Dr. John A. Schlechter - Pediatric Orthopedic Surgeon - Fracture Care, Sports Medicine and Arthroscopy for Children and Adolescents
Dr. John A. Schlechter - Pediatric Orthopedic Surgeon - Fracture Care, Sports Medicine and Arthroscopy for Children and Adolescents: (714) 633-2111
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Dr. John A. Schlechter
Dr. John A. Schlechter - Pediatric Orthopedic Surgeon

Patient Info

Hand & Elbow

Little Leaguer's Elbow :: Quadriplegia :: Upper extremities

Little Leaguer's Elbow

Little league elbow also called as medial apophysitis, is an overuse condition that occurs when there is overstress or injury to the inside portion of the elbow. It is commonly seen in children involved in sports activities that require repetitive throwing such as baseball.

Children make use of the elbow joint repetitively to throw the baseball which creates stress on the muscles and ligaments that are attached to the inner side of the elbow. The growth plate present at the bone ends become inflamed or in severe case it may break from the upper arm. One of the risk factor which causes this disease is misguided training regime.

The most common symptoms include elbow pain, tenderness, swelling on the inner side of the elbow, restricted motion, and locking of elbow joint. Pain is increased upon pressing the inner side of the elbow.
Your doctor will perform physical examination of your child's elbow. Further your doctor may also request for an X-ray which shows the break in the growth plate.

Immediately following an injury and before being evaluated by a doctor, you should initiate the PRICE method of treatment.

  • Protection – The purpose of protection is to avoid further injury. You can protect the injury by applying bandage, aluminum splint, protective tape, or braces.
  • Rest: Rest the elbow as more damage could result from putting pressure on the injured area. If the injury is not treated it can lead to complications such as ligament tear, cartilage injury, and growth disturbance.
  • Ice: Applying ice packs to the injured area will help to diminish swelling and pain. Ice should be applied over a towel to the affected area for 15-20 minutes four times a day for several days. Never place ice directly over the skin.
  • Compression: Wrapping the elbow with an elastic bandage which will help to minimize the swelling and support the elbow.
  • Elevation: Ensure that your child elevates the elbow above heart level will also reduce swelling and pain.

The treatment options include non-surgical and surgical treatment. The conservative or the non-surgical options include

• Medications such as nonsteroidal anti-inflammatory drugs will be prescribed to provide relief from pain and inflammation.

• After the pain has subsided, your doctor may suggest initiation of rehabilitation program which includes strengthening and stretching exercises to develop strength and muscle control.

Surgical treatment may be required in severe cases if there is a break in the bone. Surgery is done in girls above 12 years and boys above 14 years. Surgical method involves removal of loose fragments of the bone, bone grafting, and reattachment of ligament back to the bone.

Some of the measures to prevent little leaguer's elbow include reduction in number of pitches a child throws. Before starting with the activity, your child should perform warm up exercises.



Quadriplegia, also called tetraplegia, is a condition which results in loss of function or paralysis of the muscles in arms and legs.

Quadriplegia is caused by spinal cord injury, stroke, Bell's palsy, nerve disease such as amyotrophic lateral sclerosis, and autoimmune disorder such as Guillain-Barré syndrome.

One of a type of quadriplegia is spastic quadriplegia which is a severe form of cerebral palsy. Spastic refers to muscle stiffness. Cerebral palsy is a neurological disorder that occurs in early childhood which affects body movements, balance, posture, and muscle coordination. It is a result of damage to one or more brain parts that controls muscle movements. Cerebral palsy is caused by fetal brain injuries, infections at birth or during pregnancy, severe jaundice during birth, infections of the brain such as bacterial meningitis or viral encephalitis, or head injury following an accident, fall, or child abuse. Birth injuries can also lead to cerebral palsy in some cases.

Children affected with quadriplegia have difficulty in walking, swallowing, and speaking. Muscles may become very stiff or unusually relaxed. Body movements may be jerky, abrupt, or slow and uncontrolled. The child may not react to sound or may have a delayed speech and some may also have moderate to severe mental retardation.

Your doctor will discuss with you and your family members and gather information if any problem has occurred during pregnancy and labor and may order some of tests such as:

  • Ultrasound of the brain - Detect any abnormality such as bleeding or brain damage
  • CT scan of the brain –Reveals any abnormalities.
  • MRI of the brain - Captures the internal structure of the brain more clearly than other methods. Imaging of the spinal cord with MRI is suggested in children with spastic leg muscles and lack of bladder and bowel control.


Treatment options include non-surgical and surgical treatment. Non-surgical treatment includes:

  • Physical therapy involves stretching exercises and other activities that develop flexibility and strengthen the muscles.
  • Occupational therapy teaches physical skills to function independently in life such as eating, dressing, and teeth brushing.
  • Speech/language therapy enables the child to improve speech and overcome problems of communication
  • Medicines are recommended to relax the muscle spasms.
  • Special equipments such as walkers, positioning devices, wheelchairs help to improve function in children with cerebral palsy. Braces and other orthotic devices may be required to neutralize the muscle imbalance and improve posture and walking.

Surgery is recommended when the conservative treatments has not reduced spasticity and pain. Surgical treatment includes:

  • Dorsal rhizotomy: It is a surgical procedure performed to reduce spasticity and improve the muscle movements. In this procedure, a few nerves are cut at the roots where they divide from the spinal cord.
  • Intrathecal baclofen therapy: In this procedure, Baclofen–a muscle relaxant is injected into the spine to reduce muscle spasticity. A tiny pump is placed in the abdominal wall to pump the drug to the spastic muscles of the limbs.
  • Tendon transfer surgery: It is performed to restore the function of the hand after spinal cord injury. In this procedure, the origin of the functioning muscle is detached and reinserted into a different bone or different tendon to improve function.


Upper extremities

Tennis Elbow/Golfer's Elbow

Tennis elbow is the inflammation of muscles on the outside of the elbow where as tendinitis on the inner side of the elbow is golfer's elbow. Overuse of the arms or a traumatic blow to the hand may cause tennis elbow or golfer's elbow. These injuries may cause severe pain and tenderness of the affected muscles that radiate down into the forearm, particularly with use of the hand and wrist. Adequate rest and immobility of the affected part helps the muscles to recover and modification of the activities helps in better healing. Heat therapy, followed by a stretching and strengthening exercises and then ice massage may offer be beneficial. A tennis elbow strap may relieve the pressure from the muscle attachment. Pain medications may be recommended to relieve the pain and inflammation.


Tendonitis is inflammation of any of the tendons in the wrist. Tendonitis is usually treated with adequate rest, splinting, ice application, and with non-steroidal anti-inflammatory medicines to reduce the inflammation.

Hook of the hamate fracture

Fracture of the hook of the hamate bone, one of the small bones of the wrist, is another injury common in golfers. The hook of the hamate bone protrudes toward the palm, and is susceptible to injury from the club on a hard hit to the ground as the handle crosses right over the bony hook during gripping the club. A splint or cast may be used if the fracture is seen soon after the injury. If there is continued pain, surgery is usually performed to remove the broken bone fragment.

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