Medial epicondyle apophysitis

Last revised by Joachim Feger on 19 Dec 2021

Medial epicondyle apophysitis is one of the manifestations of little leaguer's elbow in patients with open medial epicondyle physis. It occurs due to extreme valgus and hyper extension overload forces applied over medial aspect of the elbow during throwing a ball.

It occurs in skeletally immature athletes before the closure of medial epicondyle growth plate. Younger patients are more likely to develop avulsion injury or apophysitis than ligament injuries, cause the apophysis- cartilage interface is the weakest point in medial aspect of elbow at that time. After closer of physis medial collateral ligament and flexor tendon complex is more likely to injure. 

The presentation includes: pain in a throwing arm, decreased throwing speed, power, and accuracy. Physical examination may reveal medial and proximal elbow focal tenderness and swelling. Applying valgus forces to the elbow may worsen the symptoms.

Forceful throwing or overhead strokes generates extreme valgus and extension with tensile forces in the medial elbow.

  • widening of the physis with adjacent sclerosis and cortical irregularity. MRI may show increased fluid signal and widening of the physis with apophyseal edema-like lesions
  • in severe cases, fragmentation and avulsion fracture may occur
  • by advancing age and skeletal maturity, injurers of ulnar collateral ligament become more prevalent
  • in younger children due to higher elastin and low type I collagen content, slightly high T1 and T2 signal within the ligament is considered normal and should not be mistaken for tear or tendinopathy

Treatment is conservative management including rest, physiotherapy, correction of technique, and strengthening muscles. If left untreated it results in mal- or non union. 

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