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Elbow pain in children is extremely common, with elbow injuries making up a large proportion of upper body injuries. The type of injury often depends on the child’s age and sport. Skeletal maturity and epiphyseal development also plays an important role in the type of injury.
Think of CRITOE for remembering the 6 growth centers in the elbow. They appear sequentially at approximately 1, 3, 5, 7, 9 and 11 years of age: C – capitellum, R – radial head, I – inner (medial epicondyle), T- trochlea, O – olecranon, E- External (lateral epicondyle).
Common Types of Elbow Pain and Injuries
1) Nursemaid’s Elbow: AKA ‘pulled elbow,’ is most common in children under 5. Typically occurs when a parent grabs the arm of a falling child, resulting in subluxation of the radiohumueral joint. The child typically holds their arm in the flexed and pronated position. Treatment involves reduction: with examiners thumb over radial head, supinate and flex the elbow. A relocating ‘clunk’ should be felt.
2) Little Leaguer’s Elbow: a spectrum of injuries to medial side of the elbow including in throwing athletes due to valgus stress including, medial epicondyle stress fractures, ulnar collateral ligament (UCL) injuries, flexor/pronator muscle strains. Examination reveals tenderness to palpation about medial elbow and pain/instability with valgus stress. Xrays or MRI can confirm the diagnosis, with mainstay of management being rest. Managing pitch counts can help prevent.
3) Lateral Epicondylitis: accounts for 7 percent of all sports injuries and is the most common sports-related problem at the elbow. Mechanism is the same as in adults and involves overuse of the extensor muscle in the forearm. It is more common in racquet sport athletes. Management includes rest ice, NSAIDs, use of a counterforce brace, rehabilitation exercises to stretch and strengthen the wrist extensors.
4) Panner Disease: AKA osteochondrosis of the capitellum, is a degenerative disorder where blood supply to the epiphysis is disrupted. It is common in boys aged 7 to 12, and presents with lateral elbow pain with decreased range of motion in extension. Treatment is rest until there is evidence of healing (radiographical and functional).
5) Osteocondritis Disseicans: avascular necrosis of the articular cartilage and underlying subchondral bone, with collapse of the capitellum. Presents as poorly localized lateral elbow pain with mechanical symptoms such as locking, catching and decreased range of motion. Radiographs/MRI can often determine the severity of the lesion and subsequent management.
Article written by: David White, BSc, MSc, MD, CCFP
All well-baby visits are comprised of a review of several core elements: parental concerns, nutrition, development and behavior, physical examination, anticipatory guidance, conclusion and plan.
The Government of Ontario, following the advice of an expert panel, has recognized the importance of the 18-month well-baby visit by funding a longer, more in-depth visit.
Tools have been developed to help in the identification of children at risk, to enhance the timely referral to appropriate community resources necessary in early intervention and treatment.
The Nipissing District Developmental Screen is an easy-to-use tool that reviews a child’s skills in the following areas: vision, hearing, speech, language, communication, gross motor, fine motor, cognitive, social/emotional and self-help.
The 18-month Well-Baby Pathway, developed by the 18-month Screening Work group of the Ottawa Best Start Initiative, is an easy-to-use web-based tool that provides a link to community resources based on each of the following domains: speech/language, hearing/vision, nutritional/dental, fine/gross motor development, social/emotional/behavioral/developmental and parenting and family support.
Some EMR can link websites to their system, allowing for the linkage of parents to these resources and services during the 18-month visit.
- www.machealth.ca: Resources available here include the Ontario Rourke Baby Record, the Nipissing District Development Screen™ and the Early Child Development and Parenting Resource System Pathway, which lists community services.
- Ontario Rourke Baby Record: Available at www.machealth.ca, www.cps.ca, www.cfpc.ca and www.rourkebabyrecord.ca
- Nipissing District Developmental Screen™: www.ndds.ca, www.machealth.ca
- Ministry of Children and Youth Services: www.ontario.ca/child
- Ministry of Health and Long-term Care: www.ontario.ca/health
- Ministry of Health Promotion: www.ontario.ca/mhp
- Ontario Early Years Centres: www.ontario.ca/earlyyears