Elbow Injury - Baseball

Abstract

HISTORY: 21-year-old NCAA Division IA baseball athlete with history of left shoulder impingement with some mild undersurface tearing of the distal infraspinatus tendon and elbow pain reported with decreased terminal velocity but denies any loss of accuracy. Athlete further noted he changed his pitching technique at the beginning of the fall season to resemble a side-arm approach rather than throwing over the top. Athlete underwent conservative treatment for approximately 2½ months with limited results. PHYSICAL EXAMINATION: Athlete was examined in athletic training room. No obvious deformities, gross edema or evidence of acute injury. Normal palpation of soft tissues, tendon and bony structures. Athlete presented with 5/5 graded muscular strength of the elbow flexors, extensors, pronators and supinators with limited active ROM with extension. The following tests were negative: Valgus Extension Overload, Varus and Valgus Stress, O’Brien and O’Driscoll. DIFFERENTIAL DIAGNOSIS: 1.Medical Collateral ligament sprain 2.Ulnar Neuritis 3.Common Flexor Tendon Pathology 4.Medial Epicondylitis 5.Valgus Extension Overload TEST AND RESULTS: Elbow AP/Lateral/Oblique Radiographs: - Moderate posterior olecranon osteophyte, otherwise within normal limits. MRI indirect arthrogram - Low grade stress injury within the proximal ulna, No OCD - No intra-articular body or soft tissue masses MSK Diagnostic Ultrasound Imaging - Discontinuity of medial trochlear bony surface of the humerus FINAL/WORKING DIAGNOSIS: Left valgus extension overload of elbow and left elbow grade 4 chondromalacia of the posteromedial humerus. TREATMENT AND OUTCOMES: The athlete underwent arthroscopic extensive debridement surgery and was found to have a moderate size posteromedial olecranon exostosis that was impinging on the posteromedial humerus. In addition, the athlete was found to have a 1cm x 1.5 cm grade 4 chondromalacia involving the posteromedial humerus. A gentle chondroplasty and posteromedial olecranon resection was performed. Although the diagnosis and procedure is common among throwing athletes, this case clearly illustrated the use of diagnostic musculoskeletal ultrasound in identifying these types of lesions. The athlete has made a full recovery.