Use of conservative and sport-specific management strategies for a baseball pitcher with persistent elbow pain

ObjectiveTo present a case of medial epicondylitis in an adolescent baseball pitcher that appeared to improve when addressing the upper extremity kinetic chain with a variety of conservative management strategies.Clinical FeaturesAn 18-year-old right hand dominant high school baseball pitcher had recurring sharp pain in his right elbow. Previous trials of medication and physical therapy were only partially successful in resolving the problem. The patient's pain was rated as an 8 on a numerical pain scale during throwing activities. A variety of tender points were noted in the right upper extremity. The patient had discontinued playing competitive baseball due to the pain.Intervention and OutcomeThe patient was treated 14 times over 15 weeks. Treatment included cervical, thoracic and upper extremity manipulation, soft tissue mobilization and progressive sport-specific training for the upper extremity. After the first treatment he was able to throw the ball and was able to continue throwing during the treatment program. The patient returned to league play after the treatment program.ConclusionA course of conservative care addressing multiple elements of the upper extremity kinetic chain seemed beneficial for this athlete.