Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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Little Leaguer’s Elbow

When a ball is thrown in baseball, the wrist and the fingers are vigorously pronated. The muscles responsible for this movement are all located in the inner (medial) compartment of the forearm. The force
of the throw is transmitted up through the arm to the weakest part of the muscle group, which is the medial epicondyle from which the muscles originate. In growing adolescents these muscle origins are attached to a growth area that is considerably weaker than the adjacent bone, and problems are caused by the increased traction on the epiphyseal junction.

Symptoms and diagnosis

– Pain in the elbow often starts gradually. If the pain appears suddenly the epiphysis may have been torn off, which sometimes necessitates surgery. The pain can be induced when the elbow joint is flexed.
– There is stiffness in the elbow.
– Local tenderness is felt directly over the medial epicondyle.
– Both the elbows should be X-rayed. A fissure in the epiphysis can be seen if present.

Treatment

The athlete should
– rest from painful activity;
– give up throwing movements completely until the pain has resolved (usually after 8–9 weeks);
– continue with conditioning and general strength training.

The doctor may:

– prescribe rest and sometimes immobilize the elbow. If there is a fissure in the epiphysis, a cast may be used;
– operate if displacement is significant. Neither steroid injections nor anti-inflammatory medicines should be given to growing adolescents.

Healing

If the epiphysis has been injured, throwing training can be resumed at the earliest 8 weeks after the injury occurred. Prior to that, careful rehabilitation should aim to maintain muscle function.

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