Sports Medicine Physician OhioHealth Columbus, Ohio, United States
Case Diagnosis: Ulnar Collateral Ligament Sprain and Medial Epicondyle Apophysitis in a 16 year old male baseball pitcher and second base player, that underwent a platelet rich plasma (PRP) injection.
Case Description: The right handed athlete developed 2 weeks of right elbow pain that began after a game with a large volume of pitches. On exam, he has tenderness to palpation over the medial epicondyle, common flexor tendon, and ulnar collateral ligament. Decreased elbow extension and minimal laxity with varus stress test were also present. Initial pain is 8 out of 10 and a sharp and shooting characteristic. Initial elbow x-rays were unremarkable. Underwent Magnetic Resonance Arthrogram which revealed a grade 1 sprain of the anterior band of ulnar collateral ligament with a partial thickness insertional tear and a mild medial epicondyle apophysitis.
Discussions: At initial presentation, he was treated conservatively with relative rest and athletic trainer guided rehab for 4 weeks with some improvement but was unable to progress in throwing. Thus referred for PRP injection. Under ultrasound guidance, the proximal band of the UCL and the common flexor tendon was injected with a leukocyte poor PRP injectate. He rested for a few days and is resuming athletic trainer guided rehab in strength, proprioception, and plyometric exercises. He will follow up in 2 weeks.
Conclusions: Several studies have shown that PRP injection has improved return to play timeline. It is to be seen if reinjury rate is affected. By delivering supraphysiologic concentration of platelets, cytokines, and growth factors, it is suspected that an aberrant or slow recovery process can be augmented. In our case, we suspect that PRP will allow our athlete to return to play after having failed a reasonable attempt of treatment with conservative therapy.
