Working Diagnosis:
Little League Elbow

Treatment:
The patient rested from throwing. He was also given non-steroidal anti-inflammatory medications and iced the elbow. After a period of rest, he gradually returned to activity.

Outcome:
The patient rested from sports for 3 months. He regained full range of motion in his right elbow and had no tenderness to palpation.

Author's Comments:
Little League Elbow is a spectrum of overuse pathologies that cause aching elbow pain. It worsens with continued play and potentially causes decreased strength and throwing velocity.

Although Little League Baseball has placed restrictions on pitch count, it is now believed that these overuse injuries are due to playing all year and total number of pitches in a season rather than a single game. American Sports Medicine Institute recommends avoiding pitching or overhead-throwing motions for ideally 4 months a year. With the changing mindset of overuse injury arising from year-round play, proper patient education and changes in guidelines need to take place to properly protect young athletes.

Editor's Comments:
While overuse injury in a skeletally mature baseball player can lead to ulnar collateral ligament injury, in the skeletally immature population it can lead to physis injury. Cessation of throwing is imperative to healing, and all throwing should be stopped as soon as there is concern for injury. It is important to encourage diversification in positions played in Little League Baseball, as well as in sport in general, to decreased the risk of overuse injuries. Physicians should also address biomechanical imbalances that may contribute to injuries like this, making sure the athlete has adequate core strength and shoulder range of motion.

References:
1. Collins CL, Comstock RD. Epidemiological features of high school baseball injuries in the United States, 2005-2007. Pediatrics. 2008;121(6):1181-7.
2. Little League Baseball. Protecting Young Pitching Arms. Pitch Count Regulation Guide for Parents, Coaches, and League Officials. Williamsport, PA: Little League Baseball; 2008.
3. Benjamin HJ, Briner, WW. Little League Elbow. Clin J Sport Med. 2005;15:37-40.
4. Wei AS et al. Clinical and Magnetic Resonance Imaging Findings Associated with Little League Elbow. J Pediatric Orthopaedics. 2010;30(7):715-9.
5. Hang DW, Chao CM, Hang YS. A clinical and roentgenographic study of Little League elbow. Am J Sports Med. 2004 Jan-Feb;32(1):79-84.
6. Pytiak AV, Stearns P, Bastrom TP, Dwek J, Kruk P, Roocroft JH, Pennock AT. Are the Current Little League Pitching Guidelines Adequate? A Single-Season Prospective MRI Study. Orthop J Sports Med. 2017;5(5): 2325967117704851.
7. American Sports Medicine Institute. Position statement for youth baseball pitchers. 2013. http://www.asmi.org/research.php?page. research&section.positionStatement

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