Pitchers Elbow

Pitchers elbow is a type of elbow injury that develops gradually and over time (overuse injury). This injury is caused by repeated overhead throwing.

Throwing can over-stretch the strong band of tissue (ligament) on the inside of your elbow (ulnar collateral ligament, or UCL), and it can also push the bones at the outside and back of your elbow together (compression). These forces can injure your ligament over time and create an abnormal extra bone in your elbow (osteophyte or bone spur).

This condition is also called valgus extension overload syndrome (VEOS).

What are the causes?

This condition is caused by:

• Repetitive overhead throwing, such as baseball pitching.
• Improper throwing motion.
• Tightness in the shoulder that puts added demand on the elbow.

What increases the risk?

This condition is more likely to develop in athletes who play sports that involve repetitive forceful straightening of the elbow, such as:

• Baseball or softball.
• Tennis.
• Football.
• Lacrosse.
• Gymnastics.
• Javelin.

What are the signs or symptoms?

Symptoms of this condition include:

• Elbow pain.
• Increased pain on the inside and back of your elbow as you straighten your arm forcefully, such as when throwing.
• Swelling.
• Limited range of motion or “locking” of the elbow.

How is this diagnosed?

This condition is diagnosed based on your symptoms, medical history, and a physical exam that checks the range of motion, strength, and stability of your elbow. Your health care provider may compare your injured elbow to your other elbow and may also gently press your arm and elbow to find the source of pain. You may also have imaging studies, such as:

• X-rays or CT scans to check for stress fractures and bone spurs.
• Ultrasound or MRI to check for tears in the ligaments or tendons.

How is this treated?

Treatment for this condition includes:

• Stopping activities that require overhead arm motions as told by your health care provider, then returning gradually to full activities.
• Modifying your sports technique to decrease elbow strain. This may include wearing a brace.
• Taking medicine to relieve pain.
• Doing strength and range-of-motion exercises (physical therapy) as told by your health care provider.
• Injection of an anti-inflammatory medication (corticosteroid) into your elbow to reduce swelling and pain.

If these treatments do not work, you may need surgery. This may include a procedure to repair damaged ligaments or to remove abnormal bone growths or loose pieces of bone or cartilage. After surgery, you will have to wear a brace for several weeks and eventually have physical therapy.

Follow these instructions at home:

If you have a brace:

• Wear the brace as told by your health care provider. Remove it only as told by your health care provider.
• Loosen the brace if your fingers tingle, become numb, or turn cold and blue.
• Do not let your brace get wet if it is not waterproof.
• Keep the brace clean.

Managing pain, stiffness, and swelling

• If directed, apply ice to the injured area.
  • Put ice in a plastic bag.
  • Place a towel between your cast and the bag.
  • Leave the ice on for 20 minutes, 2–3 times a day.
• Move your fingers often to avoid stiffness and to lessen swelling.
• Raise (elevate) the injured area above the level of your heart while you are sitting or lying down.

Activity

• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• Do exercises as told by your health care provider.

General instructions

• Do not use any tobacco products, including cigarettes, chewing tobacco, or e-cigarettes. Tobacco can affect how your elbow heals. If you need help quitting, ask your health care provider.
• Take over-the-counter and prescription medicines only as told by your health care provider.
• Keep all follow-up visits as told by your health care provider. This is important.

How is this prevented?

• Warm up and stretch before being active.
• Cool down and stretch after being active.
• Give your body time to rest between periods of activity.
• Maintain physical fitness, including:
  • Strength.
  • Flexibility.
• Have your technique evaluated to make sure you use proper form.
• Rest your elbow if you show signs of fatigue.
• Slowly increase your participation in any new athletic activity.
• Follow the rules and guidelines for your sport about how often and how much you can throw in competition.
• Avoid overhead throwing motions as told by your health care provider.

Contact a health care provider if:

• Your pain does not improve or it gets worse after 2–4 weeks of rest.

Get help right away if:

• You cannot move your arm or elbow.

Pitcher’s Elbow Rehab

Ask your health care provider which exercises are safe for you. Do exercises exactly as told by your health care provider and adjust them as directed. It is normal to feel mild stretching, pulling, tightness, or discomfort as you do these exercises, but you should stop right away if you feel sudden pain or your pain gets worse. Do not begin these exercises until told by your health care provider.

Stretching and range of motion exercises

These exercises warm up your muscles and joints and improve the movement and flexibility of your elbow. These exercises also help to relieve pain and stiffness.

Exercise A: Supination, active-assisted

1. Sit with your left / right elbow bent in an “L” shape (90 degrees) and rest your forearm on a table.
2. Keeping your upper body and shoulder still, roll your left / right forearm so your palm faces upward.
3. When you cannot go farther, use your other hand to help roll your forearm more until you feel a gentle to moderate stretch.
4. Hold this position for __________ seconds.
5. Slowly release the stretch and return to the starting position.

Repeat __________ times. Complete this stretch __________ times a day.

Exercise B: Pronation, active-assisted

1. Sit with your left / right elbow bent in an “L” shape (90 degrees) and rest your forearm on a table.
2. Keeping your upper body and shoulder still, roll your left / right forearm so your palm faces the tabletop.
3. When you cannot go farther, use your other hand to help roll your forearm more until you feel a gentle to moderate stretch.
4. Hold this position for __________ seconds.
5. Slowly release the stretch and return to the starting position.

Repeat __________ times. Complete this stretch __________ times a day.

Exercise C: Elbow extension, active-assisted

1. Hold your left / right arm at your side and straighten your elbow as much as you can using your left / right arm muscles.
2. Straighten the left / right elbow farther. To do this, gently push down on your left / right forearm with your other hand until you feel a gentle stretch on the inside of your elbow.
3. Hold this position for __________ seconds.
4. Slowly return to the starting position.

Repeat __________ times. Complete this stretch __________ times a day.

Exercise D: Shoulder internal rotation

1. Place your left / right hand behind your back with your palm facing up.
2. Use your other hand to dangle a towel over your shoulder. Grasp the towel with your left / right hand so you are holding onto both ends.
3. Gently pull up on the towel until you feel a stretch in your left / right shoulder.
4. Avoid shrugging your shoulder as you raise your arm. Keep your shoulder blade tucked down toward the middle of your back.
5. Hold this position for __________ seconds.
6. Release the stretch by letting go of the towel and lowering your hand.

Repeat __________ times. Complete this stretch __________ times a day.

Strengthening exercises

These exercises build strength and endurance in your elbow. Endurance is the ability to use your muscles for a long time, even after they get tired.

Exercise E: Elbow flexors, supinated

1. Sit on a firm chair without armrests, or stand.
2. Let your left / right arm rest at your side with your palm facing forward.
3. Holding a __________weight or gripping a rubber exercise band or tubing, bring your hand toward your shoulder.
4. Hold this position for __________ seconds.
5. Slowly return your hand to your side.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise F: Forearm supinators

1. Sit with your left / right forearm supported on a table, keeping your elbow below shoulder height.
2. Hold a hammer in your left / right hand.
   1. The exercise will be easier if you hold on near the head of the hammer.
   1. If you hold on toward the end of the handle, the exercise will be harder.
3. Rest your left / right hand over the edge of the table so your palm faces down.
4. Without moving your elbow, slowly turn your palm up toward the ceiling.
5. Hold this position for __________ seconds.
6. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.