Little leaguer's elbow

The little leaguer's elbow was initially coined to describe medial epicondyle avulsion, but now it refers to a range of acquired elbow abnormalities in a skeletally immature patient engaged in overhead sports such as tennis, baseball, etc.

Epidemiology

It occurs in skeletally immature athletes before the closure of growth plates. Younger patients are more likely to develop avulsion injury or apophysitis than ligament injuries. 

Clinical presentation

The presentation includes: pain in a throwing arm, decreased throwing speed, power, and accuracy. Physical examination may reveal medial and proximal elbow focal tenderness. Applying valgus forces to the elbow may worsen the symptoms and, in severe cases, may show instability.

Pathology

Forceful throwing or overhead strokes generates extreme valgus and extension with tensile forces in the medial elbow, shear forces in the posterior compartment, and compressive stress on the lateral aspect of the joint.

Radiographic features

• medial epicondyle apophysitis:

  • widening of the physis with adjacent sclerosis and cortical irregularity. MRI may show increased fluid signal and widening of the physis with apophyseal edema-like lesions

  • in severe cases, fragmentation and avulsion fracture may occur

  • with advancing age and skeletal maturity, injuries of the ulnar collateral ligament become more prevalent

  • in younger children, due to higher elastin and low type I collagen content, slightly high T1 and T2 signal within the ligament is considered normal and should not be mistaken for tear or tendinopathy

• Panner disease: benign self-limiting osteochondrosis of the capitellum secondary ossification center in patients <12 years

• osteochondritis dissecans (OCD) of the capitellum: usually in patients older than 12 years 

• traction apophysitis of the olecranon

Treatment and prognosis

Treatment depends on the type of injury. If conservative management fails surgical option would be considered. Avulsion fractures and large OCD lesions may be treated surgically. 

See also

• overhead sports injury of the elbow