Little league elbow
From Medical-Wiki
As the percentage of children participating in organized athletics has increased, so has the incidence of sports related injuries. Little league elbow (LLE) is a valgus overload or overstress injury to the medial elbow caused by repetitive throwing. The incidence of this particular injury has increased because of year-round training, very highly competitive participation at much younger ages, and conditioning and training errors.
Pathophysiology of Little league elbow
As a ball is thrown, there is considerable valgus stress placed on the elbow. This places tension on the medial structures, including the medial epicondyle, medial epicondylar apophysis, medial and collateral ligament complexes. It also compresses the lateral structures, including the radial head and capitellum. This creates microtrauma, and when the amount of damage exceeds its repair, tissue begins to break down. The full spectrum of Little league elbow encompasses delayed or accelerated growth of the medial epicondyle, in specific, a process of medial epicondylar apophysitis; medial epicondylar fragmentation; and medial epicondylitis. These are expressed as increasing medial pain and difficulties throwing.
Avulsion fractures of the medial epicondyle and ulnar collateral ligament (UCL) sprains or tears can also occur. Fractures often appear to be acute injuries, but they usually follow a period of increasing pain — indicative of the events of continued micro-injuries. Thus any thrower who experiences pain should refrain from activity.
A medial epicondyle fracture will typically present as point tenderness and swelling over the medial epicondyle. Ulnar collateral ligament injuries can take the form of an acute event — the result of a particularly valgus stress. They can also appear as overuse sprains following valgus stress. While this has many of the characteristics of little league elbow, it typically occurs in an older age group. Any athlete with a ulnar collateral ligament injury should stop activity and be evaluated.
Pathophysiology of Panner disease
Lateral compression of the elbow can result in injuries to the capitellum and radial head. The capitellum may develop osteochondrosis, Panner disease, a condition most commonly seen in preadolescence. It presents as a dull ache in the lateral elbow that may be accompanied by swelling, clicking and a decreased range of motion. Rest will usually suffice to heal Panner disease.
Osteochondritis dissecans
Osteochondritis dissecans (OCD) is also caused by repeated lateral compression. It is a localized injury of subchondral bone that may create loose bodies, capitellum deformity, flexion contractures, and degenerative disease of the elbow joint. Surgical intervention is sometimes required to correct this problem. This is a problem that most commonly occurs in the teen years.
Posterior problems, olecrenon injuries, are the result of repeated over-extension. They may present with clicking, posterior pain, and loss of extension.
While uncommon, it should be noted that lower cervical and upper thoracic neurological problems can present with elbow complaints and should remain a part of the differential. [1]
Primary care doctors have a twofold responsibility when faced with little league elbow and its related problems. The first is making an accurate diagnosis. The second is imparting a sense of the degree of seriousness of the condition and the necessity that the arm must be rested without being dismissive of the emotional impact from removing a child from participation — in both the child an the parent. [2]
