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Age / Sex : 13 / M
Chief complaint: right elbow pain during throwing
1) What is your impression?
Two weeks later, you can see the final diagnosis with a brief discussion of this case.
(Quiz는 quiz일 뿐이오니 답안은 한개만 보내주시기 바라오며, 복수의 답안을 보내주시는 분은 정답이 포함되어 있더라도 부득이 semi-correct answer로 처리토록 하겠습니다.)
Courtesy: 문승규(Sung Gyu Moon), 건국대병원(Konkuk University Medical Center)
Diagnosis: Little Leaguer’s elbow
Discussion
Findings:
Figure 1.
Elbow A-P radiograph shows subtle widening (arrow) of inferior portioin of
medial epicondylar growth plate.
Figure 2-3. Fat-saturated
T2-W axial MR image shows focal widening and abnormal high signal (arrow) in anteroinferior
portion of medial epicondylar growth plate, adjacent marrow edema in epiphysis
and metaphysic across the physis
Figure 4-5. Fat-saturated
T2-W coronal MR image shows focal widening (arrow) in medial epicondylar growth
plate at the origin of MUCL anterior band. And slight waviness and focal
increased signal (open arrow) in the proximal part of MUCL anterior band with
periligamentous edema are seen, suggesting grade 1 spain.
Diagnosis: Little
Leaguer’s elbow (medial epicondyle apophyseal injury)
Discussion:
Little
Leaguer’s elbow is a condition that is caused by repetitive throwing motions,
especially in children who play sports that involve an overhand throw. Before
apophyseal fusion, valgus stress to the elbow is imparted to the physis rather
than to the MCL. A Salter Harris 1 fracture through the medial epicondyle
apophysis is often referred to as little leaguer’s elbow.
In throwing
athletes with medial elbow pain, tenderness over the medial epicondyle with
soft tissue swelling is common. The type of injury depends on the skeletal
maturity of the patient. For skeletally immature patients, the physeal growth
plate of the medial epicondyle is the weakest link. Radiographic results may be
normal or show physeal widening with overgrowth or fragmentation of the medial
epicondyle when compared to the nondominant arm, a condition often termed
Little Leaguer's elbow. The radiographic features represent a physiologic
response to repetitive traction stress and can be seen in asymptomatic throwing
athletes (nearly 50% in one study). MR imaging is usually not necessary for
diagnosis but would show physeal widening. Treatment is conservative. If untreated,
nonunion of the medial epicondyle may result.
References:
1. Hayter
CL, Giuffre BM. Overuse and traumatic injuries of the elbow. Magn Reson Imaging
Clin N Am. 2009 Nov;17(4):617-38
2. Emery KH.
MR imaging in congenital and acquired disorders of the pediatric upper
extremity. Magn Reson Imaging Clin N Am. 2009 Aug;17(3):549-70
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