Pediatric Throwing Elbow:

- Diff Dx Pediatric Throwing Elbow: (Radiology of Pediatric Elbow)

    - osteochondritis dissecans of the capitellum
    - osteochondrosis of the medial epicondyle
    - posteromedial olecranon osteophytosis:
            - chronic repitative throwing in the young adolescent w/ lax joints, can cause impingement of the medial tip of olecraon on posteromedial tip of the olecranon fossa during the terminal swing phase of throwing;
            - results in posterior ulnohumeral impingement, restriction range of motion (extension), ulnar nerve compression neuritis, and loose body formation;
            - patient may show tenderness over the posteromedial aspect of the olecranon and a mild flexion contracture;
                    - posteromedial tenderness may be exentuated as the elbow is brought into extension;
            - either open or endoscopic osteophyte removal is curative;
            - references:
                   - Persistence of the olecranon physis: a cause of "little league elbow".
                   - Partial Posteromedial Olecranon Resection: a Kinematic Study.
                   - Medial collateral ligament strain with partial posteromedial olecranon resection. A biomechanical study.
    - olecranon stress fracture:
            - overuse injury from pitching;
            - occurs from repetitive forceful contraction of the triceps combined with varus and valgus forces against the elbow;
            - olecranon epiphysis separates from the epiphyseal plate;
            - failure of epiphysis to mature may persist into late adolescence; 
            - references:
                   - Persistence of the olecranon physis in baseball players: Results following operative management.
                   - Nonunion of olecranon stress fractures in adolescent baseball pitchers: a case series of 5 athletes
    - radial head deformation
            - ref: Anterior angulation deformity of the radial head. An unusual lesion occurring in juvenile baseball players.
    - radiocapitellar menisciod lesions
    - medial tension overload:
            - muscular (flexor pronator group)
            - strain (minor tears)
            - MCL strain or rupture:
                    - ulnar traction spurs
                    - calcium deposits
                    - medial ligament instability
            - fascial compartment syndrome
            - medial epicondylitis
            - medial epicondyle apophysitis (little leaguer's elbow);
                    - look for irregular ossification and overgrowth of the medial epicondylar apophysis;
                    - w/ cessation of throwing, tenderness will resolve, and ROM will be restored;
                    - reference:
                           - Little leaguer's elbow
                           - Poor Form Causes ‘Little League Elbow’ in Pitchers
            - avulsion of the medial epicondyle
            - references:
                    - Bony Injuries about the Elbow in Young Throwing Athletes. Andrews J. Instr Course Lect. 1985;34: 323-331.
                    - Elbow problems associated with baseball during childhood and adolescence.



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Monday, January 21, 2013 2:57 pm