Skeletally immature athletes who throw repeatedly are at
risk for elbow injuries that threaten the growth plate. Prevention and treatment of these
injuries must take into account not only the number of pitches or throws and how often the
athlete plays, but also velocity, throwing mechanics and the player's age.
Overhand throwing subjects the elbow to forces of tension, compression,
shear and torsion. Typically, these repetitive excessive forces involve the hypertrophic
zone of the growth plate, which is particularly vulnerable during peak growth velocity -
ages 10 to 12 years for girls and ages 13 to 15 years for boys, according to the authors.
A typical history may reveal the patient has persistent medial elbow
soreness, stiffness and discomfort that impair throwing and batting performance.
Physical exam findings may include medial tenderness when the ulnar
collateral ligament is placed in a valgus stretch; diffuse medial pain or discomfort
during palpation of the flexor-pronator muscle mass on the volar aspect of the proximal
forearm; and minimal swelling of the forearm and pain with resisted pronation. X-rays
should be taken to confirm the diagnosis and extent of osseous injury.
Nonsurgical treatment of players who have separation of the medial
apophysis of less than 3 mm involves stopping play, icing the medial elbow, taking
anti-inflammatory medication and starting a rehabilitation program that includes
stretching, strengthening and sport specific activities.
If treatment fails, surgery usually involves pinning the medial
apophysis if separation is greater than 3 mm and wiring if avulsion of the triceps-
olecranon complex is significant.
To prevent injuries, athletes should stretch and condition daffy. Young
players should undertake a strength training program designed for their age and ability
before beginning a formal throwing program. They also should use age guidelines for
learning new pitches and limit the number of pitches (See chart).