Pediatric emergency medicine trisk 3954 3954
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become weakened from repetitive microtrauma ( Fig. 121.10 ). Little Leaguer
elbow occurs most commonly in boys aged 9 to 12 years.
Patients complain primarily of elbow pain that is exacerbated by throwing.
Athletes report progressive drop off in throwing distance. Tenderness is localized
over the medial elbow. Applying a valgus stress to the partially flexed elbow will
reproduce the pain. Flexion of the wrist or fingers against resistance will also
elicit pain. In advanced cases, extension of the elbow becomes limited.
Radiographs or MRI may reveal nonspecific changes such as an irregular or
widened medial epicondylar physis ( Fig. 121.11 ), but in general an apophysitis
is not visible. Any abnormalities should be correlated with clinical findings to
distinguish normal musculoskeletal adaptation to stress from pathologic injury.
An avulsion fracture may appear as a bony fragment separated from the medial
epicondyle. Comparison views of the nonthrowing elbow may confirm
asymmetric changes.
