A 12-year-old male pitcher for a traveling club baseball team complains of acute worsening of right elbow pain that has been bothering him for 3 months. The radiograph is shown below (Frontal elbow view. Case courtesy of Dr. Levente István Lánczi, Radiopaedia.org, rID: 46853). What is your diagnosis? What causes this injury? What patient demographic is most susceptible to this injury? How can this injury be prevented? What is the management of this injury in the Emergency Department?
Image 2. Lateral elbow view, Case Courtesy of Dr. Levente István Lánczi, Radiopaedia.org, rID: 46853.
Pearl: Little League Elbow is a generic term that refers to an adolescent medial elbow injury. It can involve the ulnar collateral ligament (UCL), flexor-pronator mass strains, or the classic Little League Elbow which refers to medial epicondyle apophysitis .
Youth involved in sports with repetitive throwing mechanisms (baseball, softball, football, water polo, etc.) and have active distal humeral growth plates. These plates typically close in girls from age 14-17 and in boys between 16-18.
Pearl: Increased risk factors include participation in overhead throwing sports year-round, poor throwing mechanics, excessive conditioning routines, rapid skeletal growth, and poor physical conditioning .
A posterior splint with the elbow at 90 degrees is recommended. Displacement of the medial epicondyle may require surgical fixation, especially in young, valgus-stressed athletes. The level of displacement and indication for operative management is controversial . Follow-up in 1 week is recommended with sports medicine or orthopedics.