KidsMD Health Topics

Little League Elbow

  • Overview

    Little League elbow is a broad term that generally refers to an injury to the elbow’s tendons, ligaments and/or bones in a young, throwing athlete. Most of the time, the injury is due to overuse, but it can also be caused by a single, painful injury. 

    • Other conditions that are sometimes grouped with little league elbow are medial epicondylitis (also known as medial epicondylar apophysitis), medial epicondyle fracture and medial collateral ligament injury.
    • Young athletes who play sports like baseball that require a lot of overhand throwing are more prone to getting it, and it’s usually caused by overuse or poor throwing technique. 
    • In most cases of Little League elbow, a child will feel pain, irritation and inflammation in his throwing elbow. He won’t be able to move his elbow the way he normally does, and might not be able to straighten his arm all the way.
    • Your child should not be playing through elbow pain, especially if he plays on multiple teams. 
    • In most cases, Little League elbow can be fixed without surgery, but in some cases a child may have a fracture to a part of the elbow, and he/she may need surgery.
    • Little League elbow can be prevented by limiting the amount of throwing a player does, and following proper technique. USA Baseball has established guidelines to limit pitch counts for players. By following these guidelines, players can reduce stress on their arms and reduce the risk of getting injured.

    How Boston Children’s Hospital approaches Little League elbow

    At Boston Children’s Hospital, our doctors specialize not only in orthopedic care, but in pediatric orthopedic care.  Our clinical experts lead the country in research and care, and have the pediatric orthopedic expertise to treat the unique needs of children and young adults' musculoskeletal systems.

    Each year, our orthopedic team attends to more than 92,000 patient visits and performs over 6,000 surgeries. While assessing Little League elbow, our doctors search for signs that change with age and maturity level and deliver the most precise diagnosis possible so children can get back to their lives.

    Little League elbow: Reviewed by Benton Heyworth, MD

    Boston Children's Hospital  
    319 Longwood Avenue
    Boston MA 02115



    Boston Children's Hospital
    300 Longwood Avenue
    Fegan 2
    Boston MA 02115

    Boston Children's Hospital at Lexington
    482 Bedford Street
    Lexington MA 02420

    Boston Children's Hospital at Waltham
    9 Hope Avenue
    Waltham MA 02453

    Boston Children's North
    10 Centennial Drive
    Peabody MA 01960

    Boston Children's Physicians South
    Stetson Medical Center
    541 Main Street
    Weymouth MA 02190

    Children's Hospital Physicians at Good Samaritan Medical Center
    830 Oak Street
    Brockton MA 02301

  • In-Depth


    Elbow joints are made up of three bones—the upper arm bone is connected to the two bones in the forearm by a joint that works like a hinge. Around all these bones are muscles, ligaments and tendons that keep the keep it all together, and help the arm bend and move. 

    Pitching too much and too often, or simply throwing in a way that hurts the arm, can put a lot of stress on these tendons, ligaments and bones. There are several little soft areas of cartilage, called apophyses, at each end of most bones, and as older children stop growing, these areas turn into bone and harden. But before they harden, they are very easy to injure, and when players—mostly ages 9 to 14—throw too much, these areas can get inflamed and sore. 

    Signs and symptoms

    Without treatment, the ligaments and tendons may tear away from the bone or parts of the bone can separate from each other. Continuing to play through this kind of pain can make the injury worse, and your child should stop throwing and see a doctor if he has the following symptoms:

    • Pain in any part of the elbow
    • Swelling
    • Difficulty straightening the arm all the way
    • Sometimes, a bump appears on the inside of the elbow
    • A locked or stiff elbow 

    Throwing guidelines

    One of the most important things to know about little league elbow is that it can be prevented. Just by limiting the amount your child throws, you can prevent injury from happening. Even if your child already has little league elbow, these prevention guidelines can help him stay healthy when he returns to the sport. 

    USA Baseball has come up with pitch counts for young athletes. These guidelines should be applied to practices, games and multiple leagues as well. For proper reset, pitchers should not pitch on consecutive days, and should have three months a year without pitching. 

    9- to 10-year-old pitchers:

    • 50 pitches per game
    • 75 pitches per week
    • 1,000 pitches per season
    • 2,000 pitches per year 

    11- to 12-year-old pitchers:

    • 75 pitches per game
    • 100 pitches per week
    • 1,000 pitches per season
    • 3,000 pitches per year

    13- to 14-year-old pitchers:

    • 75 pitches per game
    • 125 pitches per week
    • 1,000 pitches per season
    • 3,000 pitches per year 

    More guidelines have been established in order to ensure proper rest time between pitching as well:

    For pitchers age 7 to 16:

    Pitches in a day             Rest time

    61 or more                         4 days

    41-60                                    3 days

    21-40                                    2 days

    1-20                                      1 day

    For pitchers age 17 to 18:

    Pitches in a day             Rest time

    76 or more                         4 days

    51-75                                    3 days

    26-50                                    2 days

    1-25                                      1 day

  • Tests

    • Your child’s doctor will want to know all about his sports history: how many sports he plays each year, how many leagues per sport and how often he throws on a weekly basis.
    • The doctor will examine the elbow to see how well it moves around, where the pain is and whether there is swelling.
    • The doctor may order an X-ray, which will show any changes that might have occurred where the cartilage meets the bone, and it will also show any damage to the growth plate.
  • Most athletes with little league elbow can be treated with rest and physical therapy, but in more serious cases, surgery is needed.  

    Treatment without surgery

    • The most important part of fixing little league elbow is rest. Your child should not be throwing at all until his tendons, ligaments and growth plates are fully healed.
    • Often, icing the elbow multiple times a day can help reduce inflammation until there is no pain.
    • Your doctor may also prescribe physical therapy, which can help strengthen the muscles around the elbow. 


    • If your child's elbow problem is because of a single, painful accident, then surgery may be necessary.
    • It might involve attaching the ligaments back to the bone or making sure there are no more loose bone fragments.
    • The kind of surgery required depends on your child's specific problem and the seriousness of the injury.
    • Recovery usually lasts two to three months, and involves follow up appointments, physical therapy and a very careful, gradual return to throwing.

    Coping and support 

    At Boston Children's Hospital, we understand that a hospital visit can be difficult, and sometimes overwhelming. If your child is admitted to the hospital for an extended stay, or needs more extensive care, your family may want to take advantage of the Center for Families, which can help connect you with resources, should you need them: 

    You can find more resources on the Boston Children's Patients and Families page.

  • Research & Innovation

    Because Little League elbow is preventable, USA Baseball, the STOP Sports Injuries campaign, the American Academy of Pediatrics and the National Institutes of Health are all trying to learn more about how to prevent it and other overuse injuries.

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