Module 64, Pediatric 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. During arthroscopy the lesion
was noted to be fragmented and almost completely detached.
Question 64A
Removal of the loose fragments and drilling of the subchondral bone was
performed.
Question 64B
This
lesion is seen almost exclusively in baseball pitchers.
Question 64C
If
this boy has a brother he is at increased risk for also developing this
lesion.
Question 64D
The
injury phase, during which the valgus stress is applied at the elbow causing
this lesion, occurs in deceleration after ball release.
Question 64E
After
rehabilitation this boy wants to return fast pitch softball pitching. He
should be encouraged to do this as an alternative to baseball pitching.
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