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Our 11-year-old son was diagnosed with Little League elbow (although he got the problem from doing gymnastics). We are approaching six months of therapy and rest from activity with very little change in symptoms. The surgeon is suggesting an MRI to see where we are at but the insurance company doesn't want to pay for it. What should we do?
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Young gymnasts and overhand athletes, particularly baseball pitchers and racket-sport players, are prone to an elbow condition called "Little League elbow". The forceful and repeated actions of these sports can strain the immature surface of the outer part of the elbow joint. The bone under the joint surface weakens and becomes injured, which damages the blood vessels going to the bone. Without blood flow, the small section of bone dies. The injured bone cracks. It may actually break off. The medical term for this condition is osteochondritis dissecans (OCD).
Elbow OCD affects the articular cartilage in the capitellum. The capitellum is a knob on the end of the humerus (your upper arm bone). The capitellum fits into the cup-shaped end of the radius (one of the two bones in the forearm that connects to the humerus).
The capitellum transmits two-thirds of all compressive forces across the elbow. Throwing athletes with an increased angle at the elbow (called valgus) put even more force and load through the capitellum. Overworked, poorly conditioned, and skeletally immature elbows are at increased risk for this condition.
OCD also affects the layer of bone just below the cartilage, which is called the subchondral bone. In advanced stages of OCD, the upper end of the radius, particularly the head of the radius, is also involved.
For small defects that don't involve loose fragments, conservative (nonoperative) care may be successful. The child or teen is advised to modify his or her activity and avoid putting strain and load on the joint. Activity reduction and modification may be required for several months or more.
If this treatment approach isn't successful or if there is a large lesion with loose fragments, then surgery may be required. The goals of surgery are usually to decrease pain, increase motion, and return the athlete to a preinjury level of activity. This is where advanced imaging such as MRIs and CT scans can be very helpful. X-rays are less expensive but aren't as sensitive as MRIs for showing the depth and extent of the lesions.
Before and after MRIs can also help identify if and when the problem is healing as it should. Delays in healing or worsening of the condition need to be addressed sooner than later for the best results. The insurance company may reverse its decision with a letter of justification from the surgeon. This type of documentation explains the problem and why advanced imaging techniques such as MRI are needed.
If the company still won't budge, you may have to consider paying out-of-pocket for the service. Most imaging companies will work with patients and their families to create a payment schedule that works for everyone.
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*Disclaimer:*The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic. |
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