First AD

Second AD

A 12-year-old boy presents to the emergency department with acute pain in the medial aspect of his right elbow after pitching in a baseball game. He also complains of dull lateral elbow pain that has been present for weeks. AP, oblique, and lateral radiographs of the right elbow were obtained.

Medial and lateral epicondyle avulsion fractures

Medial epicondyle avulsion fracture and osteochondritis dissecans of the capitellum


Radiographs demonstrate a medial epicondyle avulsion fracture (red arrow). There is also subchondral lucency of the capitellum, outlined by sclerosis, representing osteochondritis dissecans of the capitellum. The lateral epicondyle and olecranon apophyses appear normal for a child of this age.


Medial epicondylar fractures are frequently seen in young athletes, particularly pitchers, and have been coined the “Little League elbow”. During the overhead pitching motion, valgus stress results in distractive forces on the medial aspect of the elbow joint and compressive forces on the lateral aspect of the elbow joint.  Avulsion injury of the medial epicondyle is not uncommon, nor is apophysitis. Repeated compressive forces on the lateral aspect of the elbow can lead to osteochondritis dissecans of the capitellum. Osteochondritis dissecans of the radial head can also be seen, although not in this particular example.


Grayson, DE. The elbow: radiographic imaging pearls and pitfalls. 

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A 12-year-old boy presents to the emergency department with acute pain in the medial aspect of his right elbow after pitching in a baseball game. 

Image IQ: 12-year-old Boy With Acute Medial Elbow Pain