League Elbow > Treatments
On the medial side of the elbow, if the growth plate
gets separated by more than about four millimeters,
reattaching it surgically is sometimes performed to
treat Little League elbow. But it is recommended very
rarely. If the patient has loose bodies in his elbow,
that becomes a certain surgical situation.
Preparing for Surgery
If you and your physician have decided
on surgery to treat your Achilles tendon rupture, the
decisions you make and the actions you take before your
surgery can be every bit as important as the procedure
itself in ensuring a healthy recovery.
the potential risks and benefits of the surgery by asking
your surgeon any questions that will help you better
understand the procedure. It can also help to speak
with someone else who has undergone the same surgery.
physical problems, such as a fever or infection, should
be reported to your surgeon, and you should notify your
surgeon of any medication you are taking.
a second opinion from a surgeon who is as qualified
as the surgeon who gave the initial diagnosis is advisable
in any case.
sure the orthopedist performing the surgery is board-certified,
which can be determined by calling the American Board
of Orthopaedic Surgery at 919-929-7103.
At most medical centers, you
will go to "patient admissions" to check in
for your outpatient (ambulatory) surgery. After you
have checked in to the hospital or clinic, you will
go to a holding area where the final preparations are
made. The paperwork is completed and your elbow may
be shaved, though this is not always necessary). You
will wear a hospital gown and remove all of your jewelry.
You will meet the anesthesiologist or anesthetist (a
nurse who has done graduate training to provide anesthesia
under the supervision of an anesthesiologist). Then,
you will walk or ride on a stretcher to the operating
room. Most patients are not sedated until they go into
the operating room. Here are some important things to
remember for the day of your surgery:
will probably be told not to eat or drink anything after
midnight on the night before your surgery. This will
reduce the risk of vomiting while you are under general
you will most likely be able to go home within a few
hours of surgery, and because the anesthetic and pain
medications may make you drowsy, arrange for someone
to drive you home when you are released.
a loose, oversized shirt that will fit comfortably over
an elbow bandage when you leave the hospital.
it easy. Keeping a good frame of mind can help ease
any nerves or anxiety about undergoing surgery. Distractions
such as reading, watching television, chatting with
visitors, or talking on the telephone can also help.
Surgery to repair Little League
elbow usually takes about an hour to perform.
incision is made on the medial side of the elbow, allowing
the surgeon access to the growth plate and any loose
bodies that may be have resulted from the injury.
growth plate and loose fragments are reattached using
incision is sewn up with stitches and you are taken
to the recovery room.
When you awaken in the recovery
room following surgery, your elbow is usually wrapped
in gauze, bandaged, and covered with an ice pack. Some
surgeons place your arm in a posterior splint for seven
to 14 days after surgery. This is a sheet of plaster
wrapped in cotton and positioned along the back of your
arm that keeps your elbow bent at 90 degrees. You usually
stay in the recovery room for at least two hours while
the anesthetic wears off. General anesthesia wears off
in about an hour and regional anesthesia may take about
two hours to wear off. You will be given adequate pain
medicine, either orally or through an IV (intravenous)
line, as well as instructions for what to do over the
next couple of days. In addition, you will be given
an appointment to return and a prescription for pain
medicine. You may initially have significant pain in
the elbow and moving your wrist also may cause pain.
You should take the pain medicine as directed. Remember
that it is easier to keep pain suppressed than it is
to treat pain once it becomes present. Your temperature,
blood pressure, and heartbeat will be monitored by a
nurse, who, with the assistance of the doctor, will
determine when you are ready to leave the hospital.
The majority of patients leave the hospital after two
or three hours. As soon as you are fully awakened, you
are usually allowed to go home. You will be unable to
drive a car, so be sure to have arranged a ride home.
Doctors strongly recommend that you avoid any movement
that strains your elbow. You should picking up heavy
objects until all the pain has gone away. Here is what
you can expect and how you can cope after surgery:
will likely feel pain or discomfort for the first few
days, and you will be given pain medications as needed.
Many patients may be given a narcotic painkiller.
may be some minor drainage on the bandage since fluid
may have accumulated during the surgery. Some blood
may show through the bandage during the first 24 hours.
much as possible, you should keep your elbow elevated
above heart level to reduce swelling and pain. It often
helps to sleep with pillows under your arm. Icing your
elbow for 20 or 30 minutes a few times a day during
the first two days after surgery also will reduce pain.
It is difficult to determine when a player with Little
League elbow can start pitching again. If a young athlete
has a growth plate separation or it looks like there
is some damage, doctors will rely on the normal healing
process, which is going to be a minimum of four to six
weeks. This is based on clinical findings such as tenderness,
the integrity of the ligaments, and muscular strength.
Rehabilitation generally starts with a strengthening
program as soon as two weeks after the injury has been
diagnosed. This benefits your elbow, shoulder, forearm,
and hand. Many times the exercises can be done at home
after a couple of explanations, but you usually will
benefit from going to a physical therapist. If you have
complicated problems such as loss of movement or ligament
stiffness, rehabilitation may require more extensive
physical therapy. When conditions in the elbow improve,
the player may begin a program in which they begin throwing
again. This usually starts with a short-toss, long-toss
program to allow the player to gradually rebuild arm
strength. Eventually, pitchers progress to throwing
from a mound, but until they complete all these steps,
they should not be permitted to resume competitive pitching.
For a pitcher, prevention is the only way to keep a
young arm healthy. The number one concern is to not
overload the arm by having him throw too much. In Little
League, there is usually one pitcher who has the best
arm on the team, and the tendency is for the coach to
put him out there every chance he can. Doctors recommend
limiting young pitchers to no more than seven innings
of competitive pitching in a week. Doctors also give
young athletes pitch counts — adolescent pitchers
should not throw more than 80 to 100 pitches per week.
If a youngster starts a game and has a couple of rough
innings and gets up to 80 or 100 pitches in five innings,
well, now the seven-inning stipulation is obsolete.
Moreover, doctors ask pitchers not to throw competitively
in additional games. Pitchers can play at another position.
They should also have an exercise routine to keep their
arm strength up and build endurance. The number two
concern is that throwing curve balls and sliders puts
a tremendous load on the elbow. Doctors try to keep
youngsters throwing just fastballs and change-ups before
they get into high school. Physicians also emphasize
good form. The worse a pitcher’s mechanics are,
the more likely he is to have an injury. When young
athletes start a sport, they are not efficient with
their movements, and there is a big learning curve involved
in throwing efficiently. Until pitchers learn the mechanics
and build up their arm strength and endurance, there
is a higher incidence of injury. If Little League elbow
is caught at the early stages, it is invariably a self-limited
problem. Some kids and coaches drive their bodies harder
than others. If the coach is telling the kid, "You're
supposed to have elbow pain; it's normal," then
he is liable to get himself hurt before he realizes
he is in trouble. If a youngster really has an interest
in trying for a college scholarship and a major league
career, he has to keep in mind that he cannot go from
playing weekend baseball to practicing every day with
two teams without risking injury. Parents definitely
have a major role in prevention. Some parents push too
hard. If they see some talent in their child, sometimes
the dad will try to teach him a curve ball and have
him throwing too much at home.