What is Little League elbow?

Medial apophysitis is a common elbow overuse injury, particularly in young children. Also called “Little League elbow,” this injury occurs following fast and repetitive throwing, such as in baseball. The injury is most common in young pitchers but also occurs in those that play in other baseball positions.

Too much throwing puts stress on the ligaments and tendons that hold the elbow together. Sometimes, too much throwing can tear these structures and cause a serious injury. This may cause pain on the inside bump of the elbow.


Medial apophysitis causes problems of the elbow such as:

  • Pain and swelling on the inside
  • Limited movement
  • Locking Bone fractures
  • Abnormal bone growth

If your child experiences any of these signs or symptoms, they should stop throwing right away to avoid further injury and see their doctor.


Medial apophysitis is caused by repetitive throwing, such as in baseball. Too much throwing puts stress on the elbow ligaments and tendons (structures that hold the elbow joint together). Sometimes, too much throwing can tear these structures and cause a serious injury. This may cause pain at the inside bump of the elbow.

When to See a Doctor

See a doctor if your child has any of the signs or symptoms of medial apophysitis. If left untreated, throwing injuries can become very serious and affect elbow growth.

Diagnosis and Tests

Healthcare providers usually do a physical exam, get a medical history, and order x-rays of the elbow to diagnose medial apophysitis.


Medial apophysitis may be prevented by:

  • Getting involved in year-round fitness activities. Players should focus on strengthening muscles of the arm, shoulder, back, trunk, and hip.
  • Resting actively. Young baseball players should rest from hard-throwing activities for 3 to 6 months each year to allow their body time to rest and heal from injuries.
  • Limiting the number of throws in practice and games each week. The Pediatric Orthopaedic Society of North America recommends that children limit the number of throws to 75 for 8 to 10-year olds, 100 for 11 to 12-year olds, and 125 for 13 to 14-year olds.
  • Limiting the number of innings played. It’s recommended that young baseball pitchers limit their play to a few innings during each game.
  • Limiting the effort of certain throws. Young pitchers should avoid playing other high-speed throwing positions — such as short-stop, catcher, or third base — on days they have already pitched. Young pitchers should also rest from throwing for one to two days between pitching times.
  • Focusing more on controlling throws when a baseball player is young, then more on speed as they get older.
  • Using proper technique. Correct pitching and throwing go a long way to reduce stress on the elbow.


Treatments for medial apophysitis can be either nonsurgical or surgical.

  • Nonsurgical treatment. Younger children generally respond better to nonsurgical treatments.
    • Rest. Rest is a key treatment since continuing in the same throwing activities can cause more damage. Players should return to throwing only after being pain-free, having full range of motion, and after muscle strengthening.
    • Ice therapy. Ice helps lower swelling, which decreases pain. Improve throwing technique. Sometimes, changing a throwing technique can take stress off the elbow joint.
    • Physical therapy. Helpful physical therapy programs generally include improving range of motion and strengthening the muscles in the arm, shoulder, back, and abdomen (belly).
  • Surgical treatment. Sometimes, surgery is needed, especially in teenagers. Surgery may be necessary to reattach ligaments (structures that hold bones together) or to remove loose pieces of bone.

Locations Near

Add an address to see locations nearby