Elbow Injury - Baseball

Abstract

HISTORY: A 13-year-old male baseball player presented with intermittent lateral and posterior right elbow pain that became constant over the last month of travel baseball. The pain worsened in the cocking stage of throwing, and he reported decreased elbow extension. There was no numbness, tingling or weakness in his right upper extremity. Pain was a 4/10 at rest and worse with activity. PHYSICAL EXAMINATION: Slight right elbow effusion with tenderness over the olecranon and lateral and medial epicondyles. Range of motion was decreased to 15 degrees short of full extension. Range of motion did not elicit snapping of the triceps or ulnar nerve. There was pain with valgus stress of the right elbow but no instability. Strength of the upper extremity was normal with no pain elicited during strength testing. Tinel’s at the cubital tunnel was negative. DIFFERENTIAL DIAGNOSIS: 1. Osteochondritis Dissecans (OCD) of the capitellum 2. Panner’s Disease 3. Lateral/medial epicondylitis 4. Lateral/medial epicondyle apophysitis/avulsion fracture 5. Triceps tendinitis 6. Ulnar collateral ligament sprain 7. Olecranon stress fracture/loose body TEST AND RESULTS: Right elbow radiographs: -Small right elbow joint effusion Right elbow MRI: -Focal bone marrow signal changes in the anterior capitellum -Large joint effusion -Focal tiny subchondral fluid signal abnormality in mid capitellum -No visualized loose bodies -Suggestive of Panner disease or early OCD of the elbow Repeat right elbow MRI for increased pain after three weeks: -New 9 mm oval cartilaginous defect from the central capitellum, displaced in the medial joint recess posteriorly -No definite bony component -Underlying capitellar edema FINAL/WORKING DIAGNOSIS: -OCD of the capitellum TREATMENT AND OUTCOMES: 1. Right elbow arthroscopy with OCD drilling microfracture and loose body removal 2. Adjustable hinge elbow brace locked at 60–90 degrees of flexion for 2 weeks 3. Brace was loosened to 40–120 degrees after 2 weeks 4. Doing well at 5 week postoperative follow up. The brace was removed, and activities were restricted to no throwing activities for an additional 6 weeks. Then he was allowed slow return to throwing. 5. At one year follow up, he was doing well with no pain or symptoms. He was cleared for sports but instructed to refrain from pitching.