Sports Medicine: Little Leaguer's Elbow (Medial Epicondylar Apophysitis)

Little leaguer’s elbow is an injury to the medial epicondylar (ME-dee-al epe-CON-deler) growth plate of the inner elbow. The growth plate is a weak area. Injury to it occurs due to repeated stress. In this case, the muscles that bend the wrist attach here. When the muscles contract repeatedly, it can lead to pain.

Signs and Symptoms

• pain on the inner part of the elbow with activity, especially bending the wrist against force (curls, lifting, throwing) or following a long period of exercise
• slightly swollen and tender bump on the inner elbow
• cannot throw at full speed
• pain when bending and straightening the elbow

Increased Risk

• throwing sports (like baseball and softball)
• overweight
• boys ages 11 to 16 years
• fast skeletal growth
• poor physical conditioning (strength and flexibility)

Treatment

• Medicine
  • Anti-inflammatory medicines, such as ibuprofen (Motrin® or Advil®) or naproxen (Aleve®) may be recommended. Take these as directed by your health care provider.
  • Other minor pain relivers, such as acetaminophen (Tylenol®) may be used.
• Use of heat and cold
  • Cold is used to relieve pain and reduce swelling. Cold should be applied for 10 to 15 minutes every 2 to 3 hours and after any activity that makes symptoms worse. Use ice packs or an ice massage.
  • Use a towel between the ice and elbow to reduce chance of injury to the ulnar nerve at the inner elbow.
  • Heat should not be used on a new injury. It may be used before stretching and strengthening activities prescribed by your health care provider or athletic trainer. Use a heat pack or a warm soak.
• Activity
  • Throwing, heavy lifting and any other painful activity should be avoided.
• Braces and exercises
  • Stretching and strengthening exercises for the muscles that bend the wrist may be done at home. A referral to a physical therapist or athletic trainer is advised first.
  • Braces are rarely used for this condition.

Mild injuries can go away when you reduce activity level. Moderate to severe injuries may require much more reduced activity for 3 to 4 months.

How to Prevent

• correct warm-up and stretching before practice or competition
• maintain suitable conditioning of arm, forearm and wrist
• exercise moderately; avoid extremes
• pitchers follow recommended pitch counts
• use proper technique

When to Call the Healthcare Provider

Call your healthcare provider or the Sports Medicine team at 614-355-6000:

• if symptoms worsen or do not improve after 4 weeks of treatment
• if you develop a fever of 101 F or 38.3 C 

Sports Medicine: Little Leaguer's Elbow (Medial Epicondylar Apophysitis) (PDF)

HH-I-487 ©2021, Nationwide Children’s Hospital