synonyms: medial epicondyle apophysitis, little league elbow, Medial epicondyle avulsion
Medial Epicondyle Apophysitis ICD-10
Medial Epicondyle Apophysitis ICD-9
- 719.42 (traction aphysitis of the medial epicondyle)
Medial Epicondyle Apophysitis Etiology / Epidemiology / Natural History
- Common in youth baseball (Gugenheim JJ Jr, AJSM 1977;4: 189)
- 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.
- Valgus forces can result in repetitive submaximal injury and apophyseal fragmentation or acute avulsion of the medial epicondyle apophysis
- Medial epicondylar apophyseal fragmentation occurs in 4% of recreational pitchers age 9 to 18. (Torg JS, Pediatrics 1972;49: 267)
Medial Epicondyle Apophysitis 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.
Medial Epicondyle Apophysitis Clinical Evaluation
- Medial elbow pain with throwing.
- Medial epicondyle tenderness.
- Acute pain and loss of motion in avulsion fracture.
- 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.
Medial Epicondyle Apophysitis Xray / Diagnositc Tests
- Bilateral A/P, lateral and oblique elbow xrays indicated. Evaluate for widening of the medial epicondyle apophysis, medial epiconyle fragmentation or medial epicondyle avulsion.
Medial Epicondyle Apophysitis Classification / Treatment
- Medial epicondyle apophysitis: no throwing fot 2-3 months, rest, ice, occasional splinting hasproven successful, and surgery is usually not required. (Torg JS, Am Fam Physician 1972;6:71)
- Medial epicondyle avulsion: displaced greater than 1cm, or valgus instability should be treated with ORIF usually with a single screw.(Woods GW, Am J Sports Med 1977;5: 23), (Hines RF, CORR 1987;223:170)
- Medial epicondyle avulsion: non-displaced in a non-throwing athlete without instability: splint immobilization for 5-7 days followed by early motion.
Medial Epicondyle Apophysitis Associated Injuries / Differential Diagnosis
Medial Epicondyle Apophysitis Complications
Medial Epicondyle Apophysitis Follow-up Care
- Prevention can be accomplished by rules limiting the number and type of pitches allowed in youth baseball along with education of Little League coaches, parents, and throwers. (Andrews JR, J Orthop Sports Phys Ther 1998;27: 187)
Medial Epicondyle Apophysitis Review References