LittleLeagueElbow课程.pptVIP

Elbow Pain in Adolescents Kevin deWeber, MD, FAAFP Director, Tri-Service Sports Medicine Fellowship Goals Understand the history/mechanism of injury Develop a thorough differential diagnosis for a painful elbow Understand the findings to look for on physical exam Understand management and return to play criteria Know when to refer Case Study 11 year old Hispanic male complains of right elbow pain for the past 2 weeks. He states that the pain is present but better with rest, but worse when he pitches on his little league baseball team. He has been pitching for 2 years now, and started in a new league about 1 month ago. DDx What can cause elbow pain in the young athlete? DDx What can cause elbow pain in the young athlete? DDx What can cause elbow pain in the young athlete? DDx What can cause elbow pain in the young athlete? DDx What can cause elbow pain in the young athlete? DDx What can cause elbow pain in the young athlete? DDx What can cause elbow pain in the young athlete? DDx What can cause elbow pain in the young athlete? DDx What can cause elbow pain in the young athlete? DDx What can cause elbow pain in the young athlete? DDx What can cause elbow pain in the young athlete? DDx What can cause elbow pain in the young athlete? Physical Exam Appearance Palpation Range of Motion Provocative Tests Slight swelling over medial epicondyle and tenderness to palpation. The UCL was also tender to palpation. There was some slight tenderness over the flexor bundle distally. There was no evidence of gross atrophy of the muscle. Strength was 5/5 with extension and supination, 4+/5 with pronation and flexion, limited by pain. Normal distal sensation, pulses. Negative Tinel’s with percussion of ulnar groove. Pain with valgus stress at 20 degrees, no laxity No neck tenderness, crepitus or step off, no gross shoulder pain or instability, nor any wrist/hand pathology noted. Are radiology studies necessary for diagnosis? Diagnosis? Little Leaguer’s Elbow Cat