Physeal Stress Injuries of the Elbow

The location of the elbow within the arm makes it vulnerable to both axial and valgus overload during repetitive upper extremity sport. Additionally, the epiphyseal–physeal–metaphyseal (EPM) complex at both the distal humerus and proximal aspect of the radius and ulna make these sites vulnerable to repetitive stresses. There are apophyseal structures serving as origin and insertion points for tendons and ligaments surrounding the elbow as well. In the following sections, the distal humeral and subsequently proximal radial and ulnar epiphyseal primary periphyseal stress injuries, or epiphyseal PSIs, and apophyseal PSIs, are described. The epidemiology, pathophysiology, clinical presentation, diagnostic imaging, management, and prognostic outcome of these conditions will be reviewed. The medial epicondyle is the location of one of the most well-known repetitive stress syndromes in youth sports, the classic Little League elbow. While stress conditions of the distal humeral physis and proximal radial physis are less well reported than many other physeal stress syndromes. All told, PSIs around the elbow may be commonly encountered and will benefit from higher levels of evidence studies in the future.