Elbow Pitching Injuries

Pitching consists of four phases: windup, cocking, acceleration, and follow-through. During both the acceleration and follow-through phases, a large extension and valgus load is placed on the elbow joint.

The application of chronic stress to the elbow leads to overuse syndromes at the medial and lateral sides of the elbow.

In the acceleration phase of a pitcher’s motion, extreme valgus stress is placed on the elbow. Tensile forces that result from this stress may cause injury to the flexor musculature (wrist flexors), medial collateral ligaments, avulsion fractures of the medial epicondyles, and traction spurs of the ulnar coronoid. Compressive forces may also result in osteochondral fracture of the capitellum, osteochondritis dissecans, deformity of the radial head, lateral epicondylitis, lateral collateral ligament sprain, and formation of loose bodies all on the lateral side of the joint.

The follow-through phase of the throwing motion involves the triceps muscle forcefully extending the elbow, developing tensile forces along the length of the muscle-tendon unit, including its insertion to the olecranon (tip of the elbow). These forces may result in olecranon avulsion fractures, triceps strains, olecranon spurs, and joint degeneration. These conditions are often called "Little League Elbow" and correspondingly, in the shoulder, "Little League Shoulder."

These injuries should not be taken lightly even though their names appear to be somewhat benign. Remember, any sports injury can be potentially career-ending or perhaps even worse, lead to joint degeneration.

The most serious problems in the younger pitchers are those of the radiohumeral joints. Although less common than the medial injuries, these changes tend to be predictive of permanent deformity or disability to the elbow in the future. Medical reports have shown that disability occurs more commonly in association with a certain style of pitching, specifically related to the sidearm throw, the horizontal position of the extremity, and the whipping or snapping motion used to increase velocity. These seem to increase the compressive and tensile forces on the elbow.

In 1965, J.E. Adams drew attention to the potential risk of injury in the elbow in a study of 80 Little League pitchers ages nine to 14. He found that 45 percent of these players gave a history of pain around the elbow. All 80 pitchers showed some degree of radiographic abnormality in the dominant elbow when compared to the opposite side.

What is the best treatment for elbow injuries?

In our opinion, Hackett-Hemwall Prolotherapy is the most effective long term solution to the problem. Prolotherapy helps to regenerate tissue, unlike most pain medications, cortisone injections, and elbow surgery. We help many pitchers and athletes of all sports stay in the game with our comprehensive Prolotherapy and rehabilitation approach. If you are battling an elbow injury, we are happy to see you in our office for Prolotherapy with Dr. Ross Hauser.

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