Elbow Problems

1
Elbow Problems

• Mike Putney, MD

2
Development

• Asymptomatic pathology in high level athletes
• 87 prevalence of chronic UCL injuries
• 81 prevalence of joint injuries
• Increased medial laxity with stress in major
  league pitchers

3
Evaluation of the Injured Elbow

• Subjective complaints often precede or accompany
  pain
• Loss of command
• Loss of velocity
• Subtle change in pitching mechanics

4
Specific Injuries

• Skeletally immature acute fracture of the
  medial growth plate

5
Specific Injuries

• Little league elbow (apophysitis)
• lt 10 years old
• Medial elbow pain
• Decreased throwing effectiveness or distance
• Medial swelling
• Occasional flexion contractures

6
Specific Injuries

• Little league elbow treatment
• Rest 2 - 4 weeks
• NSAIDS
• Stretching and strengthening especially the
  forearm flexors
• May throw at 6 weeks if pain free

7
Specific Injuries

• Osteochondritis dissecans (OCD)
• gt 13 years old
• Insidious onset
• Dull poorly localized pain
• Worse with activity
• Can have locking if loose body develops

8
Specific Injuries

• Acute ulnar collateral ligament (UCL) tears
• Sudden onset
• One pitch
• Swelling
• Instability and severe pain with stability
  testing
• Early surgery

9
Specific injuries

• Chronic UCL
• Medial pain, late cocking to acceleration phase
• Stress test anterior band

10
Specific Injuries

• Chronic UCL treatment
• Same as for little league elbow
• May add hinged elbow brace for 6 weeks
• Surgery older athlete, valgus instability
  despite 6 months of nonsurgical treatment

11
Specific Injuries

• Posterior compartment
• Impingement and bone spur formation
• Possible loose bodies
• Pain and locking especially during follow through

12
Conclusions

• Elbow injuries are more frequent than shoulder
• 50 75 of adolescent baseball players report
  pain
• Side-arm 3X more prone to injury
• Curve-balls shoulder pain
  sliders elbow pain

13
Conclusions

• Overlap between prevention and treatment
• Prevention should begin as soon as athletes begin
  organized sports
• Avoiding year-round sports, 2 3 months of
  complete rest per year
• Early recognition key to preventing damage

14
Thank you