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Medial Epicondyle Apophysitis
Aka: Medial Epicondyle Apophysitis, Little Leaguer's Elbow, Apophysitis of the Medial Epicondyle, Thrower's Elbow, Pitcher's Elbow
- See Also
- Apophysitis
- Definitions
- Medial Epicondyle Apophysitis (Little Leaguer's Elbow)
- Medial Epicondyle Apophysitis in child pitchers
- Epidemiology
- Most common in ages 9 to 12
- Affects 20-40% of school aged pitchers
- Mechanism
- High risk injury in child pitchers
- Traction injury at medial epicondyle physeal plate
- Frequent throwing puts repetitive stress across medial epicondyle Growth Plate
- Side-arm throwing increases the risk
- Pathophysiology
- Medial elbow
- Ulnar ligament avulsed
- Pulls medial epicondyle from physis
- Lateral elbow (secondary to changes at medial elbow)
- Capitellum compresses into radial head
- Risk Factors
- High pitch counts per game
- Pitching on multiple teams
- Coaches encourage harder pitching
- Radar gun use to measure pitching speed
- Inadequate time off from sport during the year
- Symptoms
- Medial Elbow Pain with throwing a ball
- May effect pitch speed and accuracy
- Signs
- Decreased elbow range of motion
- Localized swelling and tenderness over the medial epicondyle
- Tenderness increased if there is avulsion Fracture
- Provocative maneuvers
- Palpation of medial epicondyle
- Resisted wrist flexexion and pronation
- Imaging: XRay elbow with comparison view of opposite side
- Often normal
- Findings suggestive of Apophysitis
- Medial epicondyl hypertrophy
- Widening or avulsion at apophysis
- Medial epicondyle fragmentation
- Differential Diagnosis
- Referred pain (esp. Shoulder)
- Medial epicondyle avulsion Fracture (Salter Harris IV)
- Diagnosis
- Clinical diagnosis based on suspicion despite XRay
- Management
- No throwing for 4-6 weeks (esp. overhead throwing)
- Analgesics (Acetaminophen, NSAIDs)
- Gradually advance throwing after 4-6 weeks of rest
- Muscle Strengthening (Scapular retractors)
- Specific thrower rehabilitation programs
- Advanced Thrower's Ten
- https://www.ortho.ufl.edu/sites/ortho.ufl.edu/files/handouts/Throwers-Ten.pdf
- High recurrence rate (avoid repeat repitive injury)
- Surgical management is rare but may be considered if avulsion Fracture widely displaced
- Prevention
- Allow for adequate recovery between outings
- Consider throwing mechanics evaluation
- Avoid rotating through pitching and catching for the same team
- Limit number of pitches per week and per outing
- Guidelines adjusted for age and pitch type
- Age 9-12 years: Max of 6 innings, and pitch count <250
- Age 13-15 years: Pitch count 300-350
- AAP: 200 pitches/week and 90 pitches/outing
- USA-BMSAC: 125 pitches/week and 75 pitches/outing
- Limitation of curve balls and sliders is most critical (excessive torque)
- Management: Orthopedic referral indications
- Elbow Osteochondritis Dissecans
- Avulsion Fractures
- Complications
- Results in chronic injury and decreased function
- References
- Achar (2019) Am Fam Physician 99(10): 610-8 [PubMed]
- Atanda (2011) Am Fam Physician 83(3): 285-91 [PubMed]
- Cain (2003) Am J Sports Med 31(4): 621-35 [PubMed]