MEDIAL EPICONDYLE APOPHYSEAL SEPARATION

Medial Epicondyle Apophyseal Separation

Medial epicondyle apophyseal separation is a condition seen in growing children and adolescents, where the bone in the medial epicondyle (part of the humerus) of the elbow is pulled apart due to excessive traction or pressure at the growth plate (epiphyseal line). This condition often results from repetitive arm-intensive activities such as baseball pitching and tennis serving. It is classified as a form of Little Leaguer's Elbow.

Mechanism of Occurrence

The medial epicondyle is the attachment site for the medial collateral ligament, which stabilizes the elbow, and the flexor muscles of the forearm. In growing children, this area contains a growth plate (epiphyseal line) that is not fully ossified, making it less resistant to external forces. Excessive traction and repetitive stress can cause the growth plate to pull apart (separate).

Main Causes

1. Repeated Stress:
   ・Repetitive motions such as baseball pitching and tennis swinging.
2. Sudden Load:
   ・Rapid increase in speed or excessive pitching during games.
3. Improper Form:
   ・Form that places excessive stress on the elbow during pitching or swinging.
4. Growth-Specific Weakness:
   ・The epiphyseal line is immature and less durable compared to adults.

Symptoms

1. Pain on the Inner Side of the Elbow:
   ・Sharp pain occurs, especially after pitching or swinging.
2. Swelling:
   ・Swelling may be present around the medial epicondyle.
3. Tenderness:
   ・Increased pain when pressing on the medial epicondyle.
4. Limited Range of Motion:
   ・Difficulty fully bending or extending the elbow.
5. Chronic Discomfort:
   ・Dull pain or discomfort persists in the early stages.

Diagnosis

1. Medical History and Physical Examination:
   ・Check the course of symptoms and sports history.
   ・Evaluate tenderness and swelling around the medial epicondyle.
2. Imaging Tests:
   ・X-ray:Confirm separation, widening, or irregularity of the growth plate.
   ・MRI:Performed when soft tissue or ligament damage is suspected.
   ・Ultrasound:Dynamically evaluate the condition of the growth plate.

Treatment

Conservative Therapy (Mild to Moderate)

1. Rest:
   ・Stop sports activities and keep the elbow at rest.
2. Icing:
   ・Cool the area to reduce pain and swelling.
3. Use of Orthotics:
   ・Use splints or elbow supports to ensure elbow stability.
4. Pain Relief:
   ・Take non-steroidal anti-inflammatory drugs (NSAIDs).
5. Rehabilitation:
   ・Gradual training to restore flexibility and strength.

Surgical Therapy (Severe Cases)

[Epiphyseal Repair]
　　・Surgery is required to fix the growth plate if it is significantly separated.
[Medial Collateral Ligament Reconstruction]
　　・Reconstruction surgery may be performed if the ligament damage is severe.

Recovery Period

• Mild: Recovery in 1 to 2 months.
• Moderate: Rehabilitation required for 2 to 3 months.
• Severe: Rehabilitation period may exceed 6 months post-surgery.

Prevention

1. Proper Form Guidance:
   ・Learn techniques to reduce stress on the elbow during pitching or swinging.
2. Pitching Limitations:
   ・Adhere to pitch count and ensure rest days.
3. Strength Training:
   ・Strengthen not only the elbow but also the shoulder and core muscles.
4. Stretching and Flexibility Improvement:
   ・Protect muscles and ligaments through stretching before and after pitching.
5. Growth Period Management:
   ・Plan training considering the stress on bones and joints during growth.

Note: If symptoms are left untreated, it can lead to chronic elbow injuries and joint deformities. It is important to consult a specialist if pain persists or physical activity becomes difficult.

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