Throwing Injuries of the Elbow

When you throw an object or do a similar action over and over again, you can overwork the elbow and the structures that support it. When throwing, force is centered on the inner elbow, but other parts of your arm and elbow are also affected. Over time, the muscles around the elbow can weaken, which may result in other injuries, such as torn tendons, cracked bones, or stretched nerves.

When you throw an object over and over, it is possible to overwork the elbow and the muscles around it. Anyone can get these types of injuries, but they are most often linked to throwing balls or objects in certain ways. Common names for these injuries are:

• Pitcher’s elbow
• Tennis elbow
• Golfer’s elbow

When throwing, the force of the action is centered on the inner elbow. This can cause:

• Flexor tendinitis [ten-DUHN-eye-TIS]. This is when the tendons that attach to the upper arm bone (the humerus) become damaged and painful. 
• Ulnar collateral ligament [LIH-guh-mint] (UCL) injury. This happens when the UCL, a ligament in your elbow, has small or large tears.
• Valgus extension overload. This happens when the humerus and the elbow (olecranon [oh-LEH-krah-non]) are pushed against one another and the cartilage is worn down, causing bone spurs.
• Olecranon stress fracture. This is a bone crack that results from an impact.
• Ulnar neuritis [noo-RAHY-tis]. When the ulnar nerve is stretched too many times, it can cause inflammation in the nerve.
• Medial apophysitis [uh-PAH-fih-sye-tis]. Also called Little Leaguer’s elbow, this condition is most common in children. It is caused by repetitive throwing that pulls too much on the tendons and ligaments. 
• Osteochondritis dissecans [os-tee-oh-kahn-DRY-tis DIS-uh-kanz]. Also common in children, this happens when bones that are not fully developed are pushed together and cartilage is loosened.

Pitcher’s Elbow

Pitcher’s elbow is typically a baseball injury, but it’s not limited to baseball. It happens when the elbow is strained while making a strong overhand motion (like a pitcher throwing a ball). Over time, this motion can cause damage and pain from overuse.

Tennis Elbow

Any repetitive movement that puts strain on the wrist and forearm can cause tennis elbow. Tennis elbow is inflammation of the tendons that connect to your forearm muscles to the outside of your elbow. These muscles can be hurt when you use them too much, especially with repeated motions like swinging a tennis racket.

Golfer’s Elbow

Golfer’s elbow is similar to tennis elbow and can be caused by repeated movement. But it is different from tennis elbow because it is caused by activities that make you twist or flex your wrist repeatedly. This causes inflammation and pain on the inside of your arm and elbow.

The different throwing injuries of the elbow have similar symptoms, including:

• Inner elbow pain. This is most common with Pitcher’s elbow 
• Forearm pain. Golfer’s elbow will cause pain on the inside of your forearm, while tennis elbow will cause pain on the outside of the forearm.
• Wrist pain. This happens when you try and flex your wrist with your palm facing down.
• Pain when shaking hands. Gripping someone else’s hand might cause pain in your wrist or forearm.
• Limited range of motion. You might find it hard to move your elbow or straighten your arm completely.
• Weak grip. You might notice that you can’t grip things as hard as you could before you were injured.
• Numbness. You might not be able to feel parts of your elbow, forearm, wrist, or fingers.

If you have not had these symptoms before or if your pain is sudden and severe, make an appointment to see a doctor. Throwing injuries of the elbow can build up over a long period of time. This means your symptoms may go away for a while, or you might not notice any symptoms until your condition gets worse.

Sometimes, golfer’s elbow or tennis elbow can go away on their own, but you should see a doctor if your condition gets worse or does not get better.

Throwing injuries of the elbow are mostly caused by two things:

• Overuse of the elbow
• Repetitive motion that strains the elbow

To diagnose an injury of the elbow, a doctor will look at your forearm and ask you to move your fingers, hand, wrist, and arm, and ask about your pain. Usually, this is enough to tell if you have pitcher’s elbow, tennis elbow, golfer’s elbow, or another elbow injury. However, x-rays may be recommended to rule out any other problems.

The first thing to do is rest your arm. Stop any sports or other activities that cause your elbow and arm pain. You can also use the RICE method to reduce pain and swelling. RICE stands for:

• Rest. Avoid putting weight on the elbow, and avoid participating in normal activities until your elbow gets better.
• Ice. Use an ice pack (you can also use a bag of frozen vegetables if you do not have an ice pack) for 15-20 minutes, 3 to 4 times a day. 
• Compression. You can use a compression bandage or compression brace to help put pressure on the elbow and reduce swelling. 
• Elevation. To keep swelling down, elevate (raise) your elbow above the level of your heart. You can do this by sitting or lying down on a couch or floor and placing pillows under your elbow until it is higher than your chest.

You can also change the way you do the activity that caused your injury so that it doesn’t hurt your arm. Your doctor or a physical therapist can give you exercises to stretch your arm and build muscle that will ease the strain on your arm.

With basic treatment, some throwing injuries will heal. Usually, golfer’s elbow and tennis elbow treatment does not involve surgery. If conservative treatment does not relieve your pain, surgery may be recommended.

There are steps you can take to reduce your risk of getting a throwing injury of the elbow. Some of these include:

• Rest your arm after throwing. Do not overuse it.
• Make changes to your form and technique when exercising or playing sports.
• Have your sports equipment checked for a good fit.
• Play your sport less often or take it easy to avoid hurting your elbow more.
• Examine your work area set-up to see if there are changes you can make to reduce strain on your body.
• Use a counterforce brace if you are high risk.

MedlinPlus: https://medlineplus.gov/ency/article/007638.htm or https://medlineplus.gov/elbowinjuriesanddisorders.html

KidsHealth: https://kidshealth.org/en/parents/safety-baseball.html#

American Academy of Orthopaedic Surgeons: http://orthoinfo.aaos.org/PDFs/A00068.pdf