Differential Diagnosis for 12 yo Male with Pain at Insertion of the Medial Collateral Ligament

• Single Most Likely Diagnosis
  • Medial epicondylitis (golfer's elbow): This condition is a common cause of medial elbow pain, especially in adolescents who participate in sports that involve repetitive throwing or gripping activities. The pain is typically localized to the medial epicondyle, where the medial collateral ligament inserts.
• Other Likely Diagnoses
  • Medial collateral ligament sprain: A sprain of the medial collateral ligament can occur due to a valgus stress or a direct blow to the medial aspect of the elbow. This would cause pain and tenderness at the insertion of the ligament.
  • Ulnar nerve entrapment: The ulnar nerve runs close to the medial epicondyle and can become irritated or entrapped, causing pain and numbness in the medial aspect of the elbow and forearm.
  • Osteochondritis dissecans of the capitellum: This condition involves a fragment of bone and cartilage becoming detached from the capitellum, often due to repetitive stress. It can cause pain on the lateral side of the elbow but may also refer pain medially.
• Do Not Miss Diagnoses
  • Fracture of the medial epicondyle: Although less common, a fracture of the medial epicondyle needs to be considered, especially if there was a significant trauma. Missing this diagnosis could lead to complications such as nonunion or growth disturbances in skeletally immature patients.
  • Infection (osteomyelitis or septic arthritis): Infection in the elbow joint or the bone can cause severe pain and requires prompt diagnosis and treatment to prevent long-term damage.
• Rare Diagnoses
  • Tumors (e.g., osteoid osteoma, osteosarcoma): Although rare, bone tumors can cause localized pain and should be considered in the differential diagnosis, especially if the pain is persistent and not explained by more common conditions.
  • Medial epicondyle apophysitis: This is an overuse injury that affects the growth plate at the medial epicondyle. It's more common in young athletes involved in throwing sports.