social pharmacy d-pharm 1st year by Pragati K. Mahajan
Pitcher's Elbow Power Point
1.
2. 10 yo male presents to ED
with parents after a little
league baseball game c/o R
arm pain. Per dad, “It was
awesome! We won in extra
innings—little Johnny
pitched all 8!” Little Johnny
is holding his pitching arm
closely, rubbing
continuously on his elbow.
No further complaints or
history of injury / direct
trauma.
T:98.4 P: 70 BP: 94/70 R:
20 O2: 100%
Gen: NAD
CV/Resp: RRR/CTA
ABD: S/NT/ND
MSK: no obvious osseous
abnormalities. Good ROM,
but TTP over medial
epicondyle of R arm
Neuro: 5/5 motor, intact
sensory
3. One may choose to
ignore the obvious
arrow as this is not a
foreign body.
4. This is a classic form of
overuse injury in it’s
extreme form. Without
fracture, this would be
pitcher’s / little league
elbow or medial
apophysitis.
5. Complete neurovascular exam
Analgesia
Plain films are sufficient and will likely be normal or
show wear of distal humerus/ avulsion of medial
humeral epicondyle.
If fracture is present, splint and FU with ortho.
Must instruct parents and child that complete
cessation of pitching must occur for 4-6 weeks with
gradual return after this period.
May use ice at home
6. Elbow is most common site of injury in adolescent baseball
players
Medial apophysitis is caused by repetitive valgus stress
Even with nml xray, medial collateral ligament may be
ruptured / damaged—should be referred for MRI if pain
persists.
Early radiographic evidence of injury may include wearing
along distal humerus.
AAP recommends limiting pitch count to 200/wk or
90/outing for healthy pitchers.
May take up to 12 weeks before competitive pitching may
resume
