Module 64, General Orthopaedist Level
This patient is a 14 year old male baseball pitcher who complains of
right elbow pain, swelling, and decreased ROM which has occurred intermittently
over the past year. He also describes clicking and "catching"
of the elbow. He claims that the pain has been getting progressively worse
and that it is worst after throwing. On physical examination, the patient
has a minimal joint effusion and is tender over his radiocapitellar joint
line. He also lacks 15 degrees of terminal elbow extension, but has full
flexion. There is some crepitus with ROM. Plain X-rays of the elbow show
focal islands of subchondral bone adjacent to the articular surface of
the capitellum demarcated by a rarefied area.
Question 64A
The
next stage in this boy's work up should be to do an MRI scan.
Question 64B
At
arthroscopy several loose fragments and several 3 mm wide loose flaps of
cartilage were seen. The loose fragment should be removed and the flaps
should be reattached using biodegradable pins.
Question 64C
Following
the arthroscopy in which only fragments were removed a physical therapy
program stressing strengthening should be instituted.
Question 64D
This
boy should plan to be out of baseball pitching for at least one year.
Question 64E
The
diagnosis in this boy is Panner's disease.
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