Disclosures: Kuntal Chowdhary, MD: No financial relationships or conflicts of interest

Case Diagnosis: Prolotherapy as a potential treatment for Little League elbow

Case Description or Program Description: Patient is a 14-year-old male baseball player with 10-month history of medial right elbow pain. Ten months prior to presentation, patient noted a sharp pain in his medial elbow after throwing a baseball from third base to first base. A radiograph of the right elbow was obtained, which showed widening of the medial apophysis. Patient stopped all throwing activity and initiated physical therapy (PT) with a focus on throwing mechanics. Patient reported that during his rest period, he had no elbow pain. Patient resumed throwing after 10 months of rest and again noted a sharp pain in his medial elbow. Physical exam revealed tenderness to palpation of the medial epicondyle and common flexor-pronator tendon (CFPT) footprint with reproduction of pain with the valgus extension overload test. An initial diagnostic ultrasound examination was completed, which additionally revealed cortical irregularities at the origin of the CFPT. Given the persistent pain, patient elected to undergo prolotherapy of the right CFPT for recalcitrant right Little League/medial epicondyle apophysitis and was discharged with instructions to complete a postprocedural course PT regimen.

Setting: Outpatient sports medicine clinic

Assessment/Results: Patient returned to clinic 4 weeks after the prolotherapy injection. He reported complete resolution of pain at rest and minimal pain with full throwing. Educational diagnostic ultrasound of the CFPT was performed and demonstrated improved appearance of the tendon.

Discussion (relevance): To the best of our knowledge, this is the first reported case of prolotherapy for treatment of Little League elbow. Prolotherapy has, however, been shown to an effective treatment in other cases of apophysitis caused by tendinopathy.

Conclusions: Prolotherapy is a promising treatment for Little League elbow. In cases of recalcitrant Little League elbow, prolotherapy can be considered as alternative to surgical intervention in children and adolescents.

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/prolotherapy-a-promising-therapy-for-recalcitrant-little-league-elbow/