Concurrent Little Leaguer’s Elbow and Shoulder in a 15-year-old Baseball Pitcher and Football Quarterback

Full article available online at ORTHOSuperSite.com. Search: 20111122-29 Little Leaguer’s elbow and Little Leaguer’s shoulder are overuse pathologies seen in overhead-throwing athletes. No instance of simultaneously occurring pathologies has been published. A 15-year-old baseball pitcher and football quarterback developed pain in his throwing shoulder and elbow during spring baseball, which partially resolved with several months of rest. During fall football practice, he felt a pop and pain over his medial throwing elbow. Five days after the initial injury, medial elbow tenderness, mild swelling, and decreased range of motion were noted. Radiographs revealed a Salter I avulsion fracture of the medial humeral epicondyle (Little Leaguer’s elbow) and a periosteal reaction along the lateral aspect of the humeral metadiaphysis with slight widening (Little Leaguer’s shoulder). Surgical fi xation of the medial epicondyle fracture and nonoperative treatment of the shoulder pathology were performed. Twoyear follow-up radiographs showed a healed medial epicondylar fracture and resolution of the periosteal reaction of the humeral metadiaphysis. The patient returned to full activity and was starting quarterback for his football team. Biomechanical forces specifi c to overhead-throwing activities are associated with the development of Little Leaguer’s elbow and shoulder. Treatments of both pathologies remain controversial, with either initial operative vs nonoperative care. In this patient, a good outcome was achieved with surgical fi xation of the elbow fracture and conservative management of the shoulder pathology. Educating coaches and parents on proper throwing technique and pitching limits should be the fi rst step in reducing the occurrence of either pathology in this population. Mr Domes and Drs Petering, Chesnutt, and Mirarchi are from the Department of Orthopaedics & Rehabilitation, Oregon Health and Science University, Portland, Oregon. Mr Domes and Drs Petering, Chesnutt, and Mirarchi have no relevant fi nancial relationships to disclose. Correspondence should be addressed to: Christopher M. Domes, ATC, BS, Department of Orthopaedics & Rehabilitation, Oregon Health and Science University, 3181 Southwest Sam Jackson Park Rd, Portland, OR 97239-2941 ([email protected]). doi: 10.3928/01477447-20111122-29 Concurrent Little Leaguer’s Elbow and Shoulder in a 15-year-old Baseball Pitcher and Football Quarterback CHRISTOPHER M. DOMES, ATC, BS; RYAN C. PETERING, MD; JAMES C. CHESNUTT, MD; ADAM MIRARCHI, MD e97 Figure: Two-year follow-up right elbow anteroposterior radiograph with healed medial epicondylar fracture in near anatomic position with intact 40 4-mm partially threaded cancellous screw and washer.