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- W2474516069 abstract "HISTORY: A 13-year-old right handed quarterback presented with a one month history of progressive right medial elbow pain that occurred two weeks into training camp. There was no traumatic event to explain his symptoms. He plays quarterback for two teams and was noted to have good throwing mechanics by his coaches. His pain worsened with throwing and had become so severe he experienced pain at rest.He denied any clicking, popping, bruising, weakness or paresthesias but noted swelling of the inner elbow. PHYSICAL EXAMINATION: Examination of the right elbow revealed normal carrying angles. There was noticeable swelling over the medial epicondyle. Active and passive range of motion in flexion was 100 degrees and 20 degrees in extension, and 80 degrees in supination/pronation. He was exquisitely tender at the medial epicondyle.There was no laxity with varus and valgus stress at 0 and 30 degrees, but pain was reproduced with valgus stress. There was pain on resisted wrist flexion and pronation. Of note, shoulder examination demonstrated gleno-humeral internal rotation deficit of 25 degrees on the right. DIFFERENTIAL DIAGNOSIS: 1.Medial epicondylitis 2.Osteochondral defect 3.Ulnar nerve entrapment 4.Medial epicondylar apophysitis 5.Fracture/stress-fracture 6.Neoplasm 7.Panner’s Disease TEST AND RESULTS: AP/Lateral X-ray of Right and Left Elbow: -Showed a minimally displaced avulsion fracture of the medial epicondyle with physeal widening compared with unaffected side and joint effusion. MRI of right elbow: - Medial epicondyle apophysitis and mild avulsion with a pronator teres strain. Ulnar collateral ligament intact FINAL WORKING DIAGNOSIS: Severe Little Leaguer’s Elbow (medial epicondyle apophysitis) in a football player TREATMENT AND OUTCOMES: 1.Wore a sling for 5-7 days 2.Avoided throwing related activity for minimum of 6 weeks 3.Sent to physical therapy to work on gentle range of motion exercises in flexion and extension, shoulder stretching for gleno-humeral internal rotation deficit and scapular strengthening as well as core strengthening exercises. 4.Repeated X-ray at 3 weeks and 6 weeks which documented healing 5. To date the patient is pain free and our plan was to begin a graduated throwing program" @default.
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- W2474516069 date "2015-05-01" @default.
- W2474516069 modified "2023-09-26" @default.
- W2474516069 title "Elbow Pain in an Adolescent Quarterback" @default.
- W2474516069 doi "https://doi.org/10.1249/01.mss.0000479021.83580.d2" @default.
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