case presentations: elbow

Case Presentations: Case Presentations: ElbowElbow

Case # 1Case # 1

Case #1: T.J.Case #1: T.J.

• HPI: 21 yo LHD collegiate pitcher c/o L HPI: 21 yo LHD collegiate pitcher c/o L elbow pain for the past 12 months. No elbow pain for the past 12 months. No acute injury. Shut down twice for total acute injury. Shut down twice for total of 3 months.of 3 months.

• PE: Full ROM, non-tender along UCL or PE: Full ROM, non-tender along UCL or with valgus stress, tender long with valgus stress, tender long

posterolateral olecranonposterolateral olecranon• X-Rays:X-Rays: olecranon sclerosisolecranon sclerosis

Case #1: T.J.Case #1: T.J.Bone ScanBone Scan

Case #1: T.J.Case #1: T.J.CT ScanCT Scan


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Case #1: T.J. Case #1: T.J. Operative ProcedureOperative Procedure


• One year post-op : returned to throwing at One year post-op : returned to throwing at same levelsame level

• 13 months post-op: Acute injury with “pop” 13 months post-op: Acute injury with “pop” while pitchingwhile pitching

• MRI: Acute UCL tearMRI: Acute UCL tear


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• Collegiate Sr. - elected to give up baseballCollegiate Sr. - elected to give up baseball

Case # 2Case # 2

Case #2: M.R.Case #2: M.R.

• HPI: High level 16 yo HS pitcher sustained HPI: High level 16 yo HS pitcher sustained an acute injury to the elbow while an acute injury to the elbow while pitching in a relief appearance during pitching in a relief appearance during summer ball. Heard/ felt a “pop”. summer ball. Heard/ felt a “pop”.

Older Older brother is a collegiate pitcher brother is a collegiate pitcher with a with a previous UCL reconstruction.previous UCL reconstruction.


• PE: swelling, ecchymosis medial elbow, PE: swelling, ecchymosis medial elbow, painful limited ROM, tender at distal painful limited ROM, tender at distal UCL/ sublime tubercle of ulnaUCL/ sublime tubercle of ulna

• X-Rays:X-Rays: Sublime tubercle ulna avulsion Sublime tubercle ulna avulsion fracturefracture


Treatment ????Treatment ????


Treatment : Conservative / RehabilitationTreatment : Conservative / Rehabilitation

Elbow and shoulder PTElbow and shoulder PT

Repeat x-ray at 2,6, 12 weeksRepeat x-ray at 2,6, 12 weeks

Valgus stress x-rays at 12 weeksValgus stress x-rays at 12 weeks


Currently throwing off the mound in preparation for HS baseball season, medial elbow is pain-free


DiscussionDiscussion

Case # 3Case # 3

Case #3: J.SCase #3: J.S

• HPI: 34 yo professional pitcher with 2 yr HPI: 34 yo professional pitcher with 2 yr history of medial elbow pain. history of medial elbow pain.

Sustained Sustained an acute medial injury during an acute medial injury during spring spring training.training.

• PE: Tender over distal UCL, + valgus PE: Tender over distal UCL, + valgus instability and pain, ROM 14 -130instability and pain, ROM 14 -130


• PMH: Two previous elbow arthroscopies PMH: Two previous elbow arthroscopies for VEO – olecranon osteophytes (3 for VEO – olecranon osteophytes (3

yrs yrs prior)prior)

• X-rays: WNLX-rays: WNL

Case #3: J.S.Case #3: J.S.


• Treatment recommendations ???Treatment recommendations ???


• Treatment: Treatment: Ulnar Collateral Ligament Ulnar Collateral Ligament

ReconstructionReconstruction


• 14 months post-operative – returned to 14 months post-operative – returned to professional levelprofessional level

• 15 months – presented with persistent 15 months – presented with persistent medial elbow pain and shoulder pain after 5 medial elbow pain and shoulder pain after 5 starts (24 innings)starts (24 innings)


Diagnosis: Diagnosis:

Flexor-pronator tendonitisFlexor-pronator tendonitis

Treatment: Treatment: ????????

Case #3Case #3ResultsResults

• Completed season as relieverCompleted season as reliever

• Signed 3 yr – $ 30 million contractSigned 3 yr – $ 30 million contract


DiscussionDiscussion

Case # 4Case # 4

Case #: M.H.Case #: M.H.

• HPI: 22 yo collegiate catcher with previous HPI: 22 yo collegiate catcher with previous UCL reconstruction 5 months post-UCL reconstruction 5 months post-operative. Reports “pop” while operative. Reports “pop” while

throwing throwing at 50% during ITP.at 50% during ITP.

• PE: swollen, tender medially, ROM limited PE: swollen, tender medially, ROM limited

• X-Rays:X-Rays: medial epicondyle avulsionmedial epicondyle avulsion

Case #4: M.H.Case #4: M.H.


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Case #4: M.H.Case #4: M.H.Operative ProcedureOperative Procedure

• ORIF medial epicondyleORIF medial epicondyle

Case #4: M.H.Case #4: M.H.3 months Post-op3 months Post-op

Case #4: M.H.Case #4: M.H.6 months Post-op6 months Post-op


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Case #4: M.H.Case #4: M.H. ResultsResults

• Returned to collegiate baseball at Returned to collegiate baseball at 11 months11 months


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Thank You

case presentations: elbow

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