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 Author | Topic: fractured medial epicondyle (Read 1,152 times) |
philthyc3
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|  | fractured medial epicondyle
« Thread Started on May 11, 2007, 7:22pm » | |
Who: My 11 year old son
When: Monday, 04/30/2007
Where: Little League baseball field, mound. 46" pitching distance.
What: Fractured (type 1) medial epicondyle on his 53rd pitch of the game. His most recent pitching appearance was 3 days prior to the injury in which he threw 1 inning, or 15 pitches. Had not thrown over 58 pitches in any one pitching appearance this early in the season.
Last week, he had a 'screw' put into the elbow area; I believe this was to help with the continued bone growth (at least that what I wrote in my notes). It is currently in a splint. Next week he gets a hard cast on it for 3 weeks.
No history of arm problems (including soreness). His coach (me) is very strict on pitch count guidelines and requires proper warm up and cool down for all throwers. I don't feel like this was a result of overuse of the arm (nor did the Ortho doctor). Ortho surgeon expects a full recovery and return to pitching next season.
Have you seen this injury much? I asked the doctor this and he mentioned that he has seen it more times in wrestlers. Where the athlete has landed on the elbow and fractured this area. But has seen it from time to time in baseball. Again, the doctor mentioned that the bone should heal properly (maybe even a "little tighter" was a comment I heard from him) and should be able to pitch again.
Have you had much experience with recovery from this injury? Any lasting effects? For example, lost velocity, lingering or long term pain/soreness, etc. Obviously understanding each situation is a little different.
Thanks in advance.
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Scott Reynolds, M. D.
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| | Re: fractured medial epicondyle
« Reply #1 on May 16, 2007, 12:21am » | |
We have seen this injury in our clinic several times. If the piece heals well, your son should do well. I would just follow your doctor's advise. sound like they know what thery are doing.
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philthyc3
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| | Re: fractured medial epicondyle
« Reply #2 on May 22, 2007, 11:35pm » | |
Thanks for the reply doctor.
How much could the arm angle of a pitcher be attributed to this type of injury?
My sons arm angle is 3/4 to low 3/4. He has thrown like that his whole life. I am on him, and reminding him, when I see him get lazy with it and at times drop the elbow to almost a side arm. I would think this tends to put more pressure on the elbow?
When he plays outfield, his throwing is more "over the top". When he plays infield it varies depending on the situation. Longer throw, more time, he has to put more on it so it's more over the top. If it is a rush thing then it becomes a low 3/4 to almost side arm.
Up until this point, I've really encouraged him to not drop too low. It does happen from time to time; but then I just remind him. He tends to get a lot of movement on his pitches. He isn't throwing a curve or slider; but rather just a fastball and change up. I've just felt like this is his "normal" arm angle and didn't want him to over compensate the other way and then potentially have shoulder problems.
Any suggestions when we start the recovery process? Do I want to start changing the arm angle? To be honest, it wouldn't bother me if he didn't pitch again; rather just play the field and hit (but I'll kind of leave that up to him assuming he is cleared by the doctor).
I've also been told this could have been a pre-injury to the date of incident and pitching just completed the fracture. But keep in mind, there was no complaints of hurting or of it being sore (but I'm not sure that is an indication either?).
He is now nearly 3 weeks from the date of the surgery. Everything seems to be going well (and the doctor confirmed last week). He is currently in a brace and can move the arm to -30 degrees (if that makes sense?) in the brace. After 4 weeks the doctor expects him to be able to straighten it out.
From the initial doctor visit, I remember him saying that after 4 months he can begin throwing and after 6 months he can begin pitching. Sound about right?
Thanks.
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Glenn Fleisig, Ph.D.
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| | Re: fractured medial epicondyle
« Reply #3 on May 24, 2007, 5:55pm » | |
philthyc3,
These are good questions that you raise. As it turns out, dropping the arm can result in higher elbow force and torque. Specifically, the biomechanics study showed a pitcher produced the least torque on the elbow when the arm was "abducted" about 90 degrees at the time of ball release. Abduction is the angle that the upper arm makes with the trunk, so 90 degrees is when the throwing elbow is essentially on a line drawn threw the two shoulders. Therefore dropping the elbow can increase the load produced at the elbow. Unfortunately it is more complicated than that. Your son might be adjusting his arm slot by tilting his trunk more or less to the glove side. If his arm slot is lower because he is decreasing his abduction angle, that is a problem; however if his arm slot is lower because his trunk is more upright, that is not necessarily a problem.
My recommendation is to continue the rehabilitation under his surgeon's guidance. If he recovers and wants to return to pitching, get his pitching biomechanics checked out. If you tell me what city you live near, I can recommend a place to get his biomechanics checked.
If he recovers and doesn't want to pitch again, you are all set.
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philthyc3
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| | Re: fractured medial epicondyle
« Reply #4 on May 24, 2007, 6:56pm » | |
Thanks Dr. Fleisig! I really appreciate the response.
We live in North Central Idaho about 100 miles south of Spokane, Washington.
Phil
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Glenn Fleisig, Ph.D.
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| | Re: fractured medial epicondyle
« Reply #5 on May 25, 2007, 2:36pm » | |
Ugh.
There are places I would recommend in San Diego, Houston, Amherst MA, DC, and Birmingham (ASMI evaluation), but I don't know anyone doing pitching biomechanics in the Northwest.
Perhaps if you get to the point where you need his mechanics checked out, you will fly him to Birmingham. You can also get a medical check-up at the same time, or just come for the biomechanical evaluation.
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philthyc3
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| | Re: fractured medial epicondyle
« Reply #6 on May 31, 2007, 8:03pm » | |
Thanks again for the input and responses.
Another question, if I may. My son had his 4 week evaluation today (from date of surgery). Doctor was pleased with the progress at this point and said he is doing well. He is still wearing the brace but now has to start working on extending the arm so it is flat.
What are the pros and cons of leaving the pin/screw in the elbow area? The plan is to discuss this at our next office visit in two weeks, but I want to be somewhat prepared and do a little research prior to this. Are there examples of leaving the pin/screw in the elbow and players continuing to pitch/throw for the long term? Any current players in the majors, minors, or college ranks you may know of?
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joe55
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| | Re: fractured medial epicondyle
« Reply #7 on May 31, 2007, 9:44pm » | |
I don't mean to intrude on this post, but who would you recommend in Amherst, MA?
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philthyc3
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| | Re: fractured medial epicondyle
« Reply #8 on Jun 1, 2007, 12:16am » | |
No problem joe55. It's all good. That's what it's here for.
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joe55
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| | Re: fractured medial epicondyle
« Reply #9 on Jun 1, 2007, 1:51pm » | |
Thanks philthyc3, I live right near Amherst MA and I was wondering who you would suggest for and elbow problem if you knew anyone. Thanks again.
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Glenn Fleisig, Ph.D.
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| | Re: fractured medial epicondyle
« Reply #10 on Jun 1, 2007, 5:33pm » | |
joe55,
What are you looking for? What is the problem? If you are looking for a pitching coach, you have one of the best in the cuontry in Amherst College manager Bill Thurston. If you have a medical question, please explain.
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joe55
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| | Re: fractured medial epicondyle
« Reply #11 on Jun 1, 2007, 9:29pm » | |
I am going to be seeing Bill Thurston for my 4th time this June for his 1 on 1 pitching clinique. Now my problem is that every season since my freshmen year I have gotten sharp elbow pains around the 2nd week in May from pitching. For the past 2 year I just threw through it and things just got worse until the high school season ended. Then when the summer season which was about 2 weeks later i was able to pitch again. This year the pain came and I stopped throwing and went to Hampshire Orthepedics in Northampton. The doctor there seemed to think that there was in impingement in my elbow when my arm straightens during my pitching motion. So he gave me a cortizone injection and said not to throw for 2 weeks. He said if after 2 weeks and 1 week of rehab throwing, they diagnosed the problem correctly and a permentant solution would be orthescopic surgery to file down one of the bones in my arm so that the impingement would go away. I start pitching again tomorrow in practice so tomorrow is the real test, but for now I have been doing physical therapy (not perscribed by orthepedic surgeon). The physical therapist seems to think that I might be able to reduce stress on my elbow by strengthing my shoulder and streching out my pectorals. And thats it, sorry its so long but i want to try to get as much info as possible. Thanks for any information, Joe.
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Glenn Fleisig, Ph.D.
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| | Re: fractured medial epicondyle
« Reply #12 on Jun 4, 2007, 8:40am » | |
Joe,
I don't know who you have seen at Hampshire Orthopedics, but I know who you should see there: Daniel McBride, M.D. Dr. McBride trained under Dr. Andrews, in Birmingham. I would recommend that you develop a plan of action with Dr. McBride.
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Scott Reynolds, M. D.
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| | Re: fractured medial epicondyle
« Reply #13 on Jun 4, 2007, 10:35pm » | |
philthyc3,
In reguards to the screw removal. It really just depends on the situation. Most of the time hardware is left in unless there is a problem or it is causing pain. In kids, however, the hardware needs to be removed it there is a lot of growth left. Otherwise bone can grow around the screw and make it difficult to remove later if needed. Keeping it in gives the area more stability as you rehab until the bone is completely solid. Having it taken out requires another procedure with the risks associated with that (anesthesia, infection, etc.). Sometimes the screw if prominant can irritate the Ulnar nerve which is in close proximity. It really just depends on the situation and the growth left in your child. It sounds like your doctors are taking good care of you. I would listen to their suggestions and work with them to make a decision.
Hope this helps some.
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philthyc3
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| | Re: fractured medial epicondyle
« Reply #14 on Jun 5, 2007, 10:37am » | |
Dr. Reynolds,
Yes, this helps and thanks. Gives me some good questions to discuss with the doctor.
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