II. Definition

  1. Medial Epicondyle Apophysitis in child pitchers

III. Epidemiology

  1. Most common in ages 9 to 12

IV. Mechanism

  1. High risk injury in child pitchers
  2. Frequent throwing puts repetitive stress across medial epicondyle Growth Plate
  3. Side-arm throwing increases the risk

V. Pathophysiology

  1. Medial elbow
    1. Ulnar ligament avulsed
    2. Pulls medial epicondyle from physis
  2. Lateral elbow (secondary to changes at medial elbow)
    1. Capitellum compresses into radial head

VI. Symptoms

  1. Medial Elbow Pain with throwing a ball
  2. May effect pitch speed and accuracy

VII. Signs

  1. Decreased elbow range of motion
  2. Localized swelling and tenderness over the medial epicondyle
    1. Tenderness increased if there is avulsion Fracture

VIII. Imaging: XRay elbow with comparison view of opposite side

  1. Often normal
  2. Findings suggestive of Apophysitis
    1. Medial epicondyl hypertrophy
    2. Widening or avulsion at apophysis
    3. Medial epicondyle fragmentation

IX. Differential Diagnosis

  1. Referred pain from Shoulder

X. Diagnosis

  1. Clinical diagnosis based on suspicion despite XRay

XI. Management

  1. No throwing for 4-6 weeks
  2. Gradually advance throwing after 4-6 weeks of rest
  3. Surgical management is rare but may be considered if avulsion Fracture widely displaced

XII. Prevention

  1. Allow for adequate recovery between outings
  2. Consider throwing mechanics evaluation
  3. Limit number of pitches per week and per outing
    1. Guidelines adjusted for age and pitch type
    2. AAP: 200 pitches/week and 90 pitches/outing
    3. USA-BMSAC: 125 pitches/week and 75 pitches/outing
    4. Limitation of curve balls and sliders is most critical (excessive torque)

XIII. Management: Orthopedic referral indications

XIV. Complications

  1. Results in chronic injury and decreased function

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Ontology: traction apophysitis of medial epicondyle (C2145091)

Concepts Disease or Syndrome (T047)
English traction apophysitis of medial epicondyle (diagnosis), traction apophysitis of medial epicondyle