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  • 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
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