Elbow Injuries in the Adolescent Thrower

Abstract

Purpose of Review With an increasing rate of adolescent elbow injuries, especially in throwing athletes, the purpose of this review is to investigate the current literature regarding the diagnosis, treatment, and non-operative and operative outcomes of medial epicondyle fractures, ulnar collateral ligament repair, osteochondritis dissecans of the elbow, and olecranon stress fractures. Recent Findings Acceptable outcomes with both non-operative and operative treatments of medial epicondyle fractures have been reported, with surgical indications continuing to evolve. Unstable osteochondritis dissecans lesions, especially in patients with closed growth plates, require operative fixation, and emerging open and arthroscopic techniques including lesion debridement, marrow stimulation, autograft transfer, and allograft transplantation are described with good outcomes. Ulnar collateral repair has emerged as an exciting treatment option for an avulsion of either end of the ligament in young throwing athletes, with faster rehabilitation times than traditional ulnar collateral ligament reconstruction. Olecranon stress fractures are increasing in prevalence, and when a non-operative treatment course is unsuccessful, athletes have a high return-to-play rate after percutaneous cannulated screw placement. Summary With proper indications, non-operative and operative treatment modalities are reported with a high return-to-play and acceptable clinical outcomes for common elbow injuries, including medial epicondyle fractures, ulnar collateral ligament repair, osteochondritis dissecans of the elbow, and olecranon stress fractures, in adolescent throwing athletes. Further research is needed to better define treatment algorithms, surgical indications, and outcomes.

Risk Factors, Diagnosis and Management of Bone Stress Injuries in Adolescent Athletes: A Narrative Review

“…Surgery is also often indicated for sesamoid stress fractures, which may involve fixation or sesamoidectomy; however, few data are available for children and adolescents [ 29 , 42 ]. Surgery for BSI of the elbow region from throwing sports may involve cannulated screw insertion or tension banding [ 145 ]. In adolescents who are still expected to grow, surgery may involve sliding pins, modified cannulated screws or planned surgical revision [ 125 ].…”

“…Biomechanical screening may identify the presence of risk factors for BSI such that preventative strategies could be put in place; for example, altering lower extremity kinematics and sporting technique (e.g., bowling, throwing, rowing) [ 145 , 177 ]. Regular musculoskeletal screening throughout training seasons has been recommended to identify developing BSI in order to implement timely activity modification or withdrawal from training [ 4 ].…”

Evaluation and management of elbow injuries in the adolescent overhead athlete

“…55 In radiographic staging for OCD, Stage 1 refers to a localized flattening and/or radiolucency, Stage 2 refers to a Source: Adapted with permission from Digiovine et al 42 non-displaced fragment, and Stage 3 refers to a displaced fragment; however, X-rays may be falsely normal or understate the degree of injury. [56][57][58] Magnetic resonance imaging (MRI) provides a better characterization of the injury, and will also provide an assessment of other soft tissue structures, such as the UCL or a possible plica. 59 The MRI staging of capitellar OCDs is shown in Figure 4.…”

Osteochondritis dissecans lesions of the capitellum in overhead athletes: a review of current evidence and proposed treatment algorithm

“…Reported benefits include a broader donor surface to permit larger plug harvesting, less donor site morbidity, and a similar composition to the subchondral bone and cartilage present in synovial joints like the knee. Autograft rib plugs have proven to be a reasonable alternative source for the surgeon who is comfortable with the costal anatomy and who understands the potential risks of violating the thoracic cavity and underlying pleura [6,44,45].…”

“…The term osteochondritis dissecans (OCD) was originally coined by Konig in 1888 to describe the presence of intraarticular loose bodies without known antecedent trauma [1][2][3]. While the exact mechanism for OCD lesion formation remains unclear, a multi-factorial etiology-altered biomechanics, repetitive microtrauma, localized ischemia, and a genetic predisposition-is most likely [4][5][6][7]. When specifically assessing OCD of the capitellum, repetitive compression at the radiocapitellar articulation from either excessive valgus or axial loading is believed to play the predominant role [8].…”