ELBOW PAIN-BASEBALL

Abstract

1114 HISTORY-A fourteen year old high school freshman pitcher presented for an evaluation of medial sided elbow pain in his dominant, pitching arm. The pain began insidiously while throwing in preparation for trying out for the varsity baseball team. He also was in several baseball camps in the previous two months and found that his pain had increased. He found that with throwing that his velocity would decrease as he threw more. He never felt a pop or snap on the medial side of the elbow, but said that he did notice some bruising there three weeks prior to the visit. He did not have any parasthesias or weakness in his hand or forearm. He did not have any locking or catching. He did not notice any swelling about the elbow or forearm. He had iced the elbow several times a day with no effect. He had not tried any medication nor any physical therapy. PHYSICAL EXAMINATION-The patient had normal muscle distribution of his upper extremities and shoulders with no swelling or deformity. His neurological examination was totally normal with normal strength in all shoulder, arm and forearm muscles. He had no pain in his elbow with resistance to finger or wrist flexion. His sensory examination to light touch was normal for all peripheral nerves and dermatomes.e had a negative Tinel's at the medial elbow. He had full range of motion of his elbow (0-145 degrees) and normal pronation and supination(85 degrees each) of his forearm. He had no effusion. He was tender 2-3 centimeters distal to the medial epicondyle to deep palpation. However, he had no pain or laxity to stress testing of the medial collateral ligament over the entire range of elbow flexion. Medial collateral ligament sprain Flexor mass strain Ulnar nerve irritation Valgus overload syndrome elbow Plain radiographs of the elbow (AP, lateral, obliques)-normal except for faint periosteal reaction along proximal, medial ulna Three phase technitium bone scan-stress reaction or periostitis proximal ulna Magnetic resonance imaging elbow-marrow edema proximal ulna consistent with stress reaction or bone bruise FINAL/WORKING DIAGNOSIS: Stress fracture-periosteal reaction proximal ulna at site of insertion of medial collateral ligament Cessation of throwing for six weeks Allowed all other activities including weight lifting and batting Follow-up radiographs showed healing of lesion Gradual return to throwing with no recurrence of symptoms up to one year later