Immature throwers are different anatomically, biome-chanically, and biochemically from adult throwers. Consequently, the growing child is vulnerable to many different and unique musculoskeletal lesions about the elbow as a result of the medial tension, lateral compression, and posterior shear forces repetitively encountered during the throwing motion. An understanding of the bio-mechanics of the throwing motion and an in-depth knowledge of the developing anatomy of the elbow and how it relates to the temporal radiographic findings are combined to delineate how various musculotendinous, ulnar nerve, medial epicondylar, lateral compression, and ole-

cranon injuries can occur. This understanding and knowledge are paramount to the physician who evaluates and treats the young thrower's elbow. Such knowledge also reinforces the importance of proper overhand throwing technique in reducing potential injury in immature athletes.

Early recognition and treatment are vital because most entities of Little League elbow respond to nonoperative treatment. Early treatment can also reduce long-term sequelae, such as ulnar neuritis, valgus instability, valgus deformity, loose bodies, osteophyte formation, flexion contracture, flexor-pronator musculotendinous problems, residual pain, and loss of supination and pronation, that cause functional disability and permanent deformity. Although early recognition and treatment of Little League elbow entities is important, prevention is really the answer to reducing the risk of developing the associated problems.

Overuse and improper throwing mechanics are the most common risk factors for developing elbow problems and, because they are preventable, certain guidelines and recommendations are necessary. Children usually have less coordination and slower reaction times and therefore a decreased ability to throw accurately and use proper mechanics. Because most young pitchers throw with more enthusiasm than skill, supervised coaching should emphasize proper basic overhand throwing mechanics and concentrate on accuracy. Young players should be advised to avoid sidearm and curveball pitches. They should focus on fastball and change-up (off-speed) pitches. Presently, the American Little League guidelines limit a pitcher to six innings of pitching per week, which is equal to 18 to 200 pitches. This does not account for warm-up pitches, hard throws from other positions, pitches or hard throws in practice, or pitches thrown while participating in another league. The Japanese recommend counting both pitches and hard throws as a total number (not to exceed 300 per week) and, because of this, it may be a better guideline. Rest periods between pitching appearances are mandatory. Training should not increase throwing by more than 10% per week, and conditioning should be done before intensive summer camp participation or competitive league play.

Enforcing these guidelines is very difficult, and it is up to local program directors, parents, and coaches to adhere to it. As physicians, we must educate those who are responsible for young athletes about the possibility of overuse injuries that result from excessive pitching and throwing and poor throwing mechanics.

Cure Tennis Elbow Without Surgery

Cure Tennis Elbow Without Surgery

Everything you wanted to know about. How To Cure Tennis Elbow. Are you an athlete who suffers from tennis elbow? Contrary to popular opinion, most people who suffer from tennis elbow do not even play tennis. They get this condition, which is a torn tendon in the elbow, from the strain of using the same motions with the arm, repeatedly. If you have tennis elbow, you understand how the pain can disrupt your day.

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