Medial apophysitis (little leaguers elbow)

Medial apophysitis is an overuse condition caused by activities that involve repetitive bending of the wrist like throwing. Too much of such activities results in a traction effect on the medial epicondyle and thus results in inflammation of the growth plate. In severe cases the growth plate may actually break away from the upper arm.

Little Leaguer’s elbow is caused by too much throwing. Too much throwing puts stress on the muscles that bend the wrist where they attach to the inner side of the elbow. The growth plate becomes inflamed. In severe cases, the growth plate may actually break way from the upper arm.

Anatomy

Making up the elbow joint is the arm bone (humerus) and one of the forearm bones (ulna). At the bottom of the humerus are two bony bumps. The one closest to the body is the medial epicondyle and the one on the outside of the elbow is the lateral epicondyle.

Attached to the medial epicondyle through their tendons are the muscles that work to bend the wrist. Too much bending of the wrist can lead to irritation of the tendons that attach to the medial epicondyle.

In a child, the bones grow from areas called growth plates. There is a growth plate at the medial epicondyle called the medial apophysis. In Little Leaguer’s elbow this growth plate is irritated or inflamed.

Symptoms of Medial apophysitis

There is pain on the inside of the elbow that is worsened with repetitive bending of the wrist such as in throwing. There may also be swelling at the elbow joint.

Diagnosis and treatment

Your physiotherapist will be able to diagnose and treat this condition. In most cases an x-ray should also be done to see if any damage or breaking of the growth plate has occurred. Initial management will involve rest from aggravating activities to allow the inflammation to settle in the tendons and growth plate. This is especially important in this condition as damage to the growth plate can result in deformity. Initial physiotherapy will aim to reduce pain and inflammation through the use of electrotherapeutic modalities and gentle soft tissue techniques. Taping or the wearing of a brace may also be used to help reduce the traction effect of the tendons on the medial epicondyle.

Once the inflammation has settled and sufficient time has been allowed for healing then progressive strengthening and stretching of the elbow can begin. Once there is no swelling and pain and the injured elbow is of the same strength as the uninjured elbow a progressive return to activity/sport can commence. In severe cases where bone has broken off surgery may be required.