Elbow pain in throwing athletes is a frequent issue, often developing from the repetitive, high-speed nature of overhead sports. The forces generated during a throw place immense strain on the complex network of bones, ligaments, and tendons that make up the elbow joint. Understanding the specific causes and biomechanics of this pain is the first step toward effective management and return to activity. This knowledge helps athletes recognize when professional medical evaluation is necessary.
Common Injuries Caused by Throwing
The repetitive overhead motion of throwing typically results in overuse injuries that develop gradually. Injuries are often categorized by the location of the pain, most commonly affecting the inner side of the elbow. The ulnar collateral ligament (UCL) is the most frequently injured structure in throwers, sustaining extreme tensile stress during the motion. UCL injuries can range from minor inflammation and strain to a complete tear.
Pain on the inner side can also stem from flexor tendinitis, which is the irritation and inflammation of the flexor/pronator tendons where they attach to the humerus bone. This condition is also known as “Golfer’s Elbow” and may cause pain that persists even during rest. In skeletally immature athletes, repetitive stress can lead to Medial Epicondyle Apophysitis, commonly called Little League Elbow. This involves inflammation or injury to the growth plate on the inside of the elbow.
The outside (lateral) part of the elbow is less commonly affected, often due to the compression forces generated during the throw. Osteochondritis Dissecans (OCD) of the capitellum involves the erosion of cartilage and underlying bone, potentially leading to loose bone fragments within the joint. The posterior side of the elbow can sustain stress fractures or bone spur formation, a condition known as Valgus Extension Overload. These posterior injuries cause pain most noticeable during the extension and follow-through phases of the throw.
The Biomechanics of Throwing Stress
The act of throwing subjects the elbow to forces far exceeding its natural limits. The primary damaging force is valgus stress, which is the outward bending force applied to the elbow. This stress is concentrated on the medial side, specifically straining the UCL.
The highest stress occurs during the late cocking and early acceleration phases. During late cocking, the elbow is rapidly positioned into maximum external rotation, generating peak valgus torque. This force causes medial structures, such as the UCL, to undergo extreme tension, while the lateral side experiences high compressive forces as the bones are pushed together.
After the ball is released, the arm enters the deceleration phase, which is a period of rapid slowing down of the arm’s momentum. This phase requires eccentric muscle contraction to prevent the arm from flying forward, placing significant stress on the posterior aspect of the elbow. Repetitive exposure to these extreme forces, especially when coupled with poor mechanics or fatigue, leads to the microtrauma that develops into an overuse injury.
Immediate Acute Pain Management
When elbow pain flares up, the first step is to stop the activity completely, as continuing to throw will worsen the underlying injury. Rest is the most important component of initial management, allowing irritated tissues to begin healing.
The application of ice is recommended to reduce inflammation and manage discomfort. Ice should be applied for 15 to 20 minutes several times daily, ensuring a barrier is used between the ice and the skin.
Gently compressing the elbow with an elastic bandage and elevating it above the heart can help limit swelling. Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be used temporarily to manage pain and inflammation. These steps provide acute, temporary relief but should not replace a professional medical diagnosis if the pain is severe or persistent.
Indicators for Professional Medical Evaluation
While minor soreness may resolve with rest and ice, certain symptoms indicate a more serious structural issue requiring professional medical attention.
Immediate Warning Signs
A sudden, sharp pain accompanied by a distinct “pop” or tearing sensation during the throwing motion is a red flag for a potential ligament rupture or severe tendon tear. Any visible deformity of the elbow joint or a complete inability to move the arm should prompt an urgent medical visit.
Concerning Symptoms
The following symptoms suggest a need for medical evaluation:
- The inability to fully straighten or bend the elbow, often described as the joint “locking” or feeling stiff. This may suggest a piece of bone or cartilage is blocking movement.
- Numbness or tingling that extends into the forearm or fingers, particularly the ring and little fingers, suggesting irritation or compression of the ulnar nerve.
- Pain that persists for more than 48 to 72 hours despite complete rest, icing, and over-the-counter pain relievers.
A sports medicine physician or orthopedic specialist will conduct a physical examination and may use diagnostic imaging to confirm the injury. X-rays can identify stress fractures or bone spurs, while a Magnetic Resonance Imaging (MRI) scan is used to assess the condition of soft tissues, such as the UCL and tendons.