Olecranon Apophysitis and Triceps Strain
This entity is the result of repetitive posterior tension and shear forces applied to the developing olecranon apoph-ysis through the pull of the triceps in children younger than 13 years of age. Excessive force during the late cocking and acceleration phases of throwing can lead to failure at the olecranon apophysis or triceps tendon inser-tion.5 This condition is similar to Osgood-Schlatter's disease of the tibial tubercle.3
The patient presents with vague posterior elbow pain and an inability to fully extend the elbow. The physical examination reveals tenderness at the olecranon or triceps insertion, or both, and pain with elbow extension against resistance. The radiographs show an irregular pattern of olecranon apophysis ossification (sclerosis, widening, or fragmentation) compared with the uninvolved side. An MRI shows apophyseal edema or physeal separation, triceps tendon edema (tendinosis), and degeneration or detachment.
This condition responds well to rest while preserving wrist and elbow motion, ice, nonsteroidal anti-inflammatory medication, and a carefully monitored rehabilitation that includes a return-to-throwing program. Treatment for olecranon avulsion consists of cast immobilization for 3 to 4 weeks. If the displacement is greater than 4 to 5 mm or if the elbow fails to heal despite cast immobilization, surgery is warranted.
Open reduction and internal fixation are performed using either a compression screw or the tension-band technique (use of suture is acceptable). In chronic cases, bone grafting is indicated. This treatment does not affect longitudinal growth because the proximal ulnar physis growth contribution is minimal. When the triceps tendon is avulsed or partially detached, debridement or reattachment may be necessary. Postoperatively, a splint is used for 10 days, after which protected range of motion is begun. Radiographs are taken at 8 weeks to document healing. An interval-throwing program is started at 10 weeks with progression to full activity. Return to play is allowed if there is full and painless range of motion and 90% strength in the injured extremity when compared with the uninjured extremity.
These fractures most commonly occur in adolescents (>13 years). They are caused by impaction of the pos-teromedial olecranon on the medial wall of the olecranon fossa and by impingement of the lateral aspect of the coronoid on the intercondylar notch during resistance to valgus stress.28
The patient presents with pain that is worse during the acceleration phase of the pitching motion and an inability to perform at his or her previous level. The physical examination reveals tenderness over the olecranon and sometimes along the anterior band of the medial collateral ligament. Radiographs show an oblique-type fracture with sclerotic changes along the fracture line. If the radiographs fail to show the fracture, a tomogram should be obtained to make the diagnosis.
Although the initial treatment is nonoperative with a combination of rest, stretching, and anti-inflammatory medication for 4 weeks, Suzuki and associates suggest early surgical treatment.28 If the fracture fails to heal, it is bone grafted and fixed internally with a compression screw across the fracture line. If present, partial injuries to the medial collateral ligament heal spontaneously with the treatment of the fracture and therefore do not require specific treatment.28
Complications from these lesions are the result of the operative treatment itself. As with any other surgery requiring hardware placement around the elbow, pain from hardware is the most common complication. This is treated by removal after the fracture has healed, as determined on radiographs. Spur formation secondary to overgrowth of the olecranon epiphysis can occur.19 In some patients, it becomes symptomatic and may have to be excised. Apophyseal arrest rarely occurs and does not have a significant effect on elbow function.
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Everything you wanted to know about. How To Cure Tennis Elbow. Are you an athlete who suffers from tennis elbow? Contrary to popular opinion, most people who suffer from tennis elbow do not even play tennis. They get this condition, which is a torn tendon in the elbow, from the strain of using the same motions with the arm, repeatedly. If you have tennis elbow, you understand how the pain can disrupt your day.