Author: David Marshall, MD, MPH
Co Author #1: J. Chris Ashton, MS, LAT, ATC
Co Author #2: Dave E. Olson, MD, CAQ, FACSM
Senior Editor: Drew Duerson, MD
Editor: Chelsea Cole, MD

Patient Presentation:
A 16-year-old, previously healthy, left-handed, male presented to clinic with 2 months of left elbow pain.

History:
This 16-year-old, previously healthy, left-handed, male is a high school baseball pitcher, who presented to clinic with 2 months of left elbow pain. He initially developed left upper arm pain during the baseball season after throwing 100+ pitches in one practice. He rested his arm for a week and the pain improved. He subsequently began throwing again and the pain returned, now localized to the medial aspect of the left elbow. Pain was insidious in nature and was not associated with any additional trauma or injury. Pain did not radiate and there was no distal numbness or tingling. He denied swelling, instability, or mechanical symptoms. He was taking ibuprofen as needed for pain, with some relief. He went to physical therapy for 6 weeks and was referred to sports medicine clinic for further evaluation. He had no history of left elbow surgery.

Physical Exam:
General: No acute distress. Musculoskeletal: Left elbow with normal carrying angle compared to right. No swelling, discoloration, or deformity of the left elbow. Tenderness to palpation over the left medial epicondyle, common flexor tendon origin, and medial aspect of the triceps insertion. Full passive and active range of motion with discomfort at terminal extension. Negative valgus stress at 0 and 30 degrees. Milking maneuver produced pain with minimal laxity noted. Neurological: Strength 5/5 throughout bilateral upper extremities.

Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.