Medial epicondyle apophysitis (MEA), also known as little league elbow, is an overuse injury prevalent among adolescent athletes who participate in sports that involve repetitive overhand throwing, racket use, or other overhead arm motions. The medial epicondyle is a bony protrusion on the medial aspect of the elbow, with its ossification center separate from the main distal humeral physis, known as an apophysis. This growth center at the medial epicondyle develops around 6-7 years of age and typically fuses by age 15. The ulnar collateral ligament (UCL) and the flexor-pronator muscle groups originate at the medial epicondyle and serve to stabilize the elbow against valgus stress. MEA occurs due to excessive and repetitive valgus stress placed on the apophysis before its closure. Over time, the repetitive strain results in a traction-type injury, which may cause pathologic widening and inflammation of the apophysis, or even an avulsion fracture. MEA may cause significant morbidity in young athletes, who must temporarily refrain from their chosen sport until the pain improves and healing occurs. Proper prevention, identification, and prompt treatment of MEA can enable young adolescents to continue participating in the sports they enjoy without prolonged interruptions to their athletic seasons.
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