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Abstract
This is a 5-year-old boy who fell off a trampoline and injured his left elbow. Radiographs, including stress views, were negative for fracture or effusion (not shown).
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This article provides an overview of common upper extremity injuries in youth sports, including injuries to the shoulder, elbow, and wrist. Pain in the shoulder and elbow is common among youngsters who participate in throwing sports, raquet sports, and swimming, while wrist pain is common among young gymnasts. Acute trauma to the shoulder and elbow can occur in almost any sporting activity. This article provides descriptions of common injuries and guidelines for treatment.
MR imaging is a highly valuable tool in the evaluation of ligamentous injuries of the elbow. Proper coil selection, patient positioning, and pulse sequence parameters are essential for optimization of image quality. Clinical evaluation of ligamentous injuries is often difficult and visualization at surgery may be limited. MR imaging can demonstrate not only ligamentous pathology but abnormalities in the adjacent osseous and soft tissue structures, making it an important aid to clinical management. In skeletally immature patients, MR imaging can demonstrate injury not only to the ligaments but to the physes and apophyses, making it useful in the evaluation of the pediatric elbow.
This article describes a variety of elbow injuries often seen in young, throwing athletes. Understandings of normal skeletal development, as well as the biomechanics of throwing, provide a basis on which to evaluate, diagnose and manage ’little league elbow’. With emphasis on an anatomically-based differential diagnosis, the pathologic forces placed upon the young thrower’s elbow, and the subsequent injury patterns, are reviewed.
Medial side injuries are the most common and relate to chronic forces of valgus overload produced during the early and late cocking phases of throwing. The majority of this force is placed on the medial epicondyle and produces age dependent injury patterns, such as apophysitis in childhood and epicondylar avulsion fractures in the more mature athlete. With repetitive valgus overload, lateral side injuries such as Panner’s disease and osteochondritis dissecans of the capitellum and radial head become more apparent. These injuries relate to the compressive forces produced by the late cocking and early acceleration phases of throwing. Finally, posterior injury patterns consisitent with olecranon apophysitis and posteromedial impingement, as well as flexion and capsular contracture, can be seen.
The key in the treatment of ’little league elbow‘ is prevention and this responsibility lies not only with the evaluating or team physician, but also with the coach, trainer, parents and officials. Proper throwing mechanics must be emphasised at an early age, and the determinants of elbow injury among young pitchers better understood. Early recognition and proper treatment of such injuries will then prevent later sequelae or functional disability.
Pediatric elbow injuries that result from repetitive throwing-type activities are common. These injuries differ from those seen in adults, because of anatomic differences. The purpose of this paper is twofold: first, to review the anatomy of the elbow and the mechanics of the throwing motion about the elbow, and second, to discuss the diagnosis, treatment, rehabilitation, and prevention of pediatric throwing injuries of the elbow.
Growth and ossification of the elbow are complex. Interpreting MR images of the elbow in children requires a knowledge of the elbow's developmental changes. This article discusses the basic principles of growth and development of the distal humerus, proximal radius, and ulna. The signal characteristics of cartilage and marrow in the immature skeleton are described. Technical factors related to imaging of growth cartilage are outlined, and specific challenges during imaging of the pediatric elbow are emphasized. The changing MR appearance of the elbow due to ossification and physeal closure is described. The article also explains several pitfalls encountered.
Elbow joint effusion with no fracture seen on radiographs of pediatric patients after acute trauma has become synonymous with occult fracture. This study evaluates the incidence of occult fractures in such cases as determined by findings on follow-up radiographs.
Initial and follow-up radiographs were reviewed for 54 children (mean age, 7 years) with a history of trauma who had joint effusion but no identifiable fracture on initial radiographs. The presence of periosteal reaction or bony sclerosis on follow-up radiographs was considered to be evidence of occult fracture. Mean time between initial and follow-up radiographs was 18 days (range, 14-50 days).
Only nine (17%) of the 54 patients showed evidence of a healing occult fracture on follow-up radiographs. However, we found a statistically significant relationship (p = .001) between persistent joint effusion on follow-up radiographs and occult fracture. Seventy-eight percent of cases with occult fracture, versus 16% of cases without occult fracture, had persistent effusions.
Joint effusion without visualized fracture on initial radiographs after trauma does not correlate with the presence of occult fracture in most cases (83%). Therefore, joint effusion as revealed by radiography should not be considered synonymous with occult fracture.
Injuries to the upper extremity in paediatric and adolescent athletes are increasingly being seen with expanded participation and higher competitive levels of youth sports. Injury patterns are unique to the growing musculoskeletal system and specific to the demands of the involved sport. Shoulder injuries include sternoclavicular joint injury, clavicle fracture, acromioclavicular joint injury, osteolysis of the distal clavicle, little league shoulder, proximal humerus fracture, glenohumeral instability and rotator cuff injury. Elbow injuries include supracondylar fracture, lateral condyle fracture, radial head/neck fracture, medial epicondyle avulsion, elbow dislocation and little league elbow. Wrist and hand injuries include distal radius fracture, distal radial physeal injury, triangular fibrocartilage tear, scaphoid fracture, wrist ligamentous injury thumb metacarpalphalangeal ulnar collateral ligament injury, proximal and distal interphalangeal joint injuries and finger fractures. Recognition of injury patterns with early activity modification and the initiation of efficacious treatment can prevent deformity/disability and return the youth athlete to sport.
This article describes a variety of elbow injuries often seen in young, throwing athletes. Understandings of normal skeletal development, as well as the biomechanics of throwing, provide a basis on which to evaluate, diagnose and manage "little league elbow". With emphasis on an anatomically-based differential diagnosis, the pathologic forces placed upon the young thrower's elbow, and the subsequent injury patterns, are reviewed. Medial side injuries are the most common and relate to chronic forces of valgus overload produced during the early and late cocking phases of throwing. The majority of this force is placed on the medial epicondyle and produces age-dependent injury patterns, such as apophysitis in childhood and epicondylar avulsion fractures in the more mature athlete. With repetitive valgus overload, lateral side injuries such as Panner's disease and osteochondritis dissecans of the capitellum and radial head become more apparent. These injuries relate to the compressive forces produced by the late cocking and early acceleration phases of throwing. Finally, posterior injury patterns consistent with olecranon apophysitis and posteromedial impingement, as well as flexion and capsular contracture, can be seen. The key in the treatment of "little league elbow" is prevention and this responsibility lies not only with the evaluating or team physician, but also with the coach, trainer, parents and officials. Proper throwing mechanics must be emphasised at an early age, and the determinants of elbow injury among young pitchers better understood. Early recognition and proper treatment of such injuries will then prevent later sequelae or functional disability.
Musculoskeletal system
- T Laor
- D Jaramillo
- A E Oestreich
- T. Laor