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Medial Epicondyle Apophysitis M25.529 719.42

synonyms: medial epicondyle apophysitis, little league elbow, Medial epicondyle avulsion

Medial Epicondyle Apophysitis ICD-10

 

Medial Epicondyle Apophysitis ICD-9

  • 719.42 (traction aphysitis of the medial epicondyle)

Medial Epicondyle Apophysitis Etiology / Epidemiology / Natural History

  • Common in youth baseball (Gugenheim JJ Jr, AJSM 1977;4: 189)
  • Throwing exposes the medial elbow to high tension forces and the lateral elbow to high compression forces.
  • Repetitive valgus stresses to the elbow occuring during the late cocking and acceleration phases of throwing can lead to medial elbow injury.
  • Valgus forces can result in repetitive submaximal injury and apophyseal fragmentation or acute avulsion of the medial epicondyle apophysis
  • Medial epicondylar apophyseal fragmentation occurs in 4% of recreational pitchers age 9 to 18. (Torg JS, Pediatrics 1972;49: 267)

Medial Epicondyle Apophysitis Anatomy

  • The medial epicondyle growth plate (apophysis) is weaker than the medial collateral ligament in skeletally immature individuals.
  • The pronator flexor muscle mass inserting into the medial epiconyle also contributes to high tension forces seen during the late cocking and acceleration phases of throwing.
  • Medial epicondyle is most vulnerable between 11-13 years old as the physis is beginning to close.
  • See also Elbow Anatomy.

Medial Epicondyle Apophysitis Clinical Evaluation

  • Medial elbow pain with throwing.
  • Medial epicondyle tenderness.
  • Acute pain and loss of motion in avulsion fracture.
  • Often 10°-15° flexion contracture.
  • Valgus Stress Test: valgus load applied to elbow with the elbow flexed 20° . Positive results = reproduction of medial elbow pain and valgus laxity greater on injured side as compared to contralateral side.
  • Moving Valgus Stress Test: rapid extention from full flexion while maintaining a constant valgus stress. Positive result = reproduction of medial elbow pain.

Medial Epicondyle Apophysitis Xray / Diagnositc Tests

  • Bilateral A/P, lateral and oblique elbow xrays indicated. Evaluate for widening of the medial epicondyle apophysis, medial epiconyle fragmentation or medial epicondyle avulsion.

Medial Epicondyle Apophysitis Classification / Treatment

  • Medial epicondyle apophysitis: no throwing fot 2-3 months, rest, ice, occasional splinting hasproven successful, and surgery is usually not required. (Torg JS, Am Fam Physician 1972;6:71)
  • Medial epicondyle avulsion: displaced greater than 1cm, or valgus instability should be treated with ORIF usually with a single screw.(Woods GW, Am J Sports Med 1977;5: 23), (Hines RF, CORR 1987;223:170)
  • Medial epicondyle avulsion: non-displaced in a non-throwing athlete without instability: splint immobilization for 5-7 days followed by early motion.

Medial Epicondyle Apophysitis Associated Injuries / Differential Diagnosis

Medial Epicondyle Apophysitis Complications


Medial Epicondyle Apophysitis Follow-up Care

  • Prevention can be accomplished by rules limiting the number and type of pitches allowed in youth baseball along with education of Little League coaches, parents, and throwers. (Andrews JR, J Orthop Sports Phys Ther 1998;27: 187)

Medial Epicondyle Apophysitis Review References