Advertisement

Elbow and Forearm Injuries

  • Anthony Luke
  • Margaret Lo
  • Marc R. Safran
Chapter
Part of the Contemporary Pediatric and Adolescent Sports Medicine book series (PASM)

Abstract

The elbow and forearm create a fascinating joint complex. It is a highly congruous joint that provides a wide range of motion required for function, including sports, yet is inherently stable. The adolescent athlete has the added dimensions of growth and development, which can affect forces around the joint, motor function and can be the source of multiple potential problems. The elbow has a complex maturation process, developing from multiple ossification centers, which can complicate the diagnosis and treatment of injuries. As a growing individual is able to perform with greater speed, strength and endurance, the loading forces, torques, and risk of injury increase.

Injuries to the elbow and forearm can result from overuse or acute trauma. Throwing sports, such as baseball, lead to frequent elbow problems. Overuse elbow injuries are also commonly seen in athletes who use the upper extremities and are involved in repetitive training, such as gymnastics, weight lifting, tennis, and golf. Trauma, typically a fall on the outstretched arm, can result in fractures and dislocation. Fractures in the upper extremity in children most frequently involve the radius and ulna, followed by hand and carpal bones then the distal humerus.

Keywords

Motor function Maturation Ossification Risk of injury Overuse Acute trauma Throwing sports Repetitive training Fracture Dislocation 

References

  1. 1.
    Hutchinson MR, Wynn S. Biomechanics and development of the elbow in the young throwing athlete. Clin Sports Med. 2004;23(4):531–44.PubMedCrossRefPubMedCentralGoogle Scholar
  2. 2.
    Fleisig GS, Barrentine SW, Zheng N, Escamilla RF, Andrews JR. Kinematic and kinetic comparison of baseball pitching among various levels of development. J Biomech. 1999;32(12):1371–5.PubMedCrossRefPubMedCentralGoogle Scholar
  3. 3.
    Sabick MB, Torry MR, Lawton RL, Hawkins RJ. Valgus torque in youth baseball pitchers: a biomechanical study. J Shoulder Elbow Surg. 2004;13(3):349–55.PubMedCrossRefPubMedCentralGoogle Scholar
  4. 4.
    Gugenheim JJ, Stanley RF, Woods GW, Tullos HS. Little League survey: the Houston study. Am J Sports Med. 1976;4(5):189–200.PubMedCrossRefPubMedCentralGoogle Scholar
  5. 5.
    Priest JD, Weise DJ. Elbow injury in women’s gymnastics. Am J Sports Med. 1981;9(5):288–95.PubMedCrossRefPubMedCentralGoogle Scholar
  6. 6.
    Snook GA. Injuries in women’s gymnastics. A 5-year study. Am J Sports Med. 1979;7(4):242–4.PubMedCrossRefPubMedCentralGoogle Scholar
  7. 7.
    Safran MR. Ulnar collateral ligament injury in the overhead athlete: diagnosis and treatment. Clin Sports Med. 2004;23(4):643–63.PubMedCrossRefPubMedCentralGoogle Scholar
  8. 8.
    Gosheger G, Liem D, Ludwig K, Greshake O, Winkelmann W. Injuries and overuse syndromes in golf. Am J Sports Med. 2003;31(3):438–43.PubMedCrossRefPubMedCentralGoogle Scholar
  9. 9.
    Cooper C, Dennison EM, Leufkens HG, Bishop N, van Staa TP. Epidemiology of childhood fractures in Britain: a study using the general practice research database. J Bone Miner Res. 2004;19(12):1976–81.PubMedCrossRefPubMedCentralGoogle Scholar
  10. 10.
    Cain EL, Dugas JR, Wolf RS, Andrews JR. Elbow injuries in throwing athletes: a current concepts review. Am J Sports Med. 2003;31(4):621–35.PubMedCrossRefPubMedCentralGoogle Scholar
  11. 11.
    Beighton P, Solomon L, Soskolne CL. Articular mobility in an African population. Ann Rheum Dis. 1973;32(5):413–8.PubMedPubMedCentralCrossRefGoogle Scholar
  12. 12.
    Do T, Herrera-Soto J. Elbow injuries in children. Curr Opin Pediatr. 2003;15(1):68–73.PubMedCrossRefPubMedCentralGoogle Scholar
  13. 13.
    Difelice GS, Meunier MJ, Paletta GA Jr. Elbow injury in the adolescent athlete. In: Altchek DW, Andrews JR, editors. The Athlete’s Elbow. Philadelphia: Lippincott Williams & Wilkins; 2001. p. 231–48.Google Scholar
  14. 14.
    Patel B, Reed M, Patel S. Gender-specific pattern differences of the ossification centers in the pediatric elbow. Pediatr Radiol. 2009;39(3):226–31.PubMedCrossRefPubMedCentralGoogle Scholar
  15. 15.
    Morrey BF. Anatomy of the elbow joint. In: Morrey BF, editor. The elbow and its disorders. Philadelphia: Saunders; 2000. p. 13–42.Google Scholar
  16. 16.
    O’Driscoll SW, Bell DF, Morrey BF. Posterolateral rotatory instability of the elbow. J Bone Joint Surg Am. 1991;73(3):440–6.PubMedCrossRefPubMedCentralGoogle Scholar
  17. 17.
    Olsen BS, Søjbjerg JO, Nielsen KK, Vaesel MT, Dalstra M, Sneppen O. Posterolateral elbow joint instability: the basic kinematics. J Shoulder Elbow Surg. 1998;7(1):19–29.PubMedCrossRefPubMedCentralGoogle Scholar
  18. 18.
    Safran MR, Baillargeon D. Soft-tissue stabilizers of the elbow. J Shoulder Elbow Surg. 2005;14(1 Suppl S):179S–85S.PubMedCrossRefPubMedCentralGoogle Scholar
  19. 19.
    Safran MR, McGarry MH, Shin S, Han S, Lee TQ. Effects of elbow flexion and forearm rotation on valgus laxity of the elbow. J Bone Joint Surg Am. 2005;87(9):2065–74.PubMedCrossRefPubMedCentralGoogle Scholar
  20. 20.
    Cohen MS, Hastings H. Rotatory instability of the elbow. The anatomy and role of the lateral stabilizers. J Bone Joint Surg Am. 1997;79(2):225–33.PubMedCrossRefPubMedCentralGoogle Scholar
  21. 21.
    Pudas T, Hurme T, Mattila K, Svedström E. Magnetic resonance imaging in pediatric elbow fractures. Acta Radiol. 2005;46(6):636–44.PubMedCrossRefPubMedCentralGoogle Scholar
  22. 22.
    Keefe DT, Lintner DM. Nerve injuries in the throwing elbow. Clin Sports Med. 2004;23(4):723–42.PubMedCrossRefPubMedCentralGoogle Scholar
  23. 23.
    O’Driscoll SW, Morrey BF, Korinek S, An KN. Elbow subluxation and dislocation. A spectrum of instability. Clin Orthop Relat Res. 1992;(280):186–97.Google Scholar
  24. 24.
    Busch M. Sports medicine children and adolescents. In: Morrissy RT, Weinstein SW, editors. Lovell and Winter’s Pediatric Orthopaedics. Philadelphia: Lippincott Williams & Wilkins; 2001. p. 1287–9.Google Scholar
  25. 25.
    Rudzki JR, Paletta GA. Juvenile and adolescent elbow injuries in sports. Clin Sports Med. 2004;23(4):581–608.PubMedCrossRefPubMedCentralGoogle Scholar
  26. 26.
    Stoane JM, Poplausky MR, Haller JO, Berdon WE. Panner’s disease: X-ray, MR imaging findings and review of the literature. Comput Med Imaging Graph. 1995;19(6):473–6.PubMedCrossRefPubMedCentralGoogle Scholar
  27. 27.
    Haraldsson S. On osteochondrosis deformas juvenilis capituli humeri including investigation of intra-osseous vasculature in distal humerus. Acta Orthop Scand Suppl. 1959;38:1–232.PubMedPubMedCentralGoogle Scholar
  28. 28.
    Safran MR. Elbow injuries in athletes. A review. Clin Orthop Relat Res. 1995;310:257–77.Google Scholar
  29. 29.
    Morrey BF. Biomechanics of the elbow and forearm. In: DeLee JC, Drez Jr. D, Miller MD, editors. DeLee & Drez’s Orthopaedic Sports Medicine. Philadelphia: Elsevier Science, 2003: 1213–1220.Google Scholar
  30. 30.
    Mihata T, Safran MR, McGarry MH, Abe M, Lee TQ. Effect of humeral rotation on elbow valgus laxity: Cadaveric Study. Presented at the 5th Annual Meeting of the International Society of Ligament and Tendons, 2005 Feb 19; Washington, DC.Google Scholar
  31. 31.
    O’Driscoll SW, Lawton RL, Smith AM. The “moving valgus stress test” for medial collateral ligament tears of the elbow. Am J Sports Med. 2005;33(2):231–9.PubMedCrossRefPubMedCentralGoogle Scholar
  32. 32.
    Shaw JL, O’Connor FG. Elbow injuries. In: Birrer RB, Griesemer BA, Cataletto MB, editors. Pediatric sports medicine for primary care. Philadelphia: Lippincott Williams & Wilkins; 2002. p. 350–66.Google Scholar
  33. 33.
    O’Driscoll SW. Classification and evaluation of recurrent instability of the elbow. Clin Orthop. 2000;370:34–43.CrossRefGoogle Scholar
  34. 34.
    Kobayashi K, Burton KJ, Rodner C, Smith B, Caputo AE. Lateral compression injuries in the pediatric elbow: Panner’s disease and osteochondritis dissecans of the capitellum. J Am Acad Orthop Surg. 2004;12(4):246–54.PubMedCrossRefPubMedCentralGoogle Scholar
  35. 35.
    Kibler WB, Sciascia A. Kinetic chain contributions to elbow function and dysfunction in sports. Clin Sports Med. 2004;23(4):545–52.PubMedCrossRefPubMedCentralGoogle Scholar
  36. 36.
    Kibler WB, Chandler TJ. Range of motion in junior tennis players participating in an injury risk modification program. J Sci Med Sport. 2003;6(1):51–62.PubMedCrossRefPubMedCentralGoogle Scholar
  37. 37.
    Kissoon N, Galpin R, Gayle M, Chacon D, Brown T. Evaluation of the role of comparison radiographs in the diagnosis of traumatic elbow injuries. J Pediatr Orthop. 1995;15(4):449–53.PubMedCrossRefGoogle Scholar
  38. 38.
    Chacon D, Kissoon N, Brown T, Galpin R. Use of comparison radiographs in the diagnosis of traumatic injuries of the elbow. Ann Emerg Med. 1992;21(8):895–9.PubMedCrossRefGoogle Scholar
  39. 39.
    Skaggs DL, Mirzayan R. The posterior fat pad sign in association with occult fracture of the elbow in children. J Bone Joint Surg Am. 1999;81(10):1429–33.PubMedCrossRefGoogle Scholar
  40. 40.
    Schwartz ML, al-Zahrani S, Morwessel RM, Andrews JR. Ulnar collateral ligament injury in the throwing athlete: evaluation with saline-enhanced MR arthrography. Radiology. 1995;197(1):297–9.PubMedCrossRefPubMedCentralGoogle Scholar
  41. 41.
    Sofka CM, Potter HG. Imaging of elbow injuries in the child and adult athlete. Radiol Clin North Am. 2002;40(2):251–65.PubMedCrossRefPubMedCentralGoogle Scholar
  42. 42.
    Lazar RD, Waters PM, Jaramillo D. The use of ultrasonography in the diagnosis of occult fracture of the radial neck. A case report. J Bone Joint Surg Am. 1998;80(9):1361–4.PubMedCrossRefPubMedCentralGoogle Scholar
  43. 43.
    Price CT, Devito DP. Management of fractures. In: Morrissy RT, Weinstein SL, editors. Lovell and Winter’s pediatric orthopaedics. Philadelphia: Lippincott Willians & Wilkins; 2001. p. 1338–56.Google Scholar
  44. 44.
    de las Heras J, Durán D, de la Cerda J, Romanillos O, Martínez-Miranda J, Rodríguez-Merchán EC. Supracondylar fractures of the humerus in children. Clin Orthop Relat Res. 2005;(432):57–64.Google Scholar
  45. 45.
    Rasool MN. Dislocations of the elbow in children. J Bone Joint Surg Br. 2004;86(7):1050–8.PubMedCrossRefPubMedCentralGoogle Scholar
  46. 46.
    Josefsson PO, Nilsson BE. Incidence of elbow dislocation. Acta Orthop Scand. 1986;57(6):537–8.PubMedCrossRefPubMedCentralGoogle Scholar
  47. 47.
    Dizdarevic I, Low S, Currie DW, Comstock RD, Hammoud S, Atanda A. Epidemiology of elbow dislocations in high school athletes. Am J Sports Med. 2016;44(1):202–8.PubMedCrossRefPubMedCentralGoogle Scholar
  48. 48.
    Thompson GH. Dislocations of the elbow. In: Beaty JH, Kasser JR, editors. Rockwood and Wilkins' Fractures in Children. Philadelphia: Lippincott Williams & Wilkins; 2001. p. 530–62.Google Scholar
  49. 49.
    Sanchez-Sotelo J, Morrey BF, SW O'D. Ligamentous repair and reconstruction for posterolateral rotatory instability of the elbow. J Bone Joint Surg Br. 2005;87(1):54–61.PubMedCrossRefPubMedCentralGoogle Scholar
  50. 50.
    Singleton SB, Conway JE. PLRI: posterolateral rotatory instability of the elbow. Clin Sports Med. 2004;23(4):629–42.PubMedCrossRefPubMedCentralGoogle Scholar
  51. 51.
    Lattanza LL, Goldfarb CA, Smucny M, Hutchinson DT. Clinical presentation of posterolateral rotatory instability of the elbow in children. J Bone Joint Surg Am. 2013;95(15):e105.PubMedCrossRefPubMedCentralGoogle Scholar
  52. 52.
    Cruz AI, Steere JT, Lawrence JT. Medial epicondyle fractures in the pediatric overhead athlete. J Pediatr Orthop. 2016;36(Suppl 1):S56–62.PubMedCrossRefGoogle Scholar
  53. 53.
    Gottschalk HP, Eisner E, Hosalkar HS. Medial epicondyle fractures in the pediatric population. J Am Acad Orthop Surg. 2012;20(4):223–32.PubMedCrossRefGoogle Scholar
  54. 54.
    Osbahr DC, Chalmers PN, Frank JS, Williams RJ, Widmann RF, Green DW. Acute, avulsion fractures of the medial epicondyle while throwing in youth baseball players: a variant of Little League elbow. J Shoulder Elbow Surg. 2010;19(7):951–7.PubMedCrossRefGoogle Scholar
  55. 55.
    Woods GW, Tullos HS. Elbow instability and medial epicondyle fractures. Am J Sports Med. 1977;5(1):23–30.PubMedCrossRefGoogle Scholar
  56. 56.
    Stepanovich M, Bastrom TP, Munch J, Roocroft JH, Edmonds EW, Pennock AT. Does operative fixation affect outcomes of displaced medial epicondyle fractures? J Child Orthop. 2016;10(5):413–9.PubMedPubMedCentralCrossRefGoogle Scholar
  57. 57.
    Ring D, Jupiter JB, Waters PM. Monteggia fractures in children and adults. J Am Acad Orthop Surg. 1998;6(4):215–24.PubMedCrossRefGoogle Scholar
  58. 58.
    Noonan KJ, Price CT. Forearm and distal radius fractures in children. J Am Acad Orthop Surg. 1998;6(3):146–56.PubMedCrossRefGoogle Scholar
  59. 59.
    Rodríguez-Merchán EC. Pediatric fractures of the forearm. Clin Orthop Relat Res. 2005;(432):65–72.Google Scholar
  60. 60.
    Lawrence JT, Patel NM, Macknin J, et al. Return to competitive sports after medial epicondyle fractures in adolescent athletes: results of operative and nonoperative treatment. Am J Sports Med. 2013;41(5):1152–7.PubMedCrossRefPubMedCentralGoogle Scholar
  61. 61.
    Adams JE. Injury to the throwing arm. A study of traumatic changes in the elbow joints of boy baseball players. Calif Med. 1965;102(2):127–32.Google Scholar
  62. 62.
    Harada M, Takahara M, Hirayama T, Sasaki J, Mura N, Ogino T. Outcome of nonoperative treatment for humeral medial epicondylar fragmentation before epiphyseal closure in young baseball players. Am J Sports Med. 2012;40(7):1583–90.PubMedCrossRefPubMedCentralGoogle Scholar
  63. 63.
    Braithwaite KA, Marshall KW. The skeletally immature and newly mature throwing athlete. Radiol Clin North Am. 2016;54(5):841–55.PubMedCrossRefPubMedCentralGoogle Scholar
  64. 64.
    Hodgins JL, Vitale M, Arons RR, Ahmad CS. Epidemiology of medial ulnar collateral ligament reconstruction: a 10-year study in New York state. Am J Sports Med. 2016;44(3):729–34.PubMedCrossRefPubMedCentralGoogle Scholar
  65. 65.
    Freehill MT, Safran MR. Diagnosis and management of ulnar collateral ligament injuries in throwers. Curr Sports Med Rep. 2011;10(5):271–8.PubMedCrossRefPubMedCentralGoogle Scholar
  66. 66.
    Erickson BJ, Chalmers PN, Axe MJ, Romeo AA. Exceeding pitch count recommendations in little league baseball increases the chance of requiring Tommy John surgery as a professional baseball pitcher. Orthop J Sports Med. 2017;5(3):2325967117695085.CrossRefGoogle Scholar
  67. 67.
    Petty DH, Andrews JR, Fleisig GS, Cain EL. Ulnar collateral ligament reconstruction in high school baseball players: clinical results and injury risk factors. Am J Sports Med. 2004;32(5):1158–64.PubMedCrossRefPubMedCentralGoogle Scholar
  68. 68.
    Conway JE, Jobe FW, Glousman RE, Pink M. Medial instability of the elbow in throwing athletes. Treatment by repair or reconstruction of the ulnar collateral ligament. J Bone Joint Surg Am. 1992;74(1):67–83.PubMedCrossRefPubMedCentralGoogle Scholar
  69. 69.
    Roedl JB, Gonzalez FM, Zoga AC, et al. Potential utility of a combined approach with US and MR arthrography to image medial elbow pain in baseball players. Radiology. 2016;279(3):827–37.PubMedCrossRefPubMedCentralGoogle Scholar
  70. 70.
    Sugimoto H, Ohsawa T. Ulnar collateral ligament in the growing elbow: MR imaging of normal development and throwing injuries. Radiology. 1994;192(2):417–22.PubMedCrossRefPubMedCentralGoogle Scholar
  71. 71.
    Mirowitz SA, London SL. Ulnar collateral ligament injury in baseball pitchers: MR imaging evaluation. Radiology. 1992;185(2):573–6.PubMedCrossRefPubMedCentralGoogle Scholar
  72. 72.
    Rettig AC, Sherrill C, Snead DS, Mendler JC, Mieling P. Nonoperative treatment of ulnar collateral ligament injuries in throwing athletes. Am J Sports Med. 2001;29(1):15–7.PubMedCrossRefPubMedCentralGoogle Scholar
  73. 73.
    Frangiamore SJ, Lynch TS, Vaughn MD, et al. Magnetic resonance imaging predictors of failure in the nonoperative management of ulnar collateral ligament injuries in professional baseball pitchers. Am J Sports Med. 2017;45(8):1783–9.PubMedCrossRefPubMedCentralGoogle Scholar
  74. 74.
    Conte SA, Hodgins JL, ElAttrache NS, Patterson-Flynn N, Ahmad CS. Media perceptions of Tommy John surgery. Phys Sportsmed. 2015;43(4):375–80.PubMedCrossRefPubMedCentralGoogle Scholar
  75. 75.
    Chen FS, Diaz VA, Loebenberg M, Rosen JE. Shoulder and elbow injuries in the skeletally immature athlete. J Am Acad Orthop Surg. 2005;13(3):172–85.PubMedCrossRefPubMedCentralGoogle Scholar
  76. 76.
    Cohen SB, Sheridan S, Ciccotti MG. Return to sports for professional baseball players after surgery of the shoulder or elbow. Sports Health. 2011;3(1):105–11.PubMedPubMedCentralCrossRefGoogle Scholar
  77. 77.
    Erickson BJ, Harris JD, Fillingham YA, et al. Treatment of ulnar collateral ligament injuries and superior labral tears by major league baseball team physicians. Arthroscopy. 2016;32(7):1271–6.PubMedCrossRefPubMedCentralGoogle Scholar
  78. 78.
    Ahmad CS, ElAttrache NS. Valgus extension overload syndrome and stress injury of the olecranon. Clin Sports Med. 2004;23(4):665–76. xPubMedCrossRefPubMedCentralGoogle Scholar
  79. 79.
    Azar FM, Andrews JR, Wilk KE, Groh D. Operative treatment of ulnar collateral ligament injuries of the elbow in athletes. Am J Sports Med. 2000;28(1):16–23.PubMedCrossRefPubMedCentralGoogle Scholar
  80. 80.
    Savoie FH, Trenhaile SW, Roberts J, Field LD, Ramsey JR. Primary repair of ulnar collateral ligament injuries of the elbow in young athletes: a case series of injuries to the proximal and distal ends of the ligament. Am J Sports Med. 2008;36(6):1066–72.PubMedCrossRefPubMedCentralGoogle Scholar
  81. 81.
    Cain EL, McGonigle O. Return to play following ulnar collateral ligament reconstruction. Clin Sports Med. 2016;35(4):577–95.PubMedCrossRefPubMedCentralGoogle Scholar
  82. 82.
    Kandemir U, Fu FH, McMahon PJ. Elbow injuries. Curr Opin Rheumatol. 2002;14(2):160–7.PubMedCrossRefPubMedCentralGoogle Scholar
  83. 83.
    Baumgarten TE, Andrews JR, Satterwhite YE. The arthroscopic classification and treatment of osteochondritis dissecans of the capitellum. Am J Sports Med. 1998;26(4):520–3.PubMedCrossRefPubMedCentralGoogle Scholar
  84. 84.
    Takahara M, Mura N, Sasaki J, Harada M, Ogino T. Classification, treatment, and outcome of osteochondritis dissecans of the humeral capitellum. J Bone Joint Surg Am. 2007;89(6):1205–14.PubMedCrossRefPubMedCentralGoogle Scholar
  85. 85.
    Lewine EB, Miller PE, Micheli LJ, Waters PM, Bae DS. Early results of drilling and/or microfracture for grade IV osteochondritis dissecans of the capitellum. J Pediatr Orthop. 2016;36(8):803–9.PubMedCrossRefPubMedCentralGoogle Scholar
  86. 86.
    Stubbs MJ, Field LD, Savoie FH. Osteochondritis dissecans of the elbow. Clin Sports Med. 2001;20(1):1–9.PubMedCrossRefPubMedCentralGoogle Scholar
  87. 87.
    Takahara M, Ogino T, Takagi M, Tsuchida H, Orui H, Nambu T. Natural progression of osteochondritis dissecans of the humeral capitellum: initial observations. Radiology. 2000;216(1):207–12.PubMedCrossRefPubMedCentralGoogle Scholar
  88. 88.
    Takahara M, Ogino T, Tsuchida H, Takagi M, Kashiwa H, Nambu T. Sonographic assessment of osteochondritis dissecans of the humeral capitellum. AJR Am J Roentgenol. 2000;174(2):411–5.PubMedCrossRefPubMedCentralGoogle Scholar
  89. 89.
    Ruch DS, Cory JW, Poehling GG. The arthroscopic management of osteochondritis dissecans of the adolescent elbow. Arthroscopy. 1998;14(8):797–803.PubMedCrossRefPubMedCentralGoogle Scholar
  90. 90.
    Yamamoto Y, Ishibashi Y, Tsuda E, Sato H, Toh S. Osteochondral autograft transplantation for osteochondritis dissecans of the elbow in juvenile baseball players: minimum 2-year follow-up. Am J Sports Med. 2006;34(5):714–20.PubMedCrossRefPubMedCentralGoogle Scholar
  91. 91.
    Takahara M, Ogino T, Fukushima S, Tsuchida H, Kaneda K. Nonoperative treatment of osteochondritis dissecans of the humeral capitellum. Am J Sports Med. 1999;27(6):728–32.PubMedCrossRefPubMedCentralGoogle Scholar
  92. 92.
    Takahara M, Ogino T, Sasaki I, Kato H, Minami A, Kaneda K. Long term outcome of osteochondritis dissecans of the humeral capitellum. Clin Orthop Relat Res. 1999;(363):108–15.CrossRefGoogle Scholar
  93. 93.
    McManama GB, Micheli LJ, Berry MV, Sohn RS. The surgical treatment of osteochondritis of the capitellum. Am J Sports Med. 1985;13(1):11–21.PubMedCrossRefPubMedCentralGoogle Scholar
  94. 94.
    Woodward AH, Bianco AJ. Osteochondritis dissecans of the elbow. Clin Orthop Relat Res. 1975;(110):35–41.CrossRefGoogle Scholar
  95. 95.
    Hennrikus WP, Miller PE, Micheli LJ, Waters PM, Bae DS. Internal fixation of unstable in situ osteochondritis dissecans lesions of the capitellum. J Pediatr Orthop. 2015;35(5):467–73.PubMedCrossRefPubMedCentralGoogle Scholar
  96. 96.
    de Graaff F, Krijnen MR, Poolman RW, Willems WJ. Arthroscopic surgery in athletes with osteochondritis dissecans of the elbow. Arthroscopy. 2011;27(7):986–93.PubMedCrossRefPubMedCentralGoogle Scholar
  97. 97.
    Kaeding CC, Whitehead R. Musculoskeletal injuries in adolescents. Prim Care. 1998;25(1):211–23.PubMedCrossRefPubMedCentralGoogle Scholar
  98. 98.
    Wilson FD, Andrews JR, Blackburn TA, McCluskey G. Valgus extension overload in the pitching elbow. Am J Sports Med. 1983;11(2):83–8.PubMedCrossRefPubMedCentralGoogle Scholar
  99. 99.
    Keppler P, Salem K, Schwarting B, Kinzl L. The effectiveness of physiotherapy after operative treatment of supracondylar humeral fractures in children. J Pediatr Orthop. 2005;25(3):314–6.PubMedCrossRefPubMedCentralGoogle Scholar
  100. 100.
    Kottke FJ, Pauley DL, Ptak RA. The rationale for prolonged stretching for correction of shortening of connective tissue. Arch Phys Med Rehabil. 1966;47(6):345–52.PubMedPubMedCentralGoogle Scholar
  101. 101.
    Green DP, McCoy H. Turnbuckle orthotic correction of elbow-flexion contractures after acute injuries. J Bone Joint Surg Am. 1979;61(7):1092–5.PubMedCrossRefPubMedCentralGoogle Scholar
  102. 102.
    Wilk KE, Reinold MM, Andrews JR. Rehabilitation of the thrower's elbow. Clin Sports Med. 2004;23(4):765–801. xiiPubMedCrossRefPubMedCentralGoogle Scholar
  103. 103.
    Kelly EW, Morrey BF, O'Driscoll SW. Complications of elbow arthroscopy. J Bone Joint Surg Am. 2001;83-A(1):25–34.PubMedCrossRefPubMedCentralGoogle Scholar
  104. 104.
    Schmittenbecher PP. What must we respect in articular fractures in childhood? Injury. 2005;36(Suppl 1):A35–43.PubMedCrossRefPubMedCentralGoogle Scholar
  105. 105.
    Lyman S, Fleisig GS, Andrews JR, Osinski ED. Effect of pitch type, pitch count, and pitching mechanics on risk of elbow and shoulder pain in youth baseball pitchers. Am J Sports Med. 2002;30(4):463–8.PubMedCrossRefPubMedCentralGoogle Scholar
  106. 106.
    Olsen SJ, Fleisig GS, Dun S, Loftice J, Andrews JR. Risk factors for shoulder and elbow injuries in adolescent baseball pitchers. Am J Sports Med. 2006;34(6):905–12.PubMedCrossRefPubMedCentralGoogle Scholar
  107. 107.
    Pratt M. Strength, flexibility, and maturity in adolescent athletes. Am J Dis Child. 1989;143(5):560–3.PubMedPubMedCentralGoogle Scholar
  108. 108.
    Mulligan IJ, Biddington WB, Barnhart BD, Ellenbecker TS. Isokinetic profile of shoulder internal and external rotators of high school aged baseball pitchers. J Strength Cond Res. 2004;18(4):861–6.PubMedPubMedCentralGoogle Scholar
  109. 109.
    Hinton RY. Isokinetic evaluation of shoulder rotational strength in high school baseball pitchers. Am J Sports Med. 1988;16(3):274–9.PubMedCrossRefPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of OrthpedicsUCSF Primary Care Sports MedicineSan FranciscoUSA
  2. 2.Department of Family Medicine and Primary Care Sports MedicineSutter Health-Palo Alto Medical FoundationLos AltosUSA
  3. 3.Division of Sports Medicine, Orthopaedic SurgeryStanford University HospitalRedwood CityUSA

Personalised recommendations