summary Little league elbow refers to a continuous spectrum of injuries to the medial side of the elbow seen in adolescent pitchers, which includes: medial epicondyle stress fractures, ulnar collateral ligament (UCL) injuries and flexor-pronator mass strains. Diagnosis is made clinically with tenderness over the medial elbow made worse with valgus stress and supplemented with MRI studies. Treament is a trial of rest, activity modification, decrease in innings pitched, and physical therapy. Epidemiology Demographics younger patients are more likely to have apophysitis or avulsion injuries, rather than UCL sprains Etiology Pathophysiology consists of 3 potential sites of injury medial epicondyle stress fractures ulnar collateral ligament (UCL) flexor-pronator mass strains due to repetitive valgus loading with throwing causing repetitive microtrauma to the immature skeleton causes tension overload of the medial structures Risk factors Greater than 80 pitches per game More than 8 months of competitive pitching per year Fastball speed > 85mph Continued pitching despite arm fatigue/pain Participating in showcases Presentation Symptoms elbow pain in throwing arm decreased throwing speed, accuracy, and distance Physical exam tenderness to palpation about medial elbow pain with valgus stress instability with valgus stress notes more severe involvement should be checked in varying degrees of elbow flexion to extension Imaging Radiographs recommended views AP/lateral elbow findings may show physeal widening may show fragmentation or avulsion of the medial epicondyle MRI will show increased edema of the medial epicondyle apophysis can be used to confirm UCL insufficiency Treatment Nonoperative rest, activity modifications, PT indication is the mainstay of treatment technique coach and parent education is critical to limit number of innings pitched per week use minimal immobilization to maintain elbow ROM Operative ORIF of medial epicondyle indication for medial epicondyle avulsion fractures UCL reconstruction indication for UCL disruption and insufficiency Technique Pediatric UCL reconstruction similar to adult treatment commonly using palmaris longus autograft Complications Ulnar nerve neuropathy Continued pain and instability Loss of motion Inability to return to same level of play
QUESTIONS 1 of 7 1 2 3 4 5 6 7 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ12.151) A 12-year-old baseball pitcher describes progressive worsening of medial elbow pain on his throwing side. Examination reveals normal elbow range of motion. He is tender over the medial elbow to palpation. A dynamic ultrasound of his elbow shows no evidence of medial widening with valgus stress. His radiograph is shown in Figure A and an MRI is shown in Figure B. What is the most likely cause of his symptoms? QID: 4511 FIGURES: A B Type & Select Correct Answer 1 Displaced medial epicondyle avulsion fracture 10% (629/6153) 2 Medial apophysitis 86% (5276/6153) 3 Medial ulnar collateral ligament tear 2% (115/6153) 4 Valgus extension overload with olecranon osteophytes 1% (64/6153) 5 Ulnar neuritis 0% (18/6153) L 3 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic (OBQ09.129) A 10-year-old little league pitcher has the triad of medial elbow pain in his throwing arm, decreased throwing effectiveness, and decreased throwing distance. What is the pathogenesis of the condition that is most likely to be occuring in this patient? QID: 2942 Type & Select Correct Answer 1 Acute fragmentation of the entire capitellar ossific nucleus 1% (59/4037) 2 Rupture of the anterior band of the anterior bundle of the ulnar collateral ligament 9% (356/4037) 3 Repetitive contraction of the flexor-pronator mass stresses the chondro-osseous origin, leading to apophysitis 78% (3159/4037) 4 Microtraumatic vascular insufficiency of the capitellum from chronic compressive and rotatory forces 11% (426/4037) 5 Repetitive triceps contraction during extension 0% (14/4037) L 1 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic This is an AAOS Self Assessment Exam (SAE) question. Orthobullets was not involved in the editorial process and does not have the ability to alter the question. If you prefer to hide SAE questions, simply turn them off in your Learning Goals. (SAE07PE.83) A 6-year-old Little League pitcher has had pain in the right elbow for the past 2 weeks. Examination reveals mild lateral elbow joint tenderness with full range of motion and no effusion or collateral laxity. A radiograph is shown in Figure 38. Initial management should consist of QID: 6143 FIGURES: A Type & Select Correct Answer 1 cessation of throwing activities. 94% (469/500) 2 a long arm cast for 3 months. 4% (22/500) 3 a corticosteroid injection into the elbow joint. 0% (2/500) 4 excision of the fragment. 0% (2/500) 5 arthroscopic drilling of the lesion. 0% (2/500) L 1 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review Tested Concept Review Full Topic
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