VCOM Research Day Program Book 2023

Medical Resident Research Case Reports

20 Fracture or Not, Medial Elbow Pain in a High School Baseball Player

Scott McIntosh, DO; Jason Le, DO; Kaitlin Mahoney, DO Corresponding author:

LewisGale Hospital Montgomery Family Medicine Residency Program Edwards Via College of Osteopathic Medicine-Virginia Campus -Sports Medicine Fellowship OrthoVirginia

play, he developed acute pain of his right medial elbow after going to catch the ball during a game. Repeat evaluation with x-rays showing acute avulsion of the right medial epicondyle with concerns for involvement of the apophysis. A CT was ordered showing an anteriorly displace medial epicondyle avulsion fracture at the ossification center. He was referred to an orthopedic hand specialist who discussed options for non-operative vs operative management. He proceeded with open reduction and internal fixation for definitive treatment. Discussion: Little league elbow is a common injury among skeletally immature patients who participate in sports that involve throwing, and in particular baseball. One severe complication of little league elbow is a medial epicondyle apophyseal avulsion fracture with one study suggesting that this

variant of little league elbow can account for up to 16% of cases. As primary care providers who will likely initially manage most non-urgent orthopedic injuries, it is vital to understand and recognize the importance of ossification centers, specifically in this case the median epicondyle, as well as how to counsel and appropriately manage these types of injuries including return to play protocols.

Background: Little league elbow incidence has increased over the years, and it is important to recognize, work-up and manage it as primary care physician. Signed consent was obtained for case report. Case Presentation: 15-year-old male high school sophomore baseball player presents to an outpatient orthopedic office with signs and symptoms consistent with little league’s elbow that started after pitching on a weekend game. His history was notable for increased weight training volume and pitching frequency, in preparation for both the wrestling and baseball season. Initial x-rays of the right elbow showed a right medial epicondyle apophysitis, and he was treated with conservative management with a gradual return to play protocol after complete resolution of his symptoms. 5 days after return to


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