Lateral Elbow Overuse Injuries in Pediatric Female Gymnasts

Abstract

Radial head stress fractures (RHSF) and capitellar osteochondritis dissecans (OCD) are rare. The purpose was to describe the clinical presentation of RHSF and compare demographic, radiographic, and clinical characteristics of pediatric gymnasts presenting with RHSF to those with capitellar OCD. A retrospective review of consecutive female gymnasts treated for either RHSF or capitellar OCD between 1/2014 and 2/2019 was performed. Gymnasts < 18 years old at the time of injury presenting with signs of a radial head stress fracture or with diagnostic features of capitellar OCD were included. Those with congenital abnormalities or prior ipsilateral elbow surgery were excluded. Patients were dichotomized into either the RHSF or OCD group. . Forty-five patients (9 with bilateral OCD, 1 with bilateral RHSF, and 3 with each lesion in alternate elbows), with 58 elbows (39 in OCD group; 19 in RHSF group), were included. Average age for all was 11.58 years (9-16 years), with no difference between groups (OCD: 11.47 vs RHSF: 11.78; p=0.34). No differences in height, weight, BMI, or laterality were noted. 94.74% of gymnasts presenting with RHSF were competing at a level 7 or higher compared with 66.67% of the OCD group (p=0.02). Compared to those with OCD, the RHSF group presented more acutely following symptom onset (p=0.014), reported more pain with valgus stress (p<0.001), and concurrent medial elbow pain than those with OCD (p<0.01). The RHSF group demonstrated smaller distal humeral width and decreased height of the proximal radial epiphysis, as well as increased valgus angulation of the radial neck shaft angles and distal humeral articular surface (p<0.05). (Table I) Gymnasts competing at a high competitive level and presenting more acutely may be at risk for RHSF. Additionally, differing anatomy in the lateral elbow may be a predisposing risk factor for RHSF and merits further investigation.