Arm pain only on mound

My 13yr. old son (primary pitcher) has some discomfort in this arm, elbow, when he pitches…only throwing from the mound. Long toss is no problem, infield (plays 3rd and short) no problem. He gets on the mound and about 15 throws he is in pain. Pain is sharp, similar to little league elbow etc. We had an xray, just in case nothing. Had an MRI, nothing…took 6 weeks off and eased back into it…long toss up to 180 feet, easy…1st bullpin, 15 throws and it hurts again, cant straighten it. Any experience and/or advice on a this issue? My son is an expertise and accomplished pitcher. He is 5’11 and 175ibs, very big, rather strong. Thinking growth spurt issue as well, possible nerve pain. At this point, we not sure what to think other than is changing his mechanics on the mound. Should long toss throw be the same, basically, as a pitching motion? Any suggestions, advice would be appreciated. Thanks

Hard to say. Assuming he is throwing hard at long toss and hard from 3rd and SS, it is odd that he would have pain only from the mound.

What doctor did he see? An orthopedic surgeon trained in sports medicine? If not, I would take him to one. If you don’t know one, Dr. Glenn Fleising at ASMI can recommend one in your area:

When he took the break did he cease all throwing or just from the mound? My sons had two bouts of tendonitis over the years. First was elbow, one week full rest and he was good to go. Second bout last summer was rotator cuff and required 6 weeks. In both cases he eased his way back in before pitching, caused him to miss almost entire summer season last year but he’s had no problems since. If he took a full 6 weeks off throwing and he continues to experience issues I’d agree with South_Paw and seek a Sports Ortho experienced in these type injuries. My understanding is levels of tendonitis can range with some chronic cases taking much longer than 6 weeks of full cessation of activity that caused the injury. Hopefully nothing serious but would definitely find the right Doc on this one.

The problem with the term “tendonitis” is that it is often used as a generic term for injuries that have nothing to do with tendons. Most elbow injuries in youth pitchers are either: (1) Injuries to the growth plate at the medial epicondyle, on the medial or “inside” of the elbow. These injuries range from inflammation of the growth plate, which requires typically 4-6 of weeks of rest and physical therapy, to complete separation of the growth plate, which requires surgery to screw the medial epicondyle back into place. These injuries are often grouped under the lay term “Little League Elbow”; and (2) Injuries to the bone structure on the lateral or “outside” of the elbow. These injuries are more rare in youth pitchers but can be very serious. One in particular, osteochondritis dissecans of the elbow (OCD), can be career ending for a pitcher. I know a 13-year-old pitcher and a 14-year-old pitcher who were diagnosed with OCD in the past year, both from overuse. One hasn’t thrown a ball in over a year, the other is just now starting his treatment. Never mess around with elbow injuries. Always err on the side of caution. Shut the kid down and have an orthopedist trained in sports medicine check him out.

Tendonitis is pretty simple. Inflammation due to repetitive overuse, only cure is to quit doing what caused it for a while. My son had similar issue as OP; able to throw without pain but hurt after a few throws from the mound. I was really concerned with the rotator cuff after a weeks rest didn’t improve. Took to Otho with diagnosis of tendonitis. Since a week hadn’t helped he recommended 6 weeks and easing back into throwing. Only made it back to the last two tournaments of the summer & no issues since. With tendonitis the more you continue doing what caused it the more severe it becomes and the longer you’ll have to sit out. I learned that the hard way in high school when Inwas an avid bowler. Developed a case on tendonitis in my wrist. Would rest it a few days and bowl again when it felt better. Over the course of several months the pain became more severe and time taken to feel better became longer. Finally went to the doctor & had to give up bowling for a year. OP’s son may or may not be tendonitis But at this point there is an issue & I’d want a diagnosis.

Thank you for your reply. We have seen an ortho guy, local expert and surgeon. MRI showed typical edema (swelling) and bone marrow edema (bone swelling) he wasn’t too excited about bone marrow edema and they treat it like a fracture, even though there was evidence of fracture or tears of any sort. we took 6 weeks off, no throwing. Eased back into with his long toss etc. flat ground pitching, no issues and as soon as we get on the mound, it flared up again. Thinking its a growth spurt issue, along with over powering his 13 year old joints with his man sized body. In conjunction, I think he is timid and not holding proper form because is he nervous about hurting it again…which makes it hurt…the irony.

He didn’t touch a baseball for 6 weeks. 4 weeks, back to throw, in the meantime was working out, stretching, doing his thing. This was is first bullpin in 10 weeks, 15 throws and it hurts. He has to throwing different and/or incorrectly. Nothing else makes sense. Like I mentioned in my reply to southpaw. He could be over powering his 13 year old joints with his man size body. He is just in a that weird transition and perhaps not all of his body has caught and joints are weaker

typo…NO evidence of fracture and/or tear of any sort on tendon/ligaments.

This sounds exactly like what my son is going through. Could you please tell me what your outcome was?
What steps you took to get better?

Stop throwing off the mound. At least, for a long enough time to recover, which might take weeks even months. Few pitching coaches (the late Dick Mills was one of those who did) understand that throwing the ball upward as in long toss is easier on the arm (and more natural as far as human biomechanics shows) than throwing down off a mound.

Even Steve Dalkowski (1939 - 2020) who threw 110 mph and faster than anyone knew the difference as he could also long toss more than 400 feet, but hurt his arm while fielding a bunt: New Britain, CT: Home of the World's Fastest Fastball

Thanks Dr, Has been 2 Months since my 16 year old son last pitched 2 innings and started to have pain. Shut him down and went to a physical therapist that has a focus on pitchers including MLB guys. They put him through a series of test and gave him exercises to build strength in his shoulder. Did that for 4 weeks and then started a throwing program every other day for the next 2 weeks that progressed to long toss. Pain was gone. Threw 10 pitches off the mound and all elbow pain returned. With a clicking in the elbow. Says his elbow feels like it needs to be popped. Getting X-Rays soon. Not sure what to think? He is growing so maybe growth plates?