Little League Elbow (Medial Epicondyle Apophysitis)
11 y/o M with h/o arm/elbow injury presents with progressive medial elbow pain in while throwing. Patient pitches for multiple teams. Reports decreased pitching velocity, numbness/paresthesia in affected arm. Elbow swelling, decreased ROM of affected elbow, tenderness with palpation of medial elbow/distal arm/forearm on exam.
X-ray showing medial epicondyle hypertrophy/epiphyseal widening, loose cartilaginous bodies, osteochondral lesions
Ice, Tylenol, NSAIDs for swelling/pain
Complete rest from throwing for 4-6 weeks; restart with graduated throwing program.
May resume competitive throwing at 12 weeks; limit pitches to 200/week and 90/outing
Loose cartilaginous bodies/avulsion fracture on x-ray and/or failure of symptoms to improve after 12 weeks; refer to orthopedics
Osgood-Schlatter Disease (Tibial Tuberosity Apophysitis)
Adolescent pt with presents with anterior knee pain/swelling. Pt actively involved in soccer, basketball, gymnastics, volleyball. Tenderness/swelling of tibial tubercle on exam.
Plain x-ray shows fragmentation/irregular ossification at tibial tubercle
Treatment
Recommend rest from painful activities, icing, NSAIDs
Perform quadriceps stretching as part of strengthening program
May return to full activity in 6-8 weeks
Pt advised that residual bony deformity may occur
Sever's Disease (Calcaneal Apophysitis)
10 y/o with h/o participation in soccer, basketball, volleyball, track presents with activity-related pain in posterior heel. Parents report pt recently started a growth spurt. Tenderness with medial/lateral compression of posterior calcaneus on exam
Consider plain x-ray
Recommend activity modification, icing, gastrocnemius-soleus stretching, NSAIDs, and heel cushions
May return to pain-free activity in 3-6 weeks