Topic

Medial elbow

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Medial epicondyle avulsion fractures

This is the most common type of fracture in adolescent athletes. Like OCD, these are more common in sports that require repeated throwing. Unlike older athletes, the medial physis is the weakest point (rather than the UCL). The valgus force seen with throwing creates a traction force that causes an avulsion-type injury.

 

History

Athletes generally present with acute medial elbow pain. They may have experienced an associated popping sensation. Occasionally may be associated prodromal symptoms.

 

Examination

Patients generally have a reduced ROM with focal medial tenderness, bruising and swelling.

 

Investigation

Radiographs show a widening of the physis. This widening can be difficult to interpret and comparison with the unaffected side is suggested.

Click on the following images to view an image of a medial epicondyle injury.

  • Medial epicondyle fracture

    A displaced medial epicondyle fracture is seen on this AP image.

Treatment

Undisplaced or minimally displaced fractures are treated conservatively. A splint can be used for comfort. Minimally displaced fractures should be placed in a backslab for a minimum of two to three weeks. Conservative treatment is generally suggested even when there is a degree of displacement. When displaced, the fracture typically heals with a fibrous union, but otherwise good results are reported.16 Other authors advocate fixation when greater than 2mm displacement is present.17

 

Medial epicondyle apophysitis

This condition is also caused from the pull of the flexor-pronator mass and the UCL. In contrast to an acute fracture, these athletes report a more gradual onset of medial elbow pain that is worse with throwing (and as a result may be more common among goalkeepers). They also have point tenderness over medial epicondyle.

X-rays may be normal, but can show a widening of the apophysis and fragmentation of the medial epicondyle.

In the throwing athlete, the treatment typically starts with rest from throwing sports (and other aggravating activities) for a six-week period. As with other injuries, it is important to remember that radiological signs lag behind clinical signs.

A similar process can also occur at the olecranon due to repeated triceps contraction, although this is less common. Non-union and persisting symptoms beyond three to six months may indicate the need for orthopaedic referral for possible surgical fixation.