Author: Madison Eichstadt, MD
Co Author #1: Justin Lockrem, MD
Senior Editor: Adam Lewno, DO

Patient Presentation:
A 14-year-old male presented to the orthopedic department with complaints of right medial elbow pain with recent worsening over the past 6 months. The pain was described as a 7/10 aching and sharp pain. He denied locking, catching, instability, or swelling. He denied any prior elbow injuries. He is a right-handed pitcher who throws in the mid 60 mph range and is able to throw a variety of pitches including a fastball, change up, slider, and curve ball. He played baseball year-round with minimal off-season and pitched as frequently as every other day. His post pitching routine includes icing of the elbow. Prior to presentation the patient tried ibuprofen and rest with minimal improvement. He expressed his primary concern was for an ulnar collateral ligament (UCL) injury.

History:
No significant past medical history.

Physical Exam:
His body height was 1.72m, and his weight was 89.5kg.
On exam, he had tenderness to palpation over the medial epicondyle. He had normal range of motion with 135 degrees elbow flexion and 0 degrees extension. Strength with flexion and extension was 5/5. Valgus and various stress to the elbow did not demonstrate laxity or reproduction of the pain. Milking maneuver was negative and resisted wrist flexion did not result in pain. Right shoulder exam was significant for right shoulder arc of 145 degrees (Abducted External Rotation of 105 and Abducted Internal Rotation of 40). Compared to the left shoulder, his internal rotation deficit was >20 degrees, meeting criteria for Glenohumeral Internal Rotation Deficiency (GIRD) as a major contributor to his symptoms.

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