Elbow injuries in throwing athletes, such as baseball pitchers, are typically overuse injuries caused by the repetitive high valgus and extension loads imparted on the elbow during the overhead throwing motion. These injuries can be acute or chronic and often involve the medial (inner) stabilizing structures of the elbow.

Common Symptoms

• Pain during or after throwing
• Decreased throwing velocity
• Pitches sailing high
• Numbness/tingling in the elbow, forearm or hand (ulnar neuritis)
• Limited range of motion
• Weak grip

Cause & Anatomy

The overhead throwing motion places tremendous stress on the elbow joint, particularly the:

• Ulnar collateral ligament (UCL) on the inner elbow
• Flexor/pronator muscles and tendons
• Ulnar nerve

The forces during throwing apply tensile stress to the medial (inner) stabilizers, compression on the lateral (outer) side, and shear stress posteriorly.

Diagnosis

• Physical exam assessing range of motion, strength, stability
• Valgus stress test
• Imaging: X-rays, CT scans, MRI

Prevention

Prevention is key and involves limiting pitch counts, innings, months per year, and throwing with fatigue/pain. Emphasis on proper mechanics is also important.

Common Injuries

• Ulnar collateral ligament (UCL) tears
• Ulnar neuritis
• Flexor-pronator tendinitis
• Medial epicondyle apophysitis (little leaguer’s elbow)
• Valgus extension overload with olecranon osteophytes
• Olecranon stress fractures
• Osteochondritis dissecans of the capitellum
• Loose bodies

Treatment

• Initial treatment is conservative:
• Rest from throwing
• Ice, anti-inflammatories
• Rehabilitation exercises

Surgery

Surgery may be required for injuries not responding to conservative treatment, such as:

• UCL reconstruction (Tommy John surgery)
• Removal of loose bodies
• Repair of osteochondritis dissecans lesions

Rehabilitation

A comprehensive rehabilitation program focused on restoring strength, flexibility and proper throwing mechanics is critical after injury or surgery before returning to play.