Little League Elbow: Difference between revisions
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== Examination == | == Examination == | ||
During childhood, medial elbow pain is usually secondary to micro-injury at the apophysis or ossification center of the medial epicondyle. In contrast, valgus overload during adolescence more commonly produces complete or partial avulsion fractures of the medial epicondyle. Once the medial epicondyle fuses during young adulthood, injuries to the musculotendinous and/or ligamentous complex predominate.<br>Pain is the most common presenting complaint and the chronicity or duration of pain must be assessed. An acute onset of symptoms is more suggestive of an avulsion type injury, whereas longstanding pain may signal a chronic, overuse type phenomenon. Location of pain will lead the evaluating physician through the appropriate differential diagnosis.<br>Physical exam begins with the inspection of both elbows, assessing for overall alignment and carrying angle of the upper extremities. The presence of swelling, atrophy, or hypertrophy should be identified. Range of motion should be tested and documented, comparing flexion, extension, pronation and supination to the contralateral, non-painful elbow. Palpation of all bony protuberances, including the medial epicondyle, the radiocapitellar joint and the posterior olecranon apophysis, may reveal tenderness and true pathology. Elbow stability is also evaluated, ideally testing the lateral ligamentous structures with a varus stress applied to an internally rotated, pronated arm, and medial structures via a valgus stress applied to an externally rotated, supinated arm with the elbow flexed ~25°. General evaluation of the neck, ipsilateral shoulder and wrist is also important, as well as a complete neurological assessment, specifically the ulnar nerve.<br>Following a complete history and physical exam, routine radiographic evaluation in the form of anterioposterior, lateral and oblique views is indicated. As stated previously, contralateral elbow films are invaluable in differentiating true pathology from normal or slightly variable development. Stress radiographs may aid in the evaluation of underlying instability. Magnetic resonance imaging (MRI) is often indicated to evaluate the displacement of fractures, delineate the extent of OCD or identify the presence of loose bodies within the joint. MRI can also be diagnostic for medial collateral ligament avulsions or isolated disruptions. Rarely, ultrasound or a three-phase bone scan can be helpful to identify certain overuse injuries.<br><br> | |||
== Medical Management <br> == | == Medical Management <br> == | ||
Revision as of 05:40, 22 November 2011
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Examination[edit | edit source]
During childhood, medial elbow pain is usually secondary to micro-injury at the apophysis or ossification center of the medial epicondyle. In contrast, valgus overload during adolescence more commonly produces complete or partial avulsion fractures of the medial epicondyle. Once the medial epicondyle fuses during young adulthood, injuries to the musculotendinous and/or ligamentous complex predominate.
Pain is the most common presenting complaint and the chronicity or duration of pain must be assessed. An acute onset of symptoms is more suggestive of an avulsion type injury, whereas longstanding pain may signal a chronic, overuse type phenomenon. Location of pain will lead the evaluating physician through the appropriate differential diagnosis.
Physical exam begins with the inspection of both elbows, assessing for overall alignment and carrying angle of the upper extremities. The presence of swelling, atrophy, or hypertrophy should be identified. Range of motion should be tested and documented, comparing flexion, extension, pronation and supination to the contralateral, non-painful elbow. Palpation of all bony protuberances, including the medial epicondyle, the radiocapitellar joint and the posterior olecranon apophysis, may reveal tenderness and true pathology. Elbow stability is also evaluated, ideally testing the lateral ligamentous structures with a varus stress applied to an internally rotated, pronated arm, and medial structures via a valgus stress applied to an externally rotated, supinated arm with the elbow flexed ~25°. General evaluation of the neck, ipsilateral shoulder and wrist is also important, as well as a complete neurological assessment, specifically the ulnar nerve.
Following a complete history and physical exam, routine radiographic evaluation in the form of anterioposterior, lateral and oblique views is indicated. As stated previously, contralateral elbow films are invaluable in differentiating true pathology from normal or slightly variable development. Stress radiographs may aid in the evaluation of underlying instability. Magnetic resonance imaging (MRI) is often indicated to evaluate the displacement of fractures, delineate the extent of OCD or identify the presence of loose bodies within the joint. MRI can also be diagnostic for medial collateral ligament avulsions or isolated disruptions. Rarely, ultrasound or a three-phase bone scan can be helpful to identify certain overuse injuries.
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