Working Diagnosis:
Distal Humeral Stress Fracture with Concomitant Pronator Syndrome

Treatment:
In this case, in order to develop a successful treatment plan, it was necessary to repeat advanced imaging (MRI) to aid in progression treatment by assessment of bony healing. Visualizing resolution of stress reactions and fractures in throwing athletes arms' can help prevent additional development of injury. The timely diagnosis prevented further injury and allowed the patient's osseous structures to heal. As the bony edema resolved, the patient's neurological symptoms improved. Thus, once the patient was asymptomatic at rest he then began an appropriate rehabilitative program and then progressed to a throwing program without difficulty.

Outcome:
The patient returned to full unrestricted activity prior to the start of his high school baseball season after a progressive throwing program without difficulty.

Author's Comments:
Overuse throwing injuries can manifest in a variety of pathology. What is consistent is that repeated microtrauma to the throwing arm may result in a significant amount of injuries regardless of playing level. In order to prevent these injuries all caregivers who evaluate and treat throwing athletes must continue to emphasize that one should not throw in pain. Additionally, if one has recovered from a throwing injury it is imperative to participate in a return to sport or throwing program prior to competition to prevent a recurrence of injuries.

References:
1. Gonzalez-Zapata A, Familiari F, McFarland EG. Stress Reaction of the Humerus in a High School Baseball Player. J Orthop Sports Phys Ther 2014;44(12):998.

2. Fleisig GS, Andrews JR, Dillman CJ, Escamilla RF. Kinetics of baseball pitching with implications about injury mechanisms. Am J Sports Med. 1995;23(2):233-239.

3. Mautner BK, Blazuk J. Overuse throwing injuries in skeletally immature athletes--diagnosis, treatment, and prevention. Curr Sports Med Rep. 2015 May-Jun;14(3):209-14.

4. McFarland EG, Wasik M. Epidemiology of collegiate baseball injuries. Clin J Sport Med. 1998;8:10-13.

5. McFarland EG, Ireland ML. Rehabilitation programs and prevention strategies in adolescent throwing athletes. Instr Course Lect. 2003;52:37-42.

Acknowledgments:
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