
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.
Medial epicondyle avulsion fracture (medial displacement).
- 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 [1].
- Pearl: Due to their immature skeletons, remember that pediatric patients are more likely to sustain a fracture compared to a ligament (UCL) or tendon injury.
- 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 [1].
- Players should warm-up and stretch properly prior to playing.
- Young players should avoid throwing breaking pitches (curveballs, sliders, etc.) and avoid playing a single sport year-round.
- Conditioning should focus on improving arm strength, flexibility, and cardiovascular fitness.
Resources and References:
Looking to bone up in general? Check out the SplintER archives. Want more information on pediatric elbow radiographs? Check out SplintER Series: Pediatric Elbow Pain.