Elbow Pain in Young Athletes
Elbow pain is a common complaint in teens participating in sports. Although elbow pain can be the result of a specific injury, it often occurs because of overuse.
When determining the cause of elbow pain it is helpful to know its location, when it occurs, how long it has been present, if it is aggravated by certain motions, and if there is associated swelling. When a throwing athlete complains of elbow pain, it is also helpful to know when during the throwing cycle the pain occurs.
Because the skeleton of young athletes is still growing, many ligaments attach to areas of bone that are not yet fully fused to the skeleton. Because of this, young athletes may actually injure a growth plate (area in the bone where growth occurs) instead of tearing the attaching ligament.
Common injuries around the elbow in young athletes include:
An apophysis is an area of bone where ligaments and tendons attach. The bone is connected to the skeleton via an area of growth. The area where growth occurs is weaker than the attaching ligaments and tendons and; therefore, it's more susceptible to injury.
Apophysitis occurs when the area of growth is irritated from overuse. The elbow has three apophyses: the medial epicondyle apophysis, lateral epicondyle apophysis, and the olecranon apophysis.
Symptoms of apophysitis include point tenderness over the bony prominence rather than over the tendons or ligaments. The pain is made worse by the ligaments pulling against their attachment on the bone. Treatment includes rest, ice, and physical therapy for stretching and strengthening. Surgery is rarely needed.
Avulsion fractures occur when a tendon or ligament is forcefully pulled away from a bone taking a piece of bone with it. Depending on how far the bone is pulled away from its attachment site, some avulsion fractures can be treated non-operatively. Others, where the bone is pulled farther out of place, may need surgery to fix the bone back in its correct position for healing to occur.
Because of the weakness of the growth plate in comparison to the ligaments that attach at the elbow, ligament injuries in skeletally immature athletes are rare. When they do occur an athlete's pain is localized over the tendons and ligaments rather than directly over the boney prominences. Radiographs are usually taken to rule out bony injury. An MRI may be ordered to confirm the diagnosis.
For ligament injuries where the joint is still stable, treatment consists of rest, ice, anti-inflammatory medications, and physical therapy. Braces can help relieve stress on an injured ligament while it is healing. Ligament injuries rarely require surgery.
Osteochondritis dissecans is a condition that occurs most commonly in the knee, but can also occur in other joints such as the elbow and ankle. Osteochondritis dissecans refers to a condition where a small area of bone just below articular cartilage loses its blood supply. The overlying cartilage softens and can eventually fragment and potentially detach. Although the exact cause is unknown, trauma injury seems to be a major contributor.
Athletes with osteochondritis dissecans complain of pain that is often worse with activities. Swelling is sometimes present and motion is often limited (especially extension). Radiographs are usually diagnostic. An MRI is helpful in determining the extent of cartilage involvement and assists in determining appropriate treatment options.
Treatment consists of removing impact activities for sufficient time to allow the area of bone to heal. If the bone fails to heal or if the cartilage becomes unstable, surgery may be needed to stabilize the cartilage.
Article by Jeffrey M. Vaughn, D.O.
Phoenix Children's Hospital
This article was published in the March 2009 issue of Kids & Sports, the Valley's youth sports parenting resource.