Elbow Flashcards
What is Little League Elbow Syndrome?
A valgus overload or overstress injury to the medial elbow resulting from repetitive throwing motions
This syndrome occurs primarily in young athletes participating in organized sports.
What are contributing factors to increased injury rates in pediatric athletes?
Increased single-sport participation, year-round training, higher intensities at young ages, and longer competitive seasons
Conditioning and training errors also significantly contribute to injury risk.
What structures are affected by valgus stress during the throwing motion?
Medial epicondyle, medial epicondylar apophysis, medial collateral ligament complex, radial head capitellum
Valgus stress results in tension on medial structures and compression of lateral structures.
What leads to an overuse injury in the context of Little League Elbow?
Tissue breakdown exceeding tissue repair due to repeated stress
This can result in various injuries to the elbow joint.
What are the three components encompassed by Little League Elbow syndrome?
- Delayed or accelerated growth of the medial epicondyle (medial epicondylar apophysitis)
- Traction apophysitis (medial epicondylar fragmentation)
- Medial epicondylitis
These components are linked to repetitive valgus stress.
What symptoms are associated with medial epicondylar apophysitis?
Progressive medial pain, decreased throwing effectiveness, and decreased throwing distance
These symptoms often arise from overuse injuries.
What other causes of medial elbow pain should be considered?
- Avulsion fractures of the medial epicondyle
- Ulnar collateral ligament (UCL) sprains or tears
A preceding history of medial elbow pain is a common risk factor for acute fractures.
What are the clinical signs of a medial epicondyle fracture?
Point tenderness and swelling over the medial epicondyle, often with an elbow flexion contracture greater than 15°
This injury manifests due to repetitive medial stress.
How can UCL injuries manifest?
- Acute ligament tears following a single valgus stress
- Overuse sprains following repetitive valgus overloads
The clinical presentation is similar to Little League Elbow but typically involves older teenagers.
True or False: Athletes with UCL injuries should be allowed to pitch until evaluated.
False
Athletes with suspected UCL injuries must not pitch until they have been properly evaluated.
What is the typical age range of athletes affected by Little League Elbow Syndrome?
Older teenagers
True or False: Neurologic injuries such as C8-T1 radiculopathy and ulnar neuritis are common in children.
False
What does lateral compression of the elbow most frequently result in?
Injuries to the capitellum and radial head
What is Panner disease?
Osteochondrosis of the capitellum occurring in children aged 7-12 years
What are common symptoms of Panner disease?
Dull, achy, activity-related lateral elbow pain
How is Panner disease generally treated?
Complete rest from inciting activities
What age group does Osteochondritis dissecans (OCD) of the capitellum occur in?
Adolescents aged 13-17 years
List the potential sequelae of Osteochondritis dissecans.
- Loose body formation
- Residual capitellum deformity
- Elbow degenerative joint disease
What are the types of Osteochondritis dissecans lesions?
- Type I: no displacement and no articular cartilage fracture
- Type II: evidence of articular cartilage fracture or partial displacement
- Type III: completely displaced with loose bodies in the joint
What can cause posterior elbow injuries during throwing?
Extension overload and valgus stress during the follow-through stage
Fill in the blank: Anatomic malalignment of the lower extremities can cause _______.
[Little League Elbow Syndrome]
What role does growth patterns play in Little League Elbow Syndrome?
They are sometimes implicated as the cause
Why are skeletally immature athletes more likely to develop growth plate injuries?
Physeal or growth cartilage is less resistant to repetitive trauma than fused adult bone
What can rapid growth during growth spurts lead to?
Increased muscle and tendon tightness around a joint
What is the incidence of all baseball-related overuse injuries per year?
2-8%
This statistic indicates the prevalence of injuries in baseball.
What is the incidence of overuse injuries in the 9- to 12-year-old range for baseball?
20-40%
This age group is particularly vulnerable to overuse injuries.
What is the incidence of overuse injuries in the adolescent age group?
30-50%
This indicates a significant risk of injury in older youth athletes.
Why is early recognition of Little League Elbow Syndrome important?
It leads to better outcomes and decreases the risk of persistent functional disabilities
Early intervention can significantly improve recovery.
What mnemonic is used to remember the order of ossification centers in the elbow?
CRITOE
It stands for capitellum, radius, internal epicondyle, trochlea, olecranon, external epicondyle.
At what age does the closure of the medial epicondyle typically occur?
Approximately age 15 years
This is part of the overall growth and development of the elbow.
What are the static stabilizers around the elbow?
Bony articulations, joint capsule, and various ligament bundles
These structures provide support to the elbow joint.
What are the primary components of the medial (ulnar) collateral ligamentous complex?
Anterior oblique bundle, posterior oblique bundle, transverse ligament
These structures are crucial for medial support during valgus stress.
What muscles are considered dynamic stabilizers of the elbow?
Triceps, biceps, brachioradialis
These muscles help stabilize the elbow joint during movement.
What is the normal range of flexion for the elbow?
Approximately 150°
This is essential for normal elbow function.
True or False: A flexion contracture in a young thrower is always a sign of injury.
True
Unlike experienced pitchers, a flexion contracture in youth is concerning.
What is the normal range of motion for pronation and supination at the elbow?
Pronation of 75° and supination of 85°
These movements are essential for various throwing techniques.
What is the normal range of varus-valgus laxity in the elbow?
3-4°
This range indicates normal stability in the elbow joint.
What stages can the pitching or throwing motion be divided into?
6 stages:
* Windup
* Stride
* Cocking
* Acceleration
* Deceleration
* Follow-through
Understanding these stages is crucial for recognizing injury risks in young athletes.
What occurs during the Windup phase of throwing?
The pitcher balances weight over the rear leg, with the elbow flexed and the forward leg flexed at least 90°.
What happens during the Stride phase of throwing?
The lead leg descends toward the plate, and the arms separate. The elbow flexes from extension into 80-100° flexion.
Describe the Cocking phase in throwing.
The humerus is in extreme abduction and external rotation, elbow is flexed, and medial tension and lateral compression forces are applied.
What is the duration of the Acceleration phase?
It is the shortest pitching phase, lasting from maximal external shoulder rotation to ball release.
What forces act during the Acceleration phase?
Varus torque forces resist the valgus extension ‘overload’ phenomenon and can contribute to posterior elbow impingement.
What occurs during the Deceleration phase?
Initiated at ball release, it ends when the shoulder reaches full internal rotation, dissipating forces in the elbow and shoulder.
What is the purpose of the Follow-through phase?
Ends with the pitcher reaching a balanced fielding position, with full trunk rotation and body weight transferred to the forward leg.
What is the prognosis for recovery from Little League Elbow Syndrome?
Guarded, depends on the specific pathologic process; short-term cases often resolve with rest and conservative management.
What are potential long-term complications of Little League Elbow Syndrome?
Osteoarthritis, functional disability, and permanent deformity can result from improper management.
True or False: Medial elbow injuries are the most common type seen in throwers.
True
Fill in the blank: The elbow moves from extension into _______ of 80-100° during the Stride phase.
flexion
What initiates deceleration in the throwing motion?
Ball release.
What is the final phase of the baseball pitch called?
Follow-through.
What occurs during the follow-through phase of a pitch?
The pitcher reaches a balanced fielding position with full-trunk rotation and transfers body weight from the rear leg to the forward leg.
What is the prognosis for recovery from Little League Elbow Syndrome?
Guarded and depends on the specific pathologic process.
Which disorders have the worst long-term prognosis in Little League Elbow Syndrome?
Disorders affecting the articular surfaces of the elbow, such as the capitellum and radial head.
What is the common short-term management for Little League Elbow Syndrome?
Rest and conservative management.
What is a potential long-term complication of Little League Elbow Syndrome?
Osteoarthritis.
What complications may occur even with a reasonable long-term maintenance program?
- Posttraumatic arthritis
- Permanent flexion contractures
- Growth or angular deformities
When is an excellent opportunity for physicians to educate about sports injuries?
During the preparticipation physical examination.
True or False: Most cases of Little League Elbow Syndrome resolve with rest and conservative management.
True.
Fill in the blank: During follow-through, the elbow flexes into a _______ position.
relaxed
