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Medial Epicondyle Avulsion
A. Carlson Merrow, Jr., MD, FAAP
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KEY FACTS

  • Terminology

    • Imaging

      • Pathology

        • Clinical Issues

          TERMINOLOGY

          • Synonyms

            • Acute medial epicondyle (ME) injury: Avulsion fracture
            • Chronic injury: Stress injury, medial epicondylitis, traction apophysitis, Little Leaguer's elbow
          • Definitions

            • Acute injury: Avulsion of ME ossification center
            • Chronic stress injury: Repetitive traction microtrauma exceeds healing capacity; causes inflammation, growth disturbance, degeneration
              • Skeletally immature: Apophysitis of ME
              • Skeletally mature: Partial tearing/degeneration of common flexor tendon, medial/ulnar collateral ligament
            • Apophysis: Nonarticular cartilaginous ossification center
              • Does not contribute to longitudinal growth
              • Serves as site of tendon, muscle, or ligament attachment

          IMAGING

          • General Features

            • Radiographic Findings

              • MR Findings

                • Ultrasonographic Findings

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        CLINICAL ISSUES

                        • Presentation

                          • Demographics

                            • Natural History & Prognosis

                              • Treatment

                                DIAGNOSTIC CHECKLIST

                                • Image Interpretation Pearls

                                  Selected References

                                  1. Emery KH et al: Pediatric elbow fractures: a new angle on an old topic. Pediatr Radiol. 46(1):61-6, 2016
                                  2. Pathy R et al: Medial epicondyle fractures in children. Curr Opin Pediatr. 27(1):58-66, 2015
                                  3. Tarallo L et al: Pediatric medial epicondyle fractures with intra-articular elbow incarceration. J Orthop Traumatol. 16(2):117-23, 2015
                                  4. Marshall KW: Overuse upper extremity injuries in the skeletally immature patient: beyond Little League shoulder and elbow. Semin Musculoskelet Radiol. 18(5):469-77, 2014
                                  5. Gottschalk HP et al: Medial epicondyle fractures in the pediatric population. J Am Acad Orthop Surg. 20(4):223-32, 2012
                                  6. Davis KW: Imaging pediatric sports injuries: upper extremity. Radiol Clin North Am. 48(6):1199-211, 2010
                                  7. Osbahr DC et al: Acute, avulsion fractures of the medial epicondyle while throwing in youth baseball players: a variant of Little League elbow. J Shoulder Elbow Surg. 19(7):951-7, 2010
                                  8. Wei AS et al: Clinical and magnetic resonance imaging findings associated with Little League elbow. J Pediatr Orthop. 30(7):715-9, 2010
                                  9. Ahmad CS et al: Valgus extension overload syndrome and stress injury of the olecranon. Clin Sports Med. 23(4):665-76, x, 2004
                                  10. Kijowski R et al: Magnetic resonance imaging of the elbow. Part I: normal anatomy, imaging technique, and osseous abnormalities. Skeletal Radiol. 33(12):685-97, 2004
                                  11. Williams RJ 3rd et al: Medial collateral ligament tears in the throwing athlete. Instr Course Lect. 53:579-86, 2004
                                  12. Parr TJ et al: Overuse injuries of the olecranon in adolescents. Orthopedics. 26(11):1143-6, 2003
                                  13. Gilchrist AD et al: Valgus instability of the elbow due to medial epicondyle nonunion: treatment by fragment excision and ligament repair--a report of 5 cases. J Shoulder Elbow Surg. 11(5):493-7, 2002
                                  14. Klingele KE et al: Little league elbow: valgus overload injury in the paediatric athlete. Sports Med. 32(15):1005-15, 2002
                                  15. Fritz RC: MR imaging of sports injuries of the elbow. Magn Reson Imaging Clin N Am. 7(1):51-72, viii, 1999
                                  16. Fowles JV et al: Elbow dislocation with avulsion of the medial humeral epicondyle. J Bone Joint Surg Br. 72(1):102-4, 1990
                                  17. Harrison RB et al: Radiographic clues to fractures of the unossified medial humeral condyle in young children. Skeletal Radiol. 11(3):209-12, 1984
                                  Related Anatomy
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                                  Related Differential Diagnoses
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                                  References
                                  Tables

                                  Tables

                                  KEY FACTS

                                  • Terminology

                                    • Imaging

                                      • Pathology

                                        • Clinical Issues

                                          TERMINOLOGY

                                          • Synonyms

                                            • Acute medial epicondyle (ME) injury: Avulsion fracture
                                            • Chronic injury: Stress injury, medial epicondylitis, traction apophysitis, Little Leaguer's elbow
                                          • Definitions

                                            • Acute injury: Avulsion of ME ossification center
                                            • Chronic stress injury: Repetitive traction microtrauma exceeds healing capacity; causes inflammation, growth disturbance, degeneration
                                              • Skeletally immature: Apophysitis of ME
                                              • Skeletally mature: Partial tearing/degeneration of common flexor tendon, medial/ulnar collateral ligament
                                            • Apophysis: Nonarticular cartilaginous ossification center
                                              • Does not contribute to longitudinal growth
                                              • Serves as site of tendon, muscle, or ligament attachment

                                          IMAGING

                                          • General Features

                                            • Radiographic Findings

                                              • MR Findings

                                                • Ultrasonographic Findings

                                                  • Imaging Recommendations

                                                    DIFFERENTIAL DIAGNOSIS

                                                      PATHOLOGY

                                                      • General Features

                                                        CLINICAL ISSUES

                                                        • Presentation

                                                          • Demographics

                                                            • Natural History & Prognosis

                                                              • Treatment

                                                                DIAGNOSTIC CHECKLIST

                                                                • Image Interpretation Pearls

                                                                  Selected References

                                                                  1. Emery KH et al: Pediatric elbow fractures: a new angle on an old topic. Pediatr Radiol. 46(1):61-6, 2016
                                                                  2. Pathy R et al: Medial epicondyle fractures in children. Curr Opin Pediatr. 27(1):58-66, 2015
                                                                  3. Tarallo L et al: Pediatric medial epicondyle fractures with intra-articular elbow incarceration. J Orthop Traumatol. 16(2):117-23, 2015
                                                                  4. Marshall KW: Overuse upper extremity injuries in the skeletally immature patient: beyond Little League shoulder and elbow. Semin Musculoskelet Radiol. 18(5):469-77, 2014
                                                                  5. Gottschalk HP et al: Medial epicondyle fractures in the pediatric population. J Am Acad Orthop Surg. 20(4):223-32, 2012
                                                                  6. Davis KW: Imaging pediatric sports injuries: upper extremity. Radiol Clin North Am. 48(6):1199-211, 2010
                                                                  7. Osbahr DC et al: Acute, avulsion fractures of the medial epicondyle while throwing in youth baseball players: a variant of Little League elbow. J Shoulder Elbow Surg. 19(7):951-7, 2010
                                                                  8. Wei AS et al: Clinical and magnetic resonance imaging findings associated with Little League elbow. J Pediatr Orthop. 30(7):715-9, 2010
                                                                  9. Ahmad CS et al: Valgus extension overload syndrome and stress injury of the olecranon. Clin Sports Med. 23(4):665-76, x, 2004
                                                                  10. Kijowski R et al: Magnetic resonance imaging of the elbow. Part I: normal anatomy, imaging technique, and osseous abnormalities. Skeletal Radiol. 33(12):685-97, 2004
                                                                  11. Williams RJ 3rd et al: Medial collateral ligament tears in the throwing athlete. Instr Course Lect. 53:579-86, 2004
                                                                  12. Parr TJ et al: Overuse injuries of the olecranon in adolescents. Orthopedics. 26(11):1143-6, 2003
                                                                  13. Gilchrist AD et al: Valgus instability of the elbow due to medial epicondyle nonunion: treatment by fragment excision and ligament repair--a report of 5 cases. J Shoulder Elbow Surg. 11(5):493-7, 2002
                                                                  14. Klingele KE et al: Little league elbow: valgus overload injury in the paediatric athlete. Sports Med. 32(15):1005-15, 2002
                                                                  15. Fritz RC: MR imaging of sports injuries of the elbow. Magn Reson Imaging Clin N Am. 7(1):51-72, viii, 1999
                                                                  16. Fowles JV et al: Elbow dislocation with avulsion of the medial humeral epicondyle. J Bone Joint Surg Br. 72(1):102-4, 1990
                                                                  17. Harrison RB et al: Radiographic clues to fractures of the unossified medial humeral condyle in young children. Skeletal Radiol. 11(3):209-12, 1984