Little Leaguer's Elbow
- synonyms: medial epicondyle apophysitis,
ICD-9
- 719.42 (traction aphysitis of the medial epicondyle)
Etiology / Epidemiology / Natural History
- Throwing exposes the medial elbow to high tension forces and the lateral elbow to high compression forces.
- Repetitive valgus stresses to the elbow occuring during the late cocking and acceleration phases of throwing can lead to medial elbow injury.
Anatomy
- The medial epicondyle growth plate (apophysis) is weaker than the medial collateral ligament in skeletally immature individuals.
- The pronator flexor muscle mass inserting into the medial epiconyle also contributes to high tension forces seen during the late cocking and acceleration phases of throwing.
- Medial epicondyle is most vulnerable between 11-13 years old as the physis is beginning to close.
- See also Elbow Anatomy.
Clinical Evaluation
- Medial elbow pain with throwing.
- Medial epicondyle tenderness.
- Often 10°-15° flexion contracture.
- Valgus Stress Test: valgus load applied to elbow with the elbow flexed 20° . Positive results = reproduction of medial elbow pain and valgus laxity greater on injured side as compared to contralateral side.
- Moving Valgus Stress Test: rapid extention from full flexion while maintaining a constant valgus stress. Positive result = reproduction of medial elbow pain.
Xray / Diagnositc Tests
- Bilateral A/P, lateral and oblique elbow xrays indicated. Evaluate for widening of the medial epicondyle apophysis or medial epicondyle avulsion.
Classification / Treatment
- Medial epicondyle apophysitis: Activity modifications, no throwing fot 2-3 months.
- Medial epicondyle avulsion: displaced greater than 1cm, or valgus instability should be treated with ORIF usually with a single screw.
Associated Injuries / Differential Diagnosis
Complications
Follow-up Care
Review References
|
|
