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A father brings in his 11-year-old son for medial elbow pain. The boy is the star player (and often the starting pitcher) on his little league team, and Dad is the coach. The team is in second place and there are just a few more games until playoffs. At first, the boy had medial elbow pain only at the end of the game, but lately his elbow hurts after the first throws, and he is not pitching as accurately as he had been before. On physical exam, he is tender at the medial epicondyle. On your preliminary read of the xray, there is no fracture, dislocation, and the expected ossification centers are all present.
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August 1, 2023 at 11:48 am
D) The boy should be on total rest and not play
The boy is presenting with “little leaguer’s elbow” or medial epicondyle apophysitis. This injury is found in children age 6-15 years, before the medial epicondyle ossification center fuses. It is due mainly to overuse and attribution to throwing specific types of pitches such as curveballs is controversial. Patients present with medial elbow pain and pain with valgus stress. X-rays may show widening of the medial epicondyle physis. Athletes should be placed on full rest for at least 4-6 weeks. The other positions still require throwing and are therefore also off-limits. More severe injuries can result in an avulsion fracture of the medial epicondyle. Even fractures often respond to non-operative treatment such as casting, however.