Why Your Inner Elbow Hurts During Baseball Season

Understanding Medial Elbow Pain in Throwing Athletes
Anna Staehli Wiser, DPT, FAAOMPT

Baseball season is back—and with it comes a predictable rise in medial (inner) elbow pain, especially among pitchers and frequent throwers. If you or your child notices pain on the inside of the elbow during throwing, lifting, or even daily activities, it is important to understand what structure may be involved and how to address it early.

What Could Be Causing Inner Elbow Pain?

Pain along the inner elbow is not one single diagnosis. In throwing athletes, the most common causes include:

• Medial epicondylalgia (golfer’s elbow)

• Ulnar collateral ligament (UCL) strain

• Ulnar nerve irritation (cubital tunnel syndrome)

Each of these conditions involves a different structure but shares a common theme: repetitive stress from throwing.

Medial Epicondylalgia: Tendon Overload

Medial epicondylalgia refers to irritation of the common flexor tendon, which attaches to the medial epicondyle of the humerus. Repetitive gripping, wrist flexion, and throwing create microtrauma within the tendon over time.¹

Athletes may notice:

• Aching or sharp pain on the inner elbow

• Weakness with gripping or throwing

• Stiffness after activity

Without proper management, the tendon can become degenerative rather than simply inflamed.

Ulnar Collateral Ligament (UCL): The Thrower’s Stabilizer

The ulnar collateral ligament (UCL) plays a critical role in stabilizing the elbow during high-velocity throwing. It connects the humerus to the ulna and resists valgus stress generated during the late cocking and acceleration phases of pitching.²

In baseball players—particularly pitchers—the repetitive stress can exceed the ligament’s capacity, leading to:

• Pain during throwing (especially late cocking phase)

• Decreased velocity or control

• A feeling of instability

While UCL injuries are often associated with surgery (e.g., “Tommy John”), not all cases require it.

Little League Elbow: A Growing Athlete’s Problem

In younger athletes whose bones are still developing, medial elbow pain is often referred to as “Little League elbow.” This condition involves irritation of the growth plate (medial epicondyle apophysis) rather than the tendon or ligament itself.³

It is typically caused by:

• Overuse

• Excessive pitch counts

• Inadequate rest between games

The hallmark treatment here is simple—but critical: rest from throwing.

What About the Ulnar Nerve?

The ulnar nerve runs just behind the medial elbow and can become irritated with repetitive stress or instability. This may cause:

• Numbness or tingling into the ring and small fingers

• Weakness in the hand

• Sensitivity along the inner elbow

Do You Always Need Surgery?

Not necessarily.

While surgery is sometimes appropriate—particularly for high-level athletes with complete UCL tears—many cases respond well to conservative care.⁴

Evidence-based non-surgical treatments include:

• Activity modification and load management

• Progressive strengthening programs

• Manual therapy and mobility work

• Dry needling, which may help stimulate tissue healing and reduce pain in tendinopathies⁵

• Biologic treatments such as platelet-rich plasma (PRP), which have shown promise in supporting ligament and tendon healing⁶

The Bottom Line

Inner elbow pain during baseball season is common—but it should not be ignored.

Whether the issue is tendon overload, ligament strain, or growth plate irritation, early recognition and conservative treatment are key. In many cases, a well-designed rehabilitation program can restore function, reduce pain, and help athletes return to throwing—without the need for surgery.

If you or your child is dealing with medial elbow pain, addressing it early can make all the difference in keeping you in the game this season.

References 

1. Coombes BK, Bisset L, Vicenzino B. Management of lateral and medial epicondylalgia: a systematic review and meta-analysis. Br J Sports Med. 2015;49(24):1547-1555.

2. Erickson BJ, Chalmers PN, Bush-Joseph CA, Romeo AA. Ulnar collateral ligament injury of the elbow: evaluation and management. J Am Acad Orthop Surg. 2015;23(5):315-325.

3. Harada M, Takahara M, Mura N, Sasaki J, Ito T, Ogino T. Risk factors for elbow injuries among young baseball players. J Shoulder Elbow Surg. 2010;19(4):502-507.

4. Camp CL, Dines JS, Voleti PB, James EW, Altchek DW. Ulnar collateral ligament reconstruction of the elbow: the past, present, and future. Am J Sports Med. 2016;44(2):459-468.

5. Krey D, Borchers J, McCamey K. Tendon needling for treatment of tendinopathy: a systematic review. Phys Sportsmed. 2015;43(1):80-86.

6. Podesta L, Crow SA, Volkmer D, Bert T, Yocum LA. Treatment of partial ulnar collateral ligament tears in the elbow with platelet-rich plasma. Am J Sports Med. 2013;41(7):1689-1694.