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Unusual cause of elbow pain in a baseball pitcher
  1. Nithin Natwa1,
  2. Alan Zakaria2,3,
  3. George Pujalte4
  1. 1Sports Medicine, Michigan State University, East Lansing, Michigan, USA
  2. 2Internal Medicine, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
  3. 3Pediatrics, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
  4. 4Sports Medicine, Mayo Clinic, Jacksonville, FL, USA
  1. Correspondence to Dr George Pujalte, Pujalte.George{at}


An adolescent, right hand-dominant, baseball pitcher presented to sports medicine clinic with posterolateral right elbow pain over 4 months. He rated his pain as 8/10 with pitching, especially at the late cocking phase of throwing. Prior to consult, he had rested 3 months from pitching, progressing to strengthening exercises, with no pain relief. On physical examination, he had 120° of active external rotation, 80° of active internal rotation, mild tenderness to palpation over the capitellum and normal elbow radiography. Magnetic resonance arthrogram of the right elbow revealed subtle, posterolateral joint capsular tear and adjacent synovial hypertrophy. The patient was diagnosed with elbow synovial fold syndrome that was causing impingement at the radiocapitellar joint and was referred to an orthopaedic surgeon. Arthroscopy revealed redundant tissue; scar formation at the radiocapitellar joint was debrided. The patient participated in physical therapy for 2 months and was able to start throwing 3 months later.

  • sports and exercise medicine
  • orthopaedics
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  • Contributors All the authors contributed to the conception and design, collection of data, analysis and interpretation of data, drafting of the article, generation of figures, collection of images, critical revision of the article for important intellectual content and final approval of the article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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