A-32 Clinical Case Slide - Elbow Issues May 28, 2014, 9:30 AM - 11:30 AM Room: 306
HISTORY: A 15-year-old right-handed male elite baseball pitcher presented to outpatient sports medicine clinic with new onset right (R) elbow pain. While at a baseball academy, on three successive days his team coach had him do an exhibition bullpen session, pitch in a baseball game (86 pitches), and then pitch another bullpen session. During the last bullpen session he felt a “pop”, had acute pain, and could not continue to pitch.
PHYSICAL EXAMINATION: Initial R upper limb exam revealed mild elbow swelling, full range of motion (ROM), and tenderness of his radial-capitellar joint.
Over the next few months pain persisted and the athlete developed a feeling of weakness, fatigue and numbness in his forearm. Pain radiated through the limb. Seven months after the injury, he underwent a cortisone injection into the lateral elbow that resolved the pain for one month.
Subsequent exam 9 months after initial injury showed no significant swelling, full ROM, pain at full elbow extension, tenderness over posterolateral elbow, positive Tinel’s testing over the radial nerve, negative Tinel’s testing over cubital tunnel, and no pain with resisted wrist extension and flexion. Strength testing did not reveal weakness of his right upper limb nor any relative increased strength on his dominant right side relative to his left. Spurling’s test was negative.
1. Radial head or humeral capitellum bone contusion
2. Radial tunnel syndrome
3. Right cervical radiculopathy
TESTS AND RESULTS:
MRI R elbow (1 week post injury): 1.Bone bruising of the humeral capitellum; 2.Trace elbow joint effusion; 3.No collateral ligament or tendon tears
NCS/EMG (9 months post injury): Negative for peripheral entrapment neuropathy, brachial plexopathy or radiculopathy
1. Radial tunnel syndrome
2. Humeral capitellar bone contusion
TREATMENT AND OUTCOMES:
1. Relative rest with gradual return to throwing protocol when symptoms resolve
2. Gentle stretching of his elbow joint
3. Patient had gradual resolution of his symptoms over the next 3-4 months with return to pitching without pain