Pitcher’s Elbow: Symptoms and Treatments

Elbow pain is a fairly common condition among baseball pitchers. Pitcher’s elbow usually presents as pain along the inside part of the elbow during, or after, throwing activity. This injury is usually caused by repetitive motion and stress at the elbow, resulting in pulling and stretching of the tendons and ligaments of the inner elbow. It can cause pain and swelling inside the elbow and can limit one’s range of motion. When the injury involves the tendons, it is called “medial epicondylitis”. When the injury is more advanced, it may also involve the ulnar collateral ligament (UCL), which stabilizes the elbow during the throwing motion.

“Elbow injury in young throwers is unfortunately quite common. Baseball pitchers are especially at risk of elbow injury, due to the high stresses placed on the elbow during repetitive overhand throwing. However, other sports that require repetitive forceful motion and/or high stresses on the elbow can also cause pain and decreased performance.” says Dr. Gregory Gramstad, a Rebound orthopedic surgeon with fellowship training in shoulder and elbow surgery.

Common sports that can place an individual at a higher risk of injury include softball, golf, tennis, wrestling, football, gymnastics, cheerleading, and javelin– just to name a few.

Risk Factors

While pitcher’s elbow is an injury that’s caused by repetitive use, or in some cases, trauma to the arm, there are certain risk factors that can increase one’s chance of developing pitcher’s elbow. Some risk factors include:

• Age – Younger players, especially those between the ages of nine and fourteen, are at a greater risk for permanent injury since their joints, bones, growth plates, and ligaments are still growing. More mature athletes can have a reduced ability to recover after stressful activity, resulting in overuse injury and pain.

• Overuse – Pitching too many games can also lead to pitcher’s elbow. Research has shown that overuse in baseball can contribute to injuries such as pitcher’s elbow. If you experience pain while playing, it’s important to stop playing immediately and seek medical attention if the pain does not quickly improve or if it returns after resumption of throwing activity.

• Throwing Curveballs – Curveball and breaking pitches put additional stress on the growth plate and can contribute to pitcher’s elbow. These types of pitches should be limited, especially for younger players.

• Improper Pitching Techniques – Improper throwing technique can also cause pitcher’s elbow. Proper throwing techniques should be taught to young players to help reduce the chance of injury.

• Certain Sports – While anyone can develop pitcher’s elbow, those who are involved in sports that involve forceful repetitive stress to the elbow are more at risk. Those sports include baseball, softball, golf, tennis, wrestling, football, gymnastics, cheerleading, and javelin.

Symptoms

Pitcher’s elbow often manifests itself as pain on the inside of the elbow. It most often occurs gradually, but in cases of severe injury, can occur suddenly, and sometimes with a pop or tear sensation. The elbow joint may also feel as though it is locked or stuck. Pitcher’s elbow may also limit one’s range of motion, causing the elbow to be difficult to move. If you notice any of these symptoms, you should seek medical attention immediately.

Treatment Options

The first treatment of most elbow pain from throwing is rest, to allow the elbow to recover from inflammation and injury. Conservative treatment options that your doctor might also recommend include ice, to help reduce the swelling, and nonsteroidal anti-inflammatory drugs.

In more severe cases, other treatment options may be necessary to assist the recovery process and return the athlete to competition. These treatment options include physical therapy, throwing analysis and, rarely, surgical intervention.

• Physical Therapy – Since there are multiple reasons that one may develop a painful elbow from throwing, physical therapy may be used to help to restore and improve mobility and strength throughout all the muscles and joints that are required to throw properly. While the early focus is to treat the pain, another goal is to help prevent the injury from reoccurring by improving the elbows ability to respond to, and recover from, stress. Improved strength and mobility will often improve performance when the time comes to return to competition.

• Throwing Analysis – Repetitive throwing with improper mechanics can lead to a recurrence of pain, even when the painful condition has been properly treated. A trainer or therapist with advanced knowledge can use simulation and video analysis to detect throwing motion abnormalities and make recommendations to improve technique and, ultimately, performance.
   
• Surgery – In more severe cases, surgery may be recommended. UCL reconstruction, commonly known as Tommy John Surgery, is used to correct pitcher’s elbow. This surgery is named after Tommy John, a former Los Angeles Dodgers pitcher who first underwent this type of surgery in 1974. If surgery is required, physical therapy will be recommended as follow-up to help regain mobility, strength, and function. Rehabilitation and return to competitive throwing from Tommy John surgery generally takes a year, but in some cases two years are needed for an athlete to return to their previous level of function. The recovery process depends upon the age of the patient and the severity of the injury.

“The best treatment of pitcher’s elbow is prevention. Maintaining flexibility and strength, throughout the kinetic chain, are key to avoiding overuse injury. Using proper throwing mechanics, adhering to pitch counts and avoiding off-speed pitches at a young age can help to prevent permanent injury in throwers with immature elbows. If you have experienced sudden or recurrent elbow pain, it’s important to rest the elbow immediately and seek medical attention if the pain does not rapidly improve or if it returns after a short bout of rest.” says Dr. Gramstad. “We recommend having an evaluation by one of our specialists before returning to pitching or other athletic activities.”

Rebound is a premier orthopedic, sports medicine, and neurosurgery clinic located in Portland and Southwest Washington. For more information on pitcher’s elbow and available treatments, or to book a consultation, contact us today using our online appointment form or call us at 1-800-REBOUND.

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