A-32 Clinical Case Slide - Elbow Issues May 28, 2014, 9:30 AM - 11:30 AM Room: 306
HISTORY: An 18-year-old right handed Division I college pitcher developed worsening right elbow pain over about one month while pitching. He rated his pain 3/10 at rest, and his pain would increase considerably with bending and straightening of the right elbow. He also reported that his right elbow had increased laxity. The team physician then examined the pitcher, diagnosing him with inflammation. Per the team physician, the pitcher continued to pitch through the pain. However, the pitcher sought a second opinion from another orthopaedist, who ordered magnetic resonance imaging (MRI) of the right elbow revealing a partial thickness tear of the right ulnar collateral ligament. The team physician and trainer were notified of the diagnosis and rehabilitation recommendations. Still the team pitched him regularly, further worsening his pain. The pitcher then contacted the consulting orthopaedist, who then referred the pitcher to our clinic for non-surgical management.
PHYSICAL EXAMINATION: Elbow range of motion was intact. There was tenderness to palpation of the right ulnar collateral ligament (UCL) with laxity on dynamic testing. Negative Tinel sign at the cubital tunnel.
1. Ulnar collateral ligament tear.
2. Medial epicondylitis.
3. Osteochondral defect.
4. Olecranon bursitis.
TESTS AND RESULTS: MRI showed a partial thickness tear of the right UCL, further confirmed with dynamic musculoskeletal ultrasound (US) imaging.
FINAL WORKING DIAGNOSIS: Partial thickness tear of the right elbow ulnar collateral ligament.
TREATMENT AND OUTCOMES:
1. There was a delay in appropriate rehabilitation by team medical staff leading to worsening of symptoms.
2. Subsequent orthopaedic referral recommended non-operative management and cessation of throwing.
3. Platelet-rich plasma (PRP) was injected into the right elbow under US guidance for the right partial thickness UCL tear.
4. The patient then started (and completed) our 12 week PRP rehabilitation protocol, progressing from relative rest to gradual return to activity/pitching.
5. At six weeks follow-up, US imaging showed marked interval healing of the right UCL tear.
6. He ultimately transferred to another Division I baseball program to pitch with complete resolution of his elbow pain/symptoms.