Elbow, Wrist & Hand

What It Is

Little leaguer's elbow (medial epicondyle apophysitis) is a type of pain located on the side of the elbow that is closest to the body. It is an injury to the growth plate on the inner side of the elbow (Nationwide Children's Hospital, 2021). The elbow joint is made up of the humerus (upper arm bone) and the two forearm bones, the radius and the ulna (AAOS, n.d.). The epicondyles are the bony bumps at the lower end of the humerus. The bump that is closest to the body is the medial epicondyle. The muscles responsible for bending the wrist are attached to the medial epicondyle, while the muscles that straighten the wrist are attached to the lateral epicondyle. Repeated throwing makes the wrist-bending muscles pull again and again on the medial epicondyle, which puts stress on the growth plate there (Nationwide Children's Hospital, 2021; AAOS, n.d.).

In children, bones grow from growth plates, areas of growing tissue near the ends of the bones. The medial epicondyle has its own growth plate, which is a weak area. In this condition, that growth plate becomes irritated or injured through repeated stress (Nationwide Children's Hospital, 2021).

Medial Epicondyle Apophysitis in Children Anatomy

Three bones join together to make the elbow joint. The bone in the upper part of the arm is called the humerus. Two bones from the forearm, the radius and the ulna, make up the lower part of the elbow (AAOS, n.d.). All of the bones have a distinct shape. Ligaments that are connected to the bones work to keep everything in proper alignment.

The elbow is a combination of a hinge joint and a pivot joint (AAOS, n.d.). As the muscles relax and contract, two distinct motions occur at the elbow. The hinge part lets the elbow bend and straighten, which is known as flexion and extension. The pivot part lets the forearm twist so the palm turns down and up, which is known as pronation and supination (AAOS, n.d.).

Not a diagnosis — for more information, contact me or another trusted healthcare provider.

Symptoms

How It Feels

Signs & Symptoms

Pain on the inner part of the elbow with activity, especially throwing, lifting or bending the wrist against force
A slightly swollen, tender bump on the inner elbow
Not being able to throw at full speed
Pain when bending and straightening the elbow

(Nationwide Children's Hospital, 2021)

Children who play throwing sports such as baseball and softball are most at risk, especially boys aged 11 to 16, children who are growing quickly, and those with poor strength and flexibility (Nationwide Children's Hospital, 2021).

Treatment

Self-Care & Treatment

How to Treat Medial Epicondyle Apophysitis in Children

Rest from throwing comes first, followed by stretching and strengthening exercises and a gradual return to throwing (Nationwide Children's Hospital, 2021; AAOS, n.d.). Working alongside your child's doctor, I can help with gentle hands-on care, a home exercise programme and a step-by-step return to throwing. See the My Approach tab for how I work.

1. Rest from Throwing

Throwing, heavy lifting and any other painful activity should be avoided. Mild injuries can settle when activity is reduced, but moderate to severe injuries may need much less activity for 3 to 4 months (Nationwide Children's Hospital, 2021). A return to throwing should be gradual and guided by the doctor or therapist (AAOS, n.d.). I can guide this step by step, in line with what your child's doctor advises.

2. Ice

Apply an ice pack for 10 to 15 minutes every 2 to 3 hours, and after any activity that makes the symptoms worse. Put a towel between the ice and the elbow to protect the nerve that runs along the inner elbow. Heat should not be used on a new injury (Nationwide Children's Hospital, 2021).

3. Therapy

A physiotherapist or athletic trainer can advise on stretching and strengthening exercises for the muscles that bend the wrist, which can then be done at home (Nationwide Children's Hospital, 2021). I can also teach you and your child these exercises, so you can do them together at home.

4. Adequate Coaching

Speak to your child's coach, and discuss whether there is any technique issue, or whether your child might be over-training and a rest period might help the problem to heal. Throwing technique can be checked as part of treatment (AAOS, n.d.).

5. Medication

Nationwide Children's Hospital (2021) says anti-inflammatory medicines, such as ibuprofen or naproxen, may be recommended for this condition, taken as directed by your child's healthcare provider, and that paracetamol (called acetaminophen in the US) may also be used. (This medicine information comes from Nationwide Children's Hospital, not from me. Always check with a pharmacist or your family doctor or nurse practitioner before taking any medicine.)

Braces and elbow supports are rarely used for this condition (Nationwide Children's Hospital, 2021).

Contact your child's doctor if the symptoms get worse or do not improve after 4 weeks of treatment, or if your child develops a fever (Nationwide Children's Hospital, 2021).

Tips

The best thing you can do to prevent the injury is to limit the amount of throwing the child does on a regular basis.
Since the problem tends to occur most often in pitchers, guidelines should be followed for the number of pitches the child throws and the rest days they take afterwards (Nationwide Children's Hospital, 2021; AAOS, n.d.).
Current Pitch Smart guidelines set a daily maximum of 75 pitches for ages 9 to 10, 85 pitches for ages 11 to 12, and 95 pitches for ages 13 to 14, with required rest days depending on how many pitches were thrown (MLB and USA Baseball, n.d.a; n.d.b).
Children aged 9 to 12 shouldn't pitch more than 80 innings in any 12-month period, and children aged 13 to 14 no more than 100 innings (MLB and USA Baseball, n.d.a; n.d.b).
Young pitchers should take at least 4 months off from throwing every year, with at least 2 to 3 of those months in a row, should not pitch on three days in a row, and should avoid playing catcher while not pitching (MLB and USA Baseball, n.d.a; n.d.b).
Beyond limiting the amount of pitching, it is important that children warm up properly and know how to pitch with proper technique (MLB and USA Baseball, n.d.a; Nationwide Children's Hospital, 2021).
If the child feels pain, they should stop throwing.

Treatment

My Approach

Little leaguer's elbow is a growth plate problem, so your child's doctor leads their care and decides when it's safe to throw again. I support that plan by easing tight forearm and shoulder muscles, keeping your child strong while throwing is on hold, and helping with a gradual return. Parents are welcome to sit in, with your child's agreement.

Please bring any X-ray or scan reports and notes from your child's medical team to the first visit. They're an important part of planning safe treatment for your child.

I start by assessing how the elbow, wrist and shoulder move, your child's strength and flexibility, and how much they've been throwing.

While Throwing Is on Hold

Gentle hands-on work for the forearm, upper arm and shoulder, keeping pressure off the sore bump on the inner elbow
I'll show you how to use ice safely at home
Keeping your child active in ways that don't hurt the elbow

As It Settles

Wrist stretches and strengthening, which I'll teach you both for home
Body-weight and light strength work for the shoulder, trunk and legs, so the whole body shares the work of throwing
When the doctor agrees, a step-by-step return to throwing
Talking through pitch counts, rest days and warm-ups with you and the coach

If the pain gets worse, isn't improving after 4 weeks, or your child develops a fever, contact your child's doctor.

What to Expect

Typical Course

Typical course: Visits are usually short, about once or twice a week at first, then weekly, then spaced out as you take over the home programme, with a reassessment at about 4 weeks. Mild cases can settle once throwing is cut back, while moderate to severe cases may need 3 to 4 months of much less activity before a gradual return to throwing, following your child's doctor's plan.

What I Focus On

Working With Your Child's Doctor

Gentle Forearm & Shoulder Care

Light Strength Work

Graded Return to Throwing

Pitch Count Advice

Sources

References

Nationwide Children's Hospital (2021) Little leaguer's elbow (medial epicondylar apophysitis). Available at: https://www.nationwidechildrens.org/conditions/sports-medicine-little-leaguers-elbow (Accessed: 7 October 2026).
American Academy of Orthopaedic Surgeons (n.d.) Elbow injuries in the throwing athlete. OrthoInfo. Available at: https://orthoinfo.aaos.org/en/diseases--conditions/elbow-injuries-in-the-throwing-athlete (Accessed: 7 October 2026).
MLB and USA Baseball (n.d.a) Pitch Smart: pitching guidelines ages 9-12. Available at: https://www.mlb.com/pitch-smart/pitching-guidelines/ages-9-12 (Accessed: 7 October 2026).
MLB and USA Baseball (n.d.b) Pitch Smart: pitching guidelines ages 13-14. Available at: https://www.mlb.com/pitch-smart/pitching-guidelines/ages-13-14 (Accessed: 7 October 2026).

Massage therapy · Kitchener–WaterlooMedial Epicondyle Apophysitis in Children

What It Is

Medial Epicondyle Apophysitis in Children Anatomy

How It Feels

Signs & Symptoms

Self-Care & Treatment

How to Treat Medial Epicondyle Apophysitis in Children

1. Rest from Throwing

2. Ice

3. Therapy

4. Adequate Coaching

5. Medication

Tips

My Approach

While Throwing Is on Hold

As It Settles

Typical Course

References

Related Conditions

Book a session

Massage therapy · Kitchener–WaterlooMedial Epicondyle Apophysitis in Children

What It Is

Medial Epicondyle Apophysitis in Children Anatomy

How It Feels

Signs & Symptoms

Self-Care & Treatment

How to Treat Medial Epicondyle Apophysitis in Children

1. Rest from Throwing

2. Ice

3. Therapy

4. Adequate Coaching

5. Medication

Tips

My Approach

While Throwing Is on Hold

As It Settles

Typical Course

References

Related Conditions

Bennett's Fracture

Boutonniere Deformity of the Finger

Carpal Bone Fracture

Colles' Fracture

Book a session