In children and adolescents the bones are still growing. The growth plates are made of cartilage and are actively producing more bone. The growth plates are the weakest part of the elbow, and the UCL and flexor tendon attach to a bump of bone immediately adjacent to one of the main growth plates on the inner side of the elbow.
In a child or young adolescent the ligament is stronger than the growth plate. If the elbow is over-stressed, instead of the ligament failing, the growth plate will be damaged and may develop a stress fracture through it. This is called “Little League Elbow”. The player will have pain on the inner side of the elbow made worse with throwing. Sometimes the growth plate may actually fracture and the bones pull apart. If this happens surgery is often necessary to avoid a permanent problem with the elbow. It is for this reason that persistent elbow pain in the young athlete must be closely monitored and evaluated by a physician. If it is ignored a permanent problem can develop.
This problem is becoming more common as more kids are playing more baseball. The growth of Tournament Teams and Select Teams even for six and seven year olds is indicative of the growth of year-round baseball. Often these teams overlap seasons, and the amount of throwing can double. While Little Leagues have limits on the number of innings that a pitcher can pitch in each week, these limits do not count innings in other leagues! So, the youth pitcher who pitches for multiple teams may throw many more innings than safety would allow.
A common problem is that the best youth pitchers usually play on multiple teams and take the mound for each team independent of the others. Of course, the coaches want the most talented pitchers to pitch the most innings for their team. So, the innings add up and the young athlete is vulnerable to overuse injuries of the elbow, in particular, the growth plates around the elbow and shoulder.
Dr. David Lintner is Chief of Sports Medicine at The Methodist Hospital in Houston. He is the past President of the Major League Baseball Team Physicians Association, and a member of the Baseball Commissioner’s Medical Advisory Committee. He is also the Head Team Physician for the Houston Astros and Houston Texans. For more information on the Sports Medicine Program at The Methodist Hospital in Houston, go to http://www.houstonmethodist.org/orthopedics/sports-medicine/