2. 10 yo male presents to ED T:98.4 P: 70 BP: 94/70 R:
with parents after a little 20 O2: 100%
league baseball game c/o R
arm pain. Per dad, “It was Gen: NAD
awesome! We won in extra
innings—little Johnny CV/Resp: RRR/CTA
pitched all 8!” Little Johnny ABD: S/NT/ND
is holding his pitching arm MSK: no obvious osseous
closely, rubbing abnormalities. Good
continuously on his elbow. ROM, but TTP over medial
No further complaints or epicondyle of R arm
history of injury / direct Neuro: 5/5 motor, intact
trauma. 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
