Risk factors for cubital tunnel syndrome include obesity and diabetes mellitus. Those whose work involves protracted periods of elbow flexion or the use of vibrating tools are also at risk, such as contractors and mechanics (Cutts, 2007).
Clinical Presentation The clinical presentation for cubital tunnel syndrome often includes medial elbow pain and/or hand pain, numbness and tingling in the hand along the ulnar nerve distribution, and weakness and/or atrophy in the hand (Drake et al., 2017). Physical examination findings often include impaired sensation in the ulnar nerve distribution, muscular atrophy of the first dorsal interosseous muscle, and clawing of the fourth and fifth fingers. Tinel’s sign may be positive for tingling and pain with percussion at the retrocondylar groove (Graf et al., 2023).
PEDIATRIC MEDIAL ELBOW CONDITIONS
Little league elbow Little league elbow is a term used to describe lesions to the medial elbow in preadolescent and adolescent baseball players. This injury correlates with the excess valgus stresses applied to the elbow during the early and late cocking phases of throwing. Valgus force at the elbow creates tensile stress on the medial structures of the elbow (medial epicondyle, medial epicondylar apophysis, and ulnar collateral ligament) while creating compression forces on the lateral structures of the elbow (radial head and capitellum; Physiopedia n.d.). Contraction of the flexor pronator muscles is also thought to play a role (Otoshi et al., 2017). Changes to the medial condyle noted in little league elbow include acute bony avulsion, heterogenous ossification of the ulnar collateral ligament, and widening of the medial epicondyle apophysis (Otoshi et al., 2017). Nondisplaced avulsion fractures are managed conservatively with casting/sling. The presence of intraarticular entrapment may indicate a need for surgery (Molla et al., 2022). Excessive, repetitive valgus stress to the elbow can also cause a pathological widening or inflammation of the medial epicondyle apophysis. The medial epicondyle has its own ossification center, which is different from the main distal humerus physis. This ossification center develops around age 6 to 7 and typically fuses by age 15 (Hodge & Schroeder, 2023). Osteochondritis dissecans Preadolescent and adolescent baseball players also experience an increased likelihood of osteochondritis dissecans of the humeral capitellum. This injury is particularly consequential because it can lead to elbow osteoarthritis and subsequent severe limitation of elbow function. The causes are believed to involve ischemia, genetic factors, and microtrauma (Otoshi et al., 2017).
Clinical Presentation Clinical presentation for acute avulsion fractures of the medial epicondyle typically includes immediate pain and swelling with bruising developing later, decreased elbow range of motion, and decreased hand grip. Clinical evaluation should include detailed information regarding sport and workout regimens as well as activity changes, with particular attention paid to sharp increases in workload to the throwing arm. (It should be noted that a fall on an outstretched arm and wrestling can also cause this injury.) Examination should include assessment of range of motion, which may be limited or which may have a mechanical block. Assessment of ulnar nerve function is important. Healthcare Consideration: Post et al. (2021) report that there has been a concerning rise in the rates of overuse injuries in youth baseball players. One factor that has been shown to contribute to this rise is an increase in sports specialization or year-round intensive training in a single sport. Participation in baseball for more than 8 months in a year has been identified as a risk factor for elbow injuries among adolescent baseball pitchers (Post et al., 2021). Self-Assessment Quiz Question #5 Little league shoulder is an injury to the medial elbow that includes: a. Bony avulsion. b. Ossification of the ulnar collateral ligament. c. Widening of the medial epicondyle apophysis. d. All of the above may be involved.
ELBOW FRACTURES
Olecranon fracture Olecranon fractures can be isolated fractures of the extensor mechanism in the elbow or more complex injuries, including fracture dislocations. Open olecranon fractures are rare. The size of the olecranon fracture determines the stability of the ulnohumeral joint and dictates the classification of the fracture. The Mayo classification system is most commonly used, and it divides fractures into the following types. ● Type I : Nondisplaced. ● Type II : Displaced. ● Type III : Distally displaced with volar ulnar displacement.
Olecranon fractures can be further divided into noncomminuted (nondisplaced, partial) or comminuted fracture broken in three or more places (Brüggemann et al., 2022). The primary injury mechanism for olecranon fractures is a simple fall. Olecranon fractures can occur in all age groups, but they are often osteoporosis-related fractures. In patients younger than age 65, a common mechanism of injury is falling off a bicycle (Brüggeman et al., 2022).
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