Pain on the inner side of the elbow in a throwing athlete should be taken seriously. In a pitcher who is still growing, the pain may be due to an irritated growth center in the humerus bone. Continued throwing can result in a sudden “pop” which represents a fracture of that growth center. In a pitcher this often requires surgical repair.

In an older thrower, the inner elbow pain can represent stress on the ligament that stabilizes the elbow (the ulnar collateral ligament or UCL). A properly functioning UCL is absolutely essential to accurate pitching. If an athlete continues to pitch through the pain, the ligament will stretch or a sudden “pop” will occur followed by complete inability to throw. This pop represents tearing of ligament fibers.

The best treatment is prevention. Good strength, proper throwing mechanics and adherence to recommended age specific pitch types and counts can help avoid injuries to the inner side of the elbow.

If an UCL is damaged, a course of physical therapy may be indicated. If there is continued pain, surgery is an option. An ulnar collateral ligament reconstruction, also called the “Tommy John Procedure”, is the accepted operation. It involves rebuilding the damaged part of the ligament with a tendon taken from the arm or the leg. Surgery is followed by rehabilitation and a gradual return to pitching with emphasis placed on proper mechanics. Full recovery can take up to 9 – 12 months.