Author: Steven Barrientos, DO
Co Author #1: Sunny Gupta, DO Rothman Institute Orthopedics, Marlton, New Jersey
Co Author #2: Mitesh Patel, MD Rothman Institute Orthopedics, Marlton, New Jersey
Senior Editor: Margaret Gibson, MD, FAMSSM
Editor: Bjorn Irion, MD

Patient Presentation:
Left hand dominant pitcher with left elbow pain

History:
The patient is a 16 year old left hand dominant male with a past medical history of anxiety who is a high level left-handed baseball pitcher. He first presented with several weeks of nonspecific left elbow discomfort that had been gradually getting worse. He did not recall any specific injury to the elbow joint and stated onset was progressive. He previously complained about slight numbness around his elbow area that seemingly self-resolved. However, the day prior, towards the end of a throwing showcase for college he noticed sudden sharp pain just posterior to the lateral epicondyle of his elbow. He denied hearing or feeling a pop and the pain was non-radiating. He denied any previous history of major injuries or surgeries. He also denied receiving any formal treatments such as therapy or injections to the specific joint.

The patient was recommended to start physical therapy immediately as he had an upcoming showcase.

Four weeks later the patient denied any improvement in symptoms. He identified pain mainly in his lag and release phases of throwing with persistent pain at the posterolateral elbow area. He was also having recurrence of symptoms documented by his physical therapist. No new physical exam findings were noted.

Physical Exam:
On initial exam he had no edema or ecchymosis of the left elbow. No tenderness was appreciated over the medial epicondyle, flexor pronator, or ulnar collateral ligament areas. He did have focal area tenderness at the posterior aspect of the lateral epicondyle near where the triceps tendon inserts laterally. Olecranon was non-tender. Full range of motion and strength was intact in all directions. He had pain with resisted supination, less so with pronation. Negative Tinel's at the medial elbow, negative Hook test, and negative Milking test. No gross signs of instability.

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