward motion. During this phase, rotation of the forearm can stretch ligaments and tendons on the outside of the elbow. Repeated injury to this side can cause pain where muscles that extend to the wrist are attached and result in a condition known as lateral epicondylitis.
"The third phase is follow-through, during which hyperextension of the elbow can cause injury to the end of the humerus or upper arm bone," the orthopedic surgeon says. "Bone spurs can develop or fragments of bone and cartilage can break off and become trapped in the joint."
All evidence indicates that "Little League elbow" is not something to be taken lightly and that parents, coaches and the players themselves need to be aware of its real and lasting repercussions.
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