Throwers Elbow
Mitsutoshi Hayashi
Doctor of Medicine, specialist in the Japanese Society of Rehabilitation Medicine, specialist in the Japanese Society of Orthopaedic Surgery, specialist in the Japanese Society of Rheumatology, staff to strengthen JOC, and sports physician certified by the Japan Sports Association
Thrower's elbow
Thrower’s elbow is common among more than the level of school baseball, occurring mostly in pitchers.
Disease Overview
Thrower’s elbow is a typical sports disorder of the elbow caused by excessive throwing and overuse, which is common among baseball pitchers in the junior period. Bone damage occurs during growth, not only with elbow pain, but also with bone deformities that may cause problems in the future.
Cause and mechanism of onset
Disease concept
Thrower’s elbow is a sports disorder that is caused by baseball throwing, particularly overuse, which occurs in growing pitchers, and is mainly characterized by throwing pain in the throwing elbow of the medial side (Fig. 1), the outer side (Photo 1), and the elbow head (Photo 2). Symptoms often develop gradually and become chronic, so attention should be paid to elbow pain. The acceleration phase (acceleration) of throwing movements takes place in elbow flexion, valgus, and forearm supination. In the medial type, traction is exerted by the pronator flexor in throwing on the inside of the elbow, stretching the pronator muscles, the medial collateral ligaments, and the ulnar nerve, causing micro-damage inside the elbow. In severe cases, the medial epicondyle of the humerus develops avulsion fractures due to traction. In the lateral type, pressure is applied to the capitulum of the humerus and radius on the lateral side of the elbow, resulting in osteochondritis dissecans, with bone necrosis, defects, and loose bodies. The posterior type is in an elbow extension position during deceleration (follow-through), and traction forces are applied to the olecranon of the ulna, resulting in changes such as avulsion and stress fractures.
Figure 1 Medial type: Diastasis of the medial epicondyle of the humerus
Photo 1 Lateral type: free bone in the capitulum of the humerus
Photo 2 Olecranon type: olecranon of the ulna showing bony dehiscence
Photo 3 Medial: Swelling of the medial part of the right elbow is prominent
Diagnosis
Symptoms
In the medial type, tenderness on the inside of the elbow, swelling (Photo 3), elbow pain during throwing, limited range of motion of the elbow, and sometimes numbness on the side of the little finger develop. The lateral type may present with lateral elbow pain, as well as locking symptoms. The posterior type presents with posterior elbow tenderness, throwing pain, and locking symptoms.
Diagnosis
These symptoms can be accompanied by bony changes on X-ray. In the medial type, bone thickening of the medial epicondyle of the humerus, epiphyseal line separation, and free bone in the pronator region are observed; in the lateral type, bone deformation, defect, and a free bone fragment of the capitulum of the humerus and head of the radius are observed; and in the posterior type, fissure fracture and stress fracture of the olecranon of the ulna are observed.
Common sports
Overhead throw sports, such as baseball, tennis (serve), American football (QB), and javelin throwing are popular sports.
Sports level
It is more common among players more than the level of Little League and Junior High School level, most of whom are throwers. It also occurs in the catchers.
Age predilection
It most commonly affects boys between the ages of 10 and 16, with the most common sites on the inside, outside, and back of the throwing elbow, as described above.
Treatment and rehabilitation
Treatments
It most commonly affects boys between the ages of 10 and 16, with the most common sites on the inside, outside, and back of the throwing elbow, as described above.
Precaution
If throwing is not stopped early with the onset of pain, bone changes may result, and the person may be forced to stop throwing for months or years. However, running and batting are possible, and a change in position should be considered. Because of growth, severe injuries to the epiphyseal line can result in a valgus (lateral type) or varus (medial type) deformity of the elbow.
Hitoshi Takahashi
Associate Professor, the Department of Regional Medicine, Teikyo Heisei University A certified athletic trainer from the Japan Sport Association, a practitioner of acupuncture and a massage practitioner
Thrower's elbow
Prevention
Introduction
Thrower’s elbow is a sports disorder that often occurs in growing pitchers. It can be prevented because it is caused by overuse (throwing). Preventive measures are centered on orthopedic medical checkups for physical characteristics and daily conditioning. This section focuses on the details of orthopedic medical checkups.
Orthopedic Medical Check
Orthopedic medical checkups are tend to be expected as a major operation but they are easy to perform. The following is a checklist that the instructor need to perform on-site in order to understand the physical condition of the player. Periodic medical checkups allow early detection of disabilities. Athletes with problems should be instructed to see a sports doctor immediately.
History
Investigate past injuries and disorders. The degree is based how much the person needs to rest or restrict exercises. The doctor's diagnosis, the location of the pain, and the course of the disease are also investigated. Daily conditioning is particularly important for athletes with a history.
On-site evaluation and first aid
Tenderness checks (photos 1-7)
You suspect a disorder when tenderness is present on the inside, outside, or behind the elbow. Because thrower’s elbow progresses from medial to lateral, lateral tenderness may be severe. The person is instructed to see a sports doctor immediately.
Method of checking : Positions of the medial and lateral epicondyles of the humerus and the condyle of the elbow: When the elbow joint is extended, the condyle of the elbow, medial epicondyle, and lateral epicondyle are aligned in a row. In the photograph, the examiner's thumb touches the lateral epicondyle, the index finger the condyle of the elbow, and the middle finger the medial epicondyle (the subject's elbow is right).
Sites to check for medial tenderness (in parentheses are typical expected disorders. Elbow of the subject are on the left)
Photo 2 Medial epicondyle of the humerus
Photo 3 Humerus: How to palpate the medial epicondyle (Little League Elbow)
Photo 4 Peripheral to the origin of the flexor group (medial epicondylitis)
Photo 5 Medial collateral ligament: Push the front of the inferior end of the medial epicondyle (medial collateral ligament injury)
Area to check for lateral tenderness
Photo 6 Check for lateral humeral tenderness with elbow flexion (osteochondritis dissecans)
Area to check for posterior tenderness
Photo 7 Olecranon fossa: Slight flexion of the olecranon joint to check for tenderness at the olecranon and olecranon fossa (olecranon epiphysitis)
Range of motion check (Photos 8-11)
Any problems with the elbow can result in a limited range of motion. Check extension and flexion movements. In addition, traction stress on the wrist flexors causes medial pain, and traction stress on the extensors causes lateral pain. Also check for limited range of motion in wrist flexion (plantar flexion) and wrist extension (dorsiflexion). The range of motion is about 90 degrees.
How to check range of motion
Photo 8 Elbow extension: Extend the elbow in front of the chest. Check for extension restriction while comparing left and right sides.
Photo 9 Elbow flexion: Check whether the elbow can touch on the shoulder with the elbow on the side of the body.
Photo 10 Wrist extension: Check for extension limitation and stretching pain while comparing left and right sides.
