by EBSCO Medical Review Board
(Elbow, Little League; Medial Apophysitis; Overuse Elbow Injury Related to Throwing)


Little League elbow is pain in the elbow joint due to repetitive throwing. This injury occurs in young baseball pitchers before puberty.

The Elbow Joint
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This injury happens when the ligament attached to the inner side of the elbow starts to pull one of the growth plates away from the rest of the bone. Growth plates are weak and easily injured when a child's bones are still growing. Certain types of throwing may lead to this problem, such as:

  • Throwing too hard and too often
  • Increasing the number of pitches per week too quickly
  • Throwing too many curves or sliders at a young age
  • Changing to a league where the pitcher's mound is farther away from home plate or the mound is raised

Risk Factors

This problem is more common in boys who are 10 to 15 years of age. The risk is higher in those who are pitchers, especially those who throw curve balls or sliders.


Problems may be:

  • Pain around the bony knob on the inner side of the elbow
  • Swelling
  • Pain when throwing overhand
  • Pain with gripping or carrying heavy objects


The doctor will ask about your child's symptoms and health history. You will also be asked about your child's activities. A physical exam will be done. It will focus on the elbow.

Images may be taken. This can be done with:


The goal of treatment is to ease pain and promote healing. Recovery time ranges from 6 weeks to 3 months.

Options are:

  • Supportive care, such as resting the elbow and using cold compresses to ease swelling
  • Medicines to ease pain and swelling
  • Physical therapy to promote strength, flexibility, and range of motion

Some children may need surgery. This is not common.


The risk of this problem may be lowered by:

  • Following age-based safety guidelines for the number of games, innings, and pitches
  • Not throwing curve balls or sliders until high school
  • Warming up and stretching before activity
  • Using proper pitching techniques


Family Doctor—American Academy of Family Physicians 

Ortho Info— American Academy of Orthopaedic Surgeons 


About Kids Health—The Hospital for Sick Children 

Canadian Orthopaedic Foundation 


Griffith TB, Kercher J, et al. Elbow Injuries in the Adolescent Thrower. Curr Rev Musculoskelet Med. 2018 Mar;11(1):35-47.

Management of throwing injuries of the elbow. EBSCO DynaMed website. Available at: Accessed January 29, 2021.

Throwing injuries in the elbow in children. American Academy of Orthopaedic Surgeons Ortho Info website. Available at: Accessed January 29, 2021.

Why counting pitches counts. The National Athletic Trainers' Association website. Available at: Accessed January 29, 2021.

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