WAG Elbow injury ?'s- could this be OCD? Or just strain? Or other?

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rjb123

Proud Parent
DD (age 8) woke up a week ago with pain in her elbow. Some diminished range of motion (more in the flexion but some slight decrease in extension). No injury that she could come up with. X ray was done and there was a "difference" between the right and left arm- right showed what was described by ortho as "maybe some fragmentation in growth plate". He splinted her and follow up in a week. Fast forward one week and pain is way down (from 9-10 with flexion and extension to 2-3) range is almost normal (again, some decrease in flexion,. just barely in extension) and we go back to ortho. This one says she has a "common gymnastics issue in her elbow also seen in pitchers:". Said she needs an MRI. (scheduled for later this week). Can go back to gym, no splint, but no weight bearing stuff on arm. Wants her to work ROM. DD has little to no pain at present, but I have been reading up on OCD and am kind of freaking out. No clicking or crepidus in her arm right now, but OMG!! Anyone with experience with this? How long will she be out? I can't find any good info- the range is from "no pain with movement" to "12 months!!" Ortho said 3 ish months, to which she turned into a hysterical sobbing mess in the exam room. (we were thinking it was a stress fracture for petes sake!!)
Help!
 
It can be common; it can be tendonitis; it could be other. I must say from our experience, a regular ortho doc is not your best bet; you need to see a sports ortho and if possible one that specializes in kids. You get a good sports ortho and they will understand an athlete's mind. You also need to start looking for a good sports rehab physical therapist; again, not a regular physical therapist, but one that specializes in returning athletes to competition.

Good Luck.
 
It can be common; it can be tendonitis; it could be other. I must say from our experience, a regular ortho doc is not your best bet; you need to see a sports ortho and if possible one that specializes in kids. You get a good sports ortho and they will understand an athlete's mind. You also need to start looking for a good sports rehab physical therapist; again, not a regular physical therapist, but one that specializes in returning athletes to competition.

Good Luck.

and a good radiologist to rule out OCD. :)
 
Wait and see what the MRI says. My DD started with elbow pain in January. Went to pediatric orthopedic and they did an x-ray. Diagnosed her with Little League Elbow. Put her on 3 weeks rest and then slowly back to train. Pain was still there in March so DD had a MRI. Found she had bruising near her trochlea which is on the other side of the capitellum. Then I pushed the Dr to look again and they saw a small potential lesion (again not near the side where OCD usually occurs). The dr. consulted with the radiologists a few more times and agreed the lesion was a small stable (I think type 1) OCD lesion. The MRI showed no fracture. or displaced bone, or bone fragments. at that point they didn't think surgery was necessary.
They put her on 6 weeks rest, and another MRI in 8 weeks. Well she just had her follow up MRI and OCD lesion/defect is still there with no signs of improvement, actually may have gotten a bit worse. DD really rested the full six weeks, only doing lower body and core. When she did start back she had no pain at all, until this past Monday, before we got the MRI results, she was doing vault drills and the pain started again. In fact she is still hurting even outside of the gym.

So DD is scheduled for surgery next Friday. It's a huge bummer, but ultimately if she wants to continue gymnastics I think it's the best option.

I hope the MRI shows everything is OK!!
 
I have been dealing with this for 2 months!
DS had elbow pain for a while. It goes away when he is not in gymnastics. I was freaking out about OCD too, but his hours do not add up.
In my sons case, he had wrist surgery 6 months ago so we had to consider that also.
Took x-ray, negative. Went to MRI and they found slight fraying of the Ulnar Collateral Ligament (similar to what you would see in pitchers, tennis players etc.)
The specialist felt it was common with very active kids involved with competitive sports.
Tendinitis both in forearm and triceps is pinching the nerve.
He is ice bathing 3 times a day for 15 min. (this is the worst part!)
Advil 2 a day for 2 weeks. PT to loosen the fore arm muscles and reduce tension.

You must get a ortho that specializes in kids doing sports.
 
Thanks so much everyone for your experiences and advice! I am a nurse, and have had ortho experience at work (lots of hips knees, shoulders, a few elbows) and I have a huge "need to know" mentality. It is frustrating that we have had two different diagnosis from two different orthos in one week! That plus her age, her fast recovery thus far, full extension and now (as of this morning!) flexion with 1-2/10 pain versus 9/10 pain a week ago make me wonder what is going on! EVERYTHING I have read, everyone I have talked to has indicated that it is likely NOT ocd as she is only 8 and her plates are still open at this age. I put a call into the ortho this morning (second guy- elbow surgeon) letting him know I want to talk to him and have some questions. Hopefully we will have some GOOD answers soon! (and ones with a short recovery- not the 3-4 months no gym that he threw out in the office!!)
 
My ortho SWORE to my son that ice baths, and stretching will go A LONG way.
I share your need to know mentality. We just cant sit around and wait for weeks on end not knowing. Gymnastics does not permit this.
 
My dd had OCD in her left elbow back about 3 years ago. She had competed her L9 season, made it to Easterns. From Regionals to Easterns, she has a little pain in her elbow, nothing crazy that she was complaining about. About a week before Easterns, her elbow started locking on her, very sporadically. No clicking, but locking here and there. Being that it was the week before Easterns, I gave her the choice, she could compete and then go to the doctor or we could go to the doctor right now. I told her though that by going now the doctor would probably want to shut her down. She chose to wait until after Easterns. When we went to the Ortho Surgeon, he did an MRI and definitely saw bone chips. The one we could really see on the MRI looked like a grain of rice. A month later she had elbow surgery. Turns out they removed several bone chips, they scrapped the bone and she also had stage IV traumatic arthitis. it was actually pretty bad, but she never complained about it so we never really knew what was going on. Surgery was in June, she was released out of PT in August and started working her way back, very slowly. Floor and beam were first, with bars to follow. I remember that vault was last back she didn't start vaulting until November than year. She ended up repeating 9 again. At the time, I thought that was a good thing because she was already solid at 9 and this would give her a chance to continue healing. She wouldn't be pushing the arm more than she had too. 3 years out, she has not had 1 complaint about that arm/elbow and she has done 2 yrs of 10 since then, plus the other yr of 9.
 
Does anyone know someone who recovered from OCD without surgery? My dd's doctor insists that she doesn't need to wear cast/brace, just no weight bearing until healed. What she can do at the gym? Yes, things that she doesn't need to use arms. But, how about back tuck? or even running fast (for the vault warmup)? My dd is so worried that she swings her arms very back just before doing back tuck, and swings back and forth to run fast. Better she doesn't go to gym at all? Should we go for a cast/brace to make her feel safe?
 
My daughter is 8 years old and was diagnosed with Panner's disease 3 weeks ago as a result of an MRI. She had on and off aches in her elbows for about a month prior to seeing the Ortho. What really prompted the doctor's appointment was when she wasn't fully straightening her arms during tumbling. The doctor's first impression was a stress fracture or tendon tears, but the MRI along with her inability to completely straighten her elbows at rest led to the Panner's diagnosis. She has been off of upper body gymnastics for 3 weeks now and has been doing PT 3x a week as well as PT exercises at home and icing. Her left arm is pretty straight now and her right arm is progressing, but slowly. We are hoping for full recovery by September. The doctor was very positive feeling it was caught early and that she should have 100% recovery. My understanding is the OCD is rare in gymnasts under 11, and that Panner's Disease is a similar condition but growth plates are still open, no loose bone fragmentation, and doesn't require surgery.
 
Thanks for writing, Calli. It is great that your daughter is recovering so well! Does Pannier's disease occurs on radius, too? My dd can straighten fully and bend fully. Maybe it is because her humerus (capitellum) is fine? Her affected sites are radial head. I'll ask about this at the next app.

Is your daughter wearing brace etc? Is she doing fast run? The doctor said it is okay to move around the arms in the air, but my dd is worried when she has to swing them fast.
 
I was the one who originally posted this thread :) From our experience, our ortho told us that panners tends to present in the dominant arm, showing the breakdown and compression of the capitellum. DD had a very textbook case and now is around a year out. Her ortho jokes that he should send her x ray series in for publication! You can see the exact progression that appear in medical textbooks! LOL! She was on non weight bearing for around four weeks and then gradually increased her weight bearing. Ortho stated that to start, bars was best, swinging and hanging most of all. Beam next and then slowly adding tumbling and vaulting back. DD really only did a sling for around one week and then was without anything. As far as Panners versus OCD, Panners covers the entire capitellum head, where the OCD is more focused and can be a single or multiple lesions. Panners also tends to have good blood flow to the area (seen on the MRI), where OCD has restricted blood flow which causes the lesions, and then breakage of the cartilage - fragments in the joint - which lead to the locking and clicking of the joint. I understand that it is likely that this would have occurred gym or no gym, and that it CAN appear in other joints, but is not likely to appear. There is no direct correlation between Panners and OCD later on, though there are a few studies that point to this correlation. However, many of these MAY be incorrectly diagnosed as Panners and were really just early OCD (lots of kids diagnosed with Panners who were 12, 13,etc). I also understand that OCD does not tend to occur in kids with open growth plates, and in gymnasts, really in more high levels - girls doing higher optional level vaults etc. IE: not likely from doing 15 hours as a level four. ;) (a relief to me at the time as my DD was barely 8 and L5). Hope this all helps! It was a scary thing for us, and hard to find good information on the internet about these problems!
 
Oh sorry rjb123! I didn't look carefully enough to see that your post was from a year ago. What was it that your daughter actually was diagnosed with? Panner's Disease?
 
From our experience, our ortho told us that panners tends to present in the dominant arm, showing the breakdown and compression of the capitellum. DD had a very textbook case and now is around a year out.
rjb123, thank you for writing. It is so great your dd is healing just like medical textbooks! It seems you've found a very good, nice doctor.
I would be relieved if it is Panners not OCD. According to your description, my dd is not.. Her capitellum is fine. That is why the doctor didn't think anything is wrong at the first app, and we went for MRI. I know OCD occurs on high level gymnast, and yes I thought why my 10y gets this. She did L7 two years and was preparing for L8 for this season. She's been doing Yorchenko over a year, wondering if this could be a cause. But there are so many girls who do it longer years. So it's just it's her? Anyway, thank you for sharing all the information and experiences!
 
I can give you our OCD story. DD(13 at the time) was complaining of elbow pain after Regionals 2014. We went on a cruise for a week and hoped that the pain would subside with a little rest. Pain returned, so in June we went to the pediatric orthopedist (the only one on tier 1 of our health plan). He sent her for an MRI, which revealed a capitellar OCD lesion. However, since her growth plates were still open, everyone the doctor consulted with recommended rest rather than surgery. So we waited.....and waited....getting X-rays and MRIs every couple of months and missing all of last season. They showed some progress, but the lesion was still evident in February. We finally were able to go to a sports orthopedist, since the pediatric guy realized that surgery was going to be necessary. The sports ortho guy was fantastic. He had DD scheduled for surgery a week later. She had micro fracture surgery to promote the healing of the lesion and also had a few loose bodies removed. DD started PT right away (3x/wk), and is very close to getting full range of motion back today (4.5 months post-op). She has been allowed to hang on the bar, and start doing hanging leg lifts, but no loading of the elbow until she gets full range of motion, hopefully by late August. She will be training L9, but knows that it will take time for her to build back her strength before she can really start working skills again. It still leaves her about 5 months before her first competition, but she will still be way behind. In retrospect, I should have pushed for the referral to the sports ortho sooner, so she could have maybe had the surgery sooner, and been fully recovered in time for summer training.
 
My DD tried rest for about 6 months and it did not help. During that time was in the gym doing "no-handed" training. She had surgery in May 2014, wore a brace for a short time after. She was in the gym that summer, but very limited conditioning. Was cleared to train in September 2014. Slowy went back to training and was very cautious about skills. Started PT in January 2015. Competed High School and also repeated level 8. She changed her routines initally so she would have less impact on her elbow (i.e. tumbing did RO Full- no BHS- took BHS BHS out of beam routine, replace with CWRO, however she added them back for regionals, did not pirouette on bars b/c hitting HS was too much on elbow, and replace it with uphill, and change vault from Yurchenko to Tsuk.

SHe is now training level 9 .
 
Does anyone know someone who recovered from OCD without surgery? My dd's doctor insists that she doesn't need to wear cast/brace, just no weight bearing until healed. What she can do at the gym? Yes, things that she doesn't need to use arms. But, how about back tuck? or even running fast (for the vault warmup)? My dd is so worried that she swings her arms very back just before doing back tuck, and swings back and forth to run fast. Better she doesn't go to gym at all? Should we go for a cast/brace to make her feel safe?

if the Doc said it's okay, which means she has no loose bodies or lesions, then it's okay and as long as no weight bearing until the Doc says. NO, she can't exacerbate the condition by running, swinging her arms, even jumping rope, etc; :)

eta: you sent me a PM and i replied. the location of her diagnosis makes this different than the normal presentation. so for everyone else, what i have posted tends to be for "normal" presentation of OCD at the elbow...even thought normal is an oxymoron here. :)
 
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I can give you our OCD story. DD(13 at the time) was complaining of elbow pain after Regionals 2014. We went on a cruise for a week and hoped that the pain would subside with a little rest. Pain returned, so in June we went to the pediatric orthopedist (the only one on tier 1 of our health plan). He sent her for an MRI, which revealed a capitellar OCD lesion. However, since her growth plates were still open, everyone the doctor consulted with recommended rest rather than surgery. So we waited.....and waited....getting X-rays and MRIs every couple of months and missing all of last season. They showed some progress, but the lesion was still evident in February. We finally were able to go to a sports orthopedist, since the pediatric guy realized that surgery was going to be necessary. The sports ortho guy was fantastic. He had DD scheduled for surgery a week later. She had micro fracture surgery to promote the healing of the lesion and also had a few loose bodies removed. DD started PT right away (3x/wk), and is very close to getting full range of motion back today (4.5 months post-op). She has been allowed to hang on the bar, and start doing hanging leg lifts, but no loading of the elbow until she gets full range of motion, hopefully by late August. She will be training L9, but knows that it will take time for her to build back her strength before she can really start working skills again. It still leaves her about 5 months before her first competition, but she will still be way behind. In retrospect, I should have pushed for the referral to the sports ortho sooner, so she could have maybe had the surgery sooner, and been fully recovered in time for summer training.

yes, ^^^ this is the most common presentation in gymnasts.
 

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