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Little League Elbow Cheat Sheet (DRAFT) by

Management, presentation etc

This is a draft cheat sheet. It is a work in progress and is not finished yet.


- In LLE, MCL is affected (binds ulna to humerus, consists of : Anterior oblique, posterior oblique and transv­erse) - provides support against valgus stress woith the flexor­-pr­onator muscles


- LLE is a traction apophy­sitis, meaning a traction injury of the tendon­/li­gament occurs at the apophy­sitis due to excessive loading and repetitive microt­rauma


Physis: Cartil­aginous growth plate - near end of a long bone
Epiphysis: Cap of a bone - located between growth plate and joint cartiliage
Apophysis: Outgrowth - attachment for tendon­s/l­iga­ments - attached to the host bone via growth plate

Growth plates of the elbow

Capite­llum: appears at 1-2 years old, fuses at 10-15
Radial Head: Appears at 2-5 years old - fuses at 12-16
Trochlea: Appears at 8-10 years old - fuses at 10-18
Olecranon: Appears at 8-10 years old - fuses at 13-16)
Lateral epicon­dyle: Appears 8-13 years old - fuses at 12-16
Medial Epicon­dyle: Appears at 2-8 years old - fuses at 15-17 (last to close)


- Usually child athletes (throwers)
- Overhead pitching (compr­essive stress on lateral elbow and valgus stress on medial)
- Softball, tennis, racque­tball, handball, javelin, water polo, gymnastics and weight lifting


- Young athlete compla­ining of medial elbow pain in their throwing arm
- often mid-late season - busy
- Point tenderness over medial epicondyle
- Swelling, elbow stiffness, inability to achieve full extension
- +ve valgus stress test (Appre­hen­sio­n/d­isc­omfort)
- Neuro should be normal - Ulnar nerve should be checked
- Core and hip instablity can affect biomec­hanics of elbow
- Check - scapular dyskin­esis, dysfun­ction breathing, spinal instab­ility, hip abductor weakness


- Imaging only if unresp­onsive to conser­vative care/ another pathology is suspected, signig­icant swelling and fixed flexion positi­oning should be imaged (avuls­ion­/ep­ico­ndylar f#)
- MRI - occult osteoc­art­ila­ginous pathology, ligament injury, and myoten­dinous findings


- F#
- Avulsion
- Infection
- Neoplasm
- Exotosis
- Osteoc­hon­dritis Dissecans
- Meniscoid Lesion
- Cx radicu­lopathy (C8)
- Ulnar neuropathy (CTS)
- Poster­omedial imping­ement
- Sprain­/strain - flexor­/pr­onator tendon, MUCL, joint capsule


- Rest from offending activity - 4-6 weeks
- Encourage remaining active
- Splint­ing­/wrist braces
- Ice for 10 minutes , 4 times per day
- NSAIDs­/creams
- Neurod­ynamic technique for ulnar and median nerves
- Early streng­thening of extension and supination until pt can tolerate flexion and pronation
- Progress to isotonic streng­thening of wrist flexors, extensors, pronators and supinators (low resist­anc­e/high reps)
- Reverse Tyler Twist
- Streng­thening of FCU and FDS
- Scpula stabil­isation exercises (lower traps and serratus anterior)
- Shoulder external rotation and retraction exercises (Brugger, low row and lawmower)
- Core and hip exercises (Bridging, posterior lunges, semi-stiff deadlift, clams,)
- Gradual return to throwing when there is no longer point tenderness over medial elbow (no more than 10%)
- Proper coach commun­ication is important
- Pitchers should not : pitch on consec­utive days/m­ultiple games per day/on multiple teams with overla­pping seasons
- Players should have 2-4 months breaks with no throwing
- Consider surgical interv­ention if: Conser­vative care fails, MCL disrup­tion, >2mm of medial epicondyle separa­tion, avulsion f# >5mm