What Causes Pitcher’s Elbow?

Pitcher’s elbow can occur from overuse and repetitive motion that accompanies the throwing motion of baseball pitchers and puts a strain on tendons and ligaments. 

Elbow injuries occur more often in adolescent players because their elbow structure (ligaments, growth plate, bones, etc.) isn’t fully developed. Though the injury is more common in young players, many MLB players also struggle with elbow injuries.

The instances of pitcher’s elbow injuries vary depending on:

• The number of pitches thrown
• The number of innings played; and
• The number of months out of the year spent pitching

The greatest risk of injury occurs in pitchers who continue to throw when they are experiencing pain or fatigue.

As the name demonstrates, pitcher’s elbow occurs most often in baseball pitchers, but the injury can also occur in other sports, like:

• Football
• Softball
• Gymnastics
• Wrestling
• Tennis
• Javelin
• And more

In rare cases, pitcher’s elbow can develop as a result of trauma.

Risk Factors Associated With Pitcher’s Elbow

Risk factors that may make an athlete more prone to sustaining an elbow injury include:

• Age – Young players (ages 9-14) are more susceptible to injury due to underdeveloped elbow joints.
• Number of pitches – Making too many pitches per game, per season, or per year can contribute to the likelihood of elbow injuries. Players should carefully follow pitch count rules set in place by their league.
• Improper mechanics – Improper pitching technique can put unnecessary stress on the elbow joint. Pitchers should look to their coach to learn proper technique.
• Types of pitches thrown – Curveballs and breaking pitches tend to put too much stress on the growth plate of younger players.

Pitcher’s Elbow Treatment

Rest should be the first step of pitcher’s elbow treatment. Depending on how the patient responds to rest, other nonsurgical and surgical treatments may be recommended.

Nonsurgical Treatment

After undergoing an examination by a healthcare professional, they may recommend one or a combination of the nonsurgical treatments below:

• Anti-inflammatory medication – Drugs like ibuprofen and naproxen can help reduce swelling and pain.
• Throwing analysis or change of position – A throwing analysis can reveal any mechanics that need to be corrected, or changing the position played on the field may be suggested.
• Injections – An injection of platelet-rich plasma (PRP) may be recommended to stimulate healing. 
• Physical therapy – Physical therapy for pitcher’s elbow can help to improve mobility, flexibility, and strength. PT can also help to keep the injury from recurring by improving the elbow’s ability to handle stress.

Surgical Treatment

In cases of severe injury, surgery may be necessary. Common surgical procedures include:

• Arthroscopy – Arthroscopy can be used to diagnose and treat pitcher’s elbow injuries. Bone spurs and loose fragments can be removed, and because the arthroscopic instruments used are thin, the incision is small, resulting in less pain and bleeding than open surgeries.
• UCL reconstruction – Since most UCL tears cannot be repaired, they must be reconstructed. This surgery is often referred to as “Tommy John surgery” because he was the first major league player to have a ligament successfully reconstructed in 1974.
• Ulnar nerve anterior transposition – If an athlete is diagnosed with ulnar neuritis, the nerve can be moved to the front of the elbow to keep it from stretching or snapping.

Best Pitcher’s Elbow Exercises

Your physical therapist is the best person to prescribe specific exercises for your condition and rehabilitation. Below are some common exercises that may be prescribed for those with pitcher’s elbow.

External Rotation at 0° and 90°

To perform the exercise at 0°, stand with the elbow at 90° at the side and with the forearm across the front of the body. With a stretch band attached to a stationary object, grip the band. Pull out the arm, keeping the elbow tight to the side of the body. Return the band slowly to the starting point.

To perform the exercise at 90°, stand with the elbow away from the body and bent at 90°. With a stretch band attached to a stationary object straight ahead slightly lower than the shoulder, grip the band. Keeping the elbow bent, lift the band straight up and lower to the starting position.

Internal Rotation 0° and 90°

To perform the exercise at 0°, stand with the elbow at your side at 90°. Grip the stretch band and pull the arm across the body, keeping the elbow tight to the side. Return the band to the starting point.

To perform the exercise at 90°, stand with the elbow away from the body and bent at 90° with your clenched hand facing forward. Keeping the shoulder abducted and the elbow bent, pull the stretch band down so the clenched fist faces the ground. Return to the starting position. 

Sleeper Stretch

Lie on the injured side with the arm in front of you and the elbow bent at 90°. With the other arm, apply force to the wrist and push it down toward the ground. Hold for 20 seconds and repeat 3 times.