Joe A Shaw PA-C - 2/1/2008

Question
My son was having a chronic pain in his right elbow last baseball season.  At the time he was 12.  He is very athletic with a high pain tolerance so figured something was wrong when he was always aching. I eventually took him to a children hosp. where they said he had a form of pitchers elbow but because it is in the area of the growth plate they were unable to say if it was an actual fracture.  He wore a  removable cast/splint and he didn't throw for the rest of the season.  He did bat and played 1st base for the last tournament in Cooperstown NY.  Only because it was a once in a life time chance to play there.  

It has been 6 months and the new season is starting.  He is now 13years old.  He has had 4 practices and already he is showing signs that he is feeling something there.

Does this mean it hasn't healed or could it be something more serious.  
Should I be concerned?
Should I return him to wearing his cast.  

Baseball is his passion so I want to be sure before I restrict him from it.

Answer
Andrea,
Yes you should be a little concerned. Little leaguers elbow/Pitchers elbow can become serious if aggravated enough. As you probably know it is caused by the throwing motion ( many believe an incorrect throwing motion) which causes microtears of the tendons and ligaments about the inside knobby bone of your elbow. The tearing may pull small bone fragments with it ( kind of like when you pull up a weed and the dirt stays w the roots) This can disrupt normal bone growth, resulting in deformities.
You need to find out if he has LLE or osteochondritis dissecans..it usually is to the outside bone of the elbow.

I would find an ortho/PEDS specialist or sports med. ortho and go back to him..possibly you have done this at the childrens hosp. They can take comparative xrays and get an MRI. I would also find a physical therapist experienced in throwing problems who can review your childs throwing motion. The max that a child should throw is 200 times a week (practice and playing etc..)But if he is having pain after 6 months of casting and non-usage and he were my son I would stop baseball for at least a yr or two. Most orthos will CYA and have them wear a cast and stop using it...but if it continues to come back and he keeps throwing he could have problems with that elbow down the road. For LLE surgery is occasionally necessary in boys > 14 yrs old and for OD it is often needed to correct the problem.