A rare cause of chronic elbow pain in an adolescent baseball player: a case report

OBJECTIVE

To present a case of chronic elbow pain as a result of a hidden underlying osteochondral defect.

CLINICAL FEATURES

A 17-year old baseball player presented with chronic lateral elbow pain. Examination revealed swelling of the elbow with signs of possible ligament, muscle, and tendon injury.

DIAGNOSIS AND TREATMENT

Although there was apparent soft-tissue injury, the elbow swelling created immediate suspicion of a more serious underlying condition. Examination revealed a swollen and tender elbow, with plain x-ray confirming a subchondral bone disorder (osteochondral defect) of the capitellum. Surgical repair was performed by an orthopedic surgeon using DeNovo NT Natural Tissue Grafts: the implantation of small pieces of juvenile joint cartilage into the affected area, using glue-like fibrin. Rehabilitation of the elbow began immediately following surgery.

SUMMARY

Examination and imaging indicated that elbow pain in an adolescent baseball player could be from multiple sources, however, the chronic swelling raised suspicion of a condition requiring immediate and further investigation.

Chronic pain due to Little Leaguer's Shoulder in an adolescent baseball pitcher: a case report

OBJECTIVE

To describe a case of chronic Little Leaguer's Shoulder in reference to pain presentation, physical capabilities, and recovery time.

CLINICAL FEATURES

A 17-year-old, junior baseball pitcher presented with shoulder pain when performing high velocity pitching. Conservative treatment for an assumed soft tissue injury failed to resolve the pain, which was regularly aggravated by pitching, and which subsequently prompted further evaluation, and eventual confirmation of Little Leaguer's Shoulder on subsequent computerized tomography (CT) imaging.

INTERVENTION AND OUTCOME

Prior to proper diagnosis, conservative treatment had consisted of activity modification, spinal adjusting, laser therapy, shockwave therapy, Active Release Techniques(®), Kinesiotape,(®) and rehabilitation. Later, rehabilitation, consisting of general muscle and core strengthening, continued for a further six months under the supervision of college athletic trainers. The athlete was able to return to normal pitching duties approximately 12 months later.

SUMMARY

In this case, a potentially damaging bone injury masquerading as a simple musculo-tendinous injury created a diagnostic challenge. The patient eventually recovered with rest, time, strengthening, and eventual compliance to prescribed activity modification.