Olecranon Stress Injury in an Adolescent Overhand Pitcher

Abstract

Upper extremity stress fractures, which are relatively rare, have become increasingly common, with olecranon stress injuries representing a subset primarily affecting throwing athletes. Olecranon stress fractures have been classified to fit specific radiographic patterns, with most of these injuries typified by a fracture line. Only a handful of olecranon stress injury cases report magnetic resonance imaging findings of osseous edema within the olecranon, as in our case of a 17-year-old competitive overhand baseball pitcher with elbow pain. The patient was treated conservatively and had resolution of pain after 6 weeks of rest, followed by a 6-week throwing progression with full return to pitching.

Bone Marrow Lesions in Athletic Stress Injuries: An Overview

“…There is some controversy in the literature whether olecranon tip fractures are really stress fractures or represent an acute fracture of an osteophytic process that forms at the posteromedial aspect of the olecranon tip in response to valgus stress at the elbow. 44 45 Management of olecranon tip stress fractures should include a trial of nonoperative management with rest and modification of technique. Nevertheless, surgical management is sometimes required and involves arthroscopic removal of spurs.…”

“…There are three main types of olecranon stress-related injuries. The first is a stress injury of the growth plate, preventing the closure of the olecranon physis in young athletes, 44 also called olecranon apophysitis . Radiographically, a band of irregular sclerosis develops with a widened growth plate and, in more advanced cases, an avulsion fracture can be seen.…”

Youth Throwing Elbow Injuries

“…On physical exam, there may be tenderness to palpation over the olecranon, normal to slightly reduced elbow extension with otherwise normal range of motion, and pain elicited by resisted supination. 105,109,112,113 Based on a case series of 200 baseball players, Furushima et al proposed a classification system in which they categorized OSFs in youth and young adult baseball players into one of five types based on fracture lines: physeal, classic, transitional, sclerotic, and distal. 106 The five types and their characteristics are summarized in Table 4.…”

Elbow Injuries in the Adolescent Thrower

“…Olecranon stress fractures and symptomatic, persistent olecranon physeal injuries of the elbow, though relatively rare, have become increasingly common in adolescent throwing athletes [70]. These repetitive throwing injuries represent the combined sequelae of olecranon impingement with valgus extension overload and excessive pull of the triceps muscle during the acceleration phase of throwing [71].…”