Medial Epicondylitis (12 year old!)

The definitions:

Tennis elbow is an inflammation of the tendons that join the muscles of the forearm on the outside of the elbow. It often happens as a result of strenuous overuse of the muscles and tendons of the forearm and around the elbow joint. Tennis elbow is also known as lateral elbow pain or lateral epicondylitis.

Tommy John surgery (TJS), known in medical practice as ulnar collateral ligament (UCL) reconstruction, is a surgical graft procedure in which the ulnar collateral ligament in the medial elbow is replaced with a tendon from elsewhere in the body. The procedure is common among collegiate and professional athletes in several sports, most notably baseball. The ulnar collateral ligament (UCL) can become stretched, frayed, or torn through the repetitive stress of the throwing motion. The risk of injury to the throwing athlete's UCL is thought to be extremely high as the amount of stress through this structure approaches its ultimate tensile strength during a hard throw.

I am not a doctor, but I would guess he was trying to say  "right now it's an overuse of the muscle...keep overusing that muscle and it will stretch, fray or tear resulting in the need for TJ surgery for your child to have a usable arm."

GOBLUE, if your 12 or 13 year old son is having pain on the medial (inside) part of his elbow, take the docs advice and do NOTHING for the recommended time.  Tennis elbow typically occurs on the lateral (outer) part of the elbow.  What the doc is telling you is correct that he is having precursor to TJ.  It sounds to me like your son has damaged the ligament or the growth plate that the ligament attaches to.  Take it from me, better safe than sorry, and your son may still find himself having issues in the future. 

younggun posted:

GOBLUE, if your 12 or 13 year old son is having pain on the medial (inside) part of his elbow, take the docs advice and do NOTHING for the recommended time.  Tennis elbow typically occurs on the lateral (outer) part of the elbow.  What the doc is telling you is correct that he is having precursor to TJ.  It sounds to me like your son has damaged the ligament or the growth plate that the ligament attaches to.  Take it from me, better safe than sorry, and your son may still find himself having issues in the future. 

Thanks.  Are you a Doctor by any chance?  Just looking at your avatar.  

GOBLUE33, your post just brought back vivid memories of seeing my son drop to the ground after fielding a grounder at 3rd and throwing to first when he was that same age.  To keep this short, he ended up having surgery to put a pin in his elbow because his medial epicondyle had torn loose - basically the pointy end of his elbow broke away and had to be re-attached.  

It's good that your son stopped right away.  Unlike your son, ours wasn't doing other sports like tennis or golf, but was playing a lot of ball - pitching and playing infield.  Follow the doctor's advice, and you may even want to get a second opinion to reconfirm.

GOBLUE, I'm a dentist not a physician. My remarks are from years of experience with my son that just underwent TJ surgery as a college freshman. I have read and learned more about the elbow than anyone should. So take my advice with the knowledge that I am not an orthopod. 

younggun posted:

GOBLUE, I'm a dentist not a physician. My remarks are from years of experience with my son that just underwent TJ surgery as a college freshman. I have read and learned more about the elbow than anyone should. So take my advice with the knowledge that I am not an orthopod. 

Ditto what he said.

My 2016 had medial epicondylitis as a 12-year-old.  Later learned that he suffered a mild avulsion of the growth plate.  And like YoungGun, he is now in his freshman year of college rehabbing from TJ two weeks ago, and I have spent entirely too much time the last few weeks researching UCL injury and wondering how we could have avoided it.

The precursor correlation your doctor spoke of is this: The same valgus stress that causes ME in pre-pubescents get transferred to the UCL when the growth plates fuse.  Doesn't necessarily mean that TJ is a certainty.  A lot of variables involved, but it could maybe possibly indicate that your son might possibly maybe more susceptible to UCL injury later... maybe.

But FWIW - Dr. Cain at Andrews Center in Birmingham told us that they see kids having TJ that never had ME, kids that had ME that never have TJ, and haven't seen any positive correlation between the two.  To him, the only risk factor that really matters is "throws hard."

MrBumstead posted:

But FWIW - Dr. Cain at Andrews Center in Birmingham told us that they see kids having TJ that never had ME, kids that had ME that never have TJ, and haven't seen any positive correlation between the two.  To him, the only risk factor that really matters is "throws hard."

I'm another guy who's read and thought about this quite a bit. I'm interested in the way you worded the above, because I've often wondered if ME might be a marker for a stronger than average UCL. That is, the UCL is so strong that rather than sprain or tear, it pulls the growth plate off. My son had a 12 year old teammate who had to have his growth plate reattached with screws (injury happened on the mound). The young man was good as new in 6 months, pitched a ton all through travel ball, and just finished his freshman year pitching at a D1. Hasn't had an elbow problem since. Anecdotal, but I find it interesting.

MidAtlanticDad posted:

MrBumstead posted:

But FWIW - Dr. Cain at Andrews Center in Birmingham told us that they see kids having TJ that never had ME, kids that had ME that never have TJ, and haven't seen any positive correlation between the two.  To him, the only risk factor that really matters is "throws hard."

I'm another guy who's read and thought about this quite a bit. I'm interested in the way you worded the above, because I've often wondered if ME might be a marker for a stronger than average UCL. That is, the UCL is so strong that rather than sprain or tear, it pulls the growth plate off. My son had a 12 year old teammate who had to have his growth plate reattached with screws (injury happened on the mound). The young man was good as new in 6 months, pitched a ton all through travel ball, and just finished his freshman year pitching at a D1. Hasn't had an elbow problem since. Anecdotal, but I find it interesting.

Even at the age of 12, many of the ligaments are still relatively lax. That is there's still some give to them that the older teenagers don't have. I'd guess that most likely right around age 12-13 is when those injuries turn from being growth plate and more ligamentous in nature. Obviously, every kid is a little bit different so that timing can be earlier or later. We see kids with certain growth plate injuries as freshmen and sophomores in high school and we see other kids who tear ligaments in 7th and 8th grade. It just varies.

Medial epicondylitis (which is actually its incorrect term but..) is inflammation of the medial epicondyle. Or part of the bone in the elbow where your flexor tendons attach from your forearm that operate your wrist and your fingers. ME is often referred to as "Little Leaguers' Elbow."

6-12 months off seems like a really long time! I wouldn't say fight the doctor about that, but have a healthy discussion and get an understanding of why he is telling you that long. And if you're still not satisfied with his answer, don't be afraid to get a second opinion, even if he is the "local expert."

Thanks for the of the responses, experience and advice. I really do appreciate all of it.

My 12u 6th grade son's diagnosis is in fact Medial epicondylitis (ME) with advice to rest until the spring and do some PT.  The condition is not the same as "little league elbow" which has more to do with the elbow.   He does not have separation at growth plate either which is good but we need to have further tests later to ensure this does not occur.  Now that he has stopped throwing altogether, I think we can avoid this.  

I frequent this site because I have 2 other boys one a 2020 and also a 2023 (12u) that have bright futures in baseball. The boy who got injured, ironically, is not the one who pitches 100 innings a summer.  He does catch but that is pretty limited. 

His career in baseball will likely be playing HS ball and competitive travel ball but we are not concerned about college ball for him at this point because he has never expressed the interest or ability to play beyond school ball.    So the advice that is important to me is not that someone's D1 son had this when they were 12 ( with a growth plate issue) and proved all the doctor's wrong by not getting TJ surgery, but how quickly someone with ME got back to playing youth ball (we have Cooperstown this year and if that's not a good idea I will need to make some decisions). 

By the way, 75% of what I read about this diagnosis has to do with tennis. I don't think it's  a coincidence that we (my wife actually) put him on the club tennis team and they were out playing 2-3 days a week as well as playing golf twice a week during the spring and summer.  In fact his youth team (a USSSA Major level team) stopped playing in June because their coach had to go coach another team.  So I think this is due to the other sports just really interested in experiences with ME in a young player and the road to recover.  We will follow the Dr's advice, stop throwing until the spring, do the PT and see where he is.