MEDIAL APOPHYSITIS
( Little Leaguer's Elbow )
What is medial apophysitis?
Little Leaguer's elbow is pain on the side of the elbow that is closest to the
body. The elbow joint is made up of the bone in the upper arm (humerus)
and one of the bones in the lower arm (ulna). The bony bumps at the end of
the humerus are called epicondyles. The bump closest to the body is called
the medial epicondyle, and the bump on the outer side of the elbow is called the
lateral epicondyle.
The muscles that work to bend the wrist attach at the medial epicondyle,
and the muscles that work to straighten the wrist attack at the lateral
epicondyle. Too much bending of the wrist will irritate the muscles that
attach to the medial epicondyle.
In a child, the bones grow from areas called growth plates. There
is a growth plate at the medial epicondyle called the medial apophysis. In
Little Leaguer's elbow this growth plate is irritated or inflamed.
How does it occur? Little Leaguer's elbow is caused
by too much throwing. Too much throwing puts stress on the muscles that
bend the wrist where they attach to the inner side of the elbow. The
growth plate becomes inflamed. In severe cases, the growth plate may
actually break way from the upper arm.
What are the symptoms? Symptoms include pain at
the inner side of the elbow when throwing and possible while at rest.
There may be swelling and tenderness, as well.
How is it treated? The most important treatment
for Little Leaguer's elbow is to not throw if the growth plate is
inflamed. Ice packs should be placed on the elbow for 20 minutes every 3
to 4 hours for 2 to 3 days or until the pain goes away. An elastic elbow
wrap may be placed on the inflamed elbow to give it more support and
anti-inflammatory medication and rehabilitation are common treatments. In
severe cases, in which there is a break in the bone, surgery may be
needed.
When can I return to activity? You may begin
throwing when there is no swelling around the injured elbow and it has regained
its normal strength compared to the uninjured elbow. You must have full
range of motion of the elbow. Throwing should be gradually increased but
stopped if the elbow becomes painful.
How can it be prevented? The best way to
prevent Little Leaguer's elbow is to limit the amount of throwing a child
does. Since the problem occurs the most in pitchers, there are guidelines
for how many pitches or innings a child can throw in a week. In general, a
child ages 9 through 12 years old should pitch a maximum of 6 innings per week
and no more than 250 pitches. A pitcher ages 13 through 15 should pitch a
maximum of 9 innings per week and no more than 350 pitches.
The Sports Medicine Patient Advisor
by Pierre Rouzier, M.D.
Medial Apophysitis p 198