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Case Presentations: Elbow

Case Presentations: Elbow. Case # 1. Case #1: T.J. HPI: 21 yo LHD collegiate pitcher c/o L elbow pain for the past 12 months. No acute injury. Shut down twice for total of 3 months. PE: Full ROM, non-tender along UCL or with valgus stress, tender long posterolateral olecranon

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Case Presentations: Elbow

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  1. Case Presentations: Elbow

  2. Case # 1

  3. Case #1: T.J. • HPI: 21 yo LHD collegiate pitcher c/o L elbow pain for the past 12 months. No acute injury. Shut down twice for total of 3 months. • PE: Full ROM, non-tender along UCL or with valgus stress, tender long posterolateral olecranon • X-Rays: olecranon sclerosis

  4. Case #1: T.J.

  5. Case #1: T.J.Bone Scan

  6. Case #1: T.J.

  7. Case #1: T.J.CT Scan

  8. Case #1: T.J. ?

  9. Case #1: T.J. Operative Procedure

  10. Case #1: T.J. • One year post-op : returned to throwing at same level • 13 months post-op: Acute injury with “pop” while pitching • MRI: Acute UCL tear

  11. Case #1: T.J. ?

  12. Case #1: T.J. • Collegiate Sr. - elected to give up baseball

  13. Case # 2

  14. Case #2: M.R. • HPI: High level 16 yo HS pitcher sustained an acute injury to the elbow while pitching in a relief appearance during summer ball. Heard/ felt a “pop”. Older brother is a collegiate pitcher with a previous UCL reconstruction.

  15. Case #2: M.R. • PE: swelling, ecchymosis medial elbow, painful limited ROM, tender at distal UCL/ sublime tubercle of ulna • X-Rays: Sublime tubercle ulna avulsion fracture

  16. Case #2: M.R.

  17. Case #2: M.R.

  18. Case #2: M.R. Treatment ????

  19. Case #2: M.R. Treatment : Conservative / Rehabilitation Elbow and shoulder PT Repeat x-ray at 2,6, 12 weeks Valgus stress x-rays at 12 weeks

  20. Case #2: M.R.

  21. Case #2: M.R.

  22. Case #2: M.R.

  23. Case #2: M.R.

  24. Case #2: M.R. Currently throwing off the mound in preparation for HS baseball season, medial elbow is pain-free

  25. Case #2: M.R. Discussion

  26. Case # 3

  27. Case #3: J.S • HPI: 34 yo professional pitcher with 2 yr history of medial elbow pain. Sustained an acute medial injury during spring training. • PE: Tender over distal UCL, + valgus instability and pain, ROM 14 -130

  28. Case #3: J.S • PMH: Two previous elbow arthroscopies for VEO – olecranon osteophytes (3 yrs prior) • X-rays: WNL

  29. Case #3: J.S.

  30. Case #3: J.S.

  31. Case #3: J.S. • Treatment recommendations ???

  32. Case #3: J.S. • Treatment: Ulnar Collateral Ligament Reconstruction

  33. Case #3: J.S.

  34. Case #3: J.S • 14 months post-operative – returned to professional level • 15 months – presented with persistent medial elbow pain and shoulder pain after 5 starts (24 innings)

  35. Case #3: J.S.

  36. Case #3: J.S. Diagnosis: Flexor-pronator tendonitis Treatment: ????

  37. Case #3Results • Completed season as reliever • Signed 3 yr – $ 30 million contract

  38. Case #3: J.S. Discussion

  39. Case # 4

  40. Case #: M.H. • HPI: 22 yo collegiate catcher with previous UCL reconstruction 5 months post- operative. Reports “pop” while throwing at 50% during ITP. • PE: swollen, tender medially, ROM limited • X-Rays: medial epicondyle avulsion

  41. Case #4: M.H.

  42. Case #4: M.H.

  43. Case #4: M.H. ?

  44. Case #4: M.H.Operative Procedure • ORIF medial epicondyle

  45. Case #4: M.H.

  46. Case #4: M.H.

  47. Case #4: M.H.3 months Post-op

  48. Case #4: M.H.6 months Post-op

  49. Case #4: M.H. ?

  50. Case #4: M.H.Results • Returned to collegiate baseball at 11 months

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