Dr. Cohen 'Aces' Treatment of Young Tennis Player with Elbow Overuse Injury

Jessica Hoeksema, 14, of Elmhurst, is stepping foot on the tennis court for the first time in five months, and she's doing so without any pain. The experienced tennis player has been recovering from surgery she had late last year to correct an elbow injury that has bothered her for five years. She is one of a growing number of youth athletes experiencing this injury from overuse.

Initially, Jessica assumed the pain was growing pains or tendonitis. After years of testing and misdiagnoses, Jessica sought advice from Dr. Mark Cohen, hand, wrist and elbow specialist at Midwest Orthopaedics at Rush. There, Jessica was diagnosed with a condition called osteochondritis dessicans of the elbow, a joint condition in which a piece of cartilage breaks off of the bone — an injury very familiar to Dr. Cohen.

"I've seen a drastic increase in the prevalence of osteochondritis dessicans in young athletes. Between 2010 and 2011, the number of surgeries I performed to correct this condition has more than doubled," Dr. Cohen said. "While the incidence of osteochondritis dessicans is rising, the age at which it presents itself is decreasing. It mostly affects adolescents because once people reach skeletal maturity, their cartilage may be a bit stronger and less prone to blood supply loss and cartilage death."

Osteochondritis dessicans results from chronic loading over time, often in throwing sports or gymnastics, in which repetitive weight-bearing stress is placed on the elbow. The stress causes a portion of cartilage to die in the part of the elbow that develops osteochondritis dessicans. Eventually, this section of cartilage may break away from the bone entirely. Along with the elbow, it can occur in other joints including the ankle, shoulder, hip and knee.

Back in fifth grade, much of Jessica's life revolved around sports. She participated in softball, soccer, track and tennis. However, those hobbies became more challenging when the then-10-year-old started having pain in her left elbow.

"I was in a significant amount of pain doing normal things like opening the refrigerator and things that shouldn't give people pain," she said. Soon after, Jessica said her elbow began to lock suddenly.

"I'd go to reach for something and my elbow suddenly couldn't move. And that would happen multiple times a day; fifteen times in one day if not more," Jessica said. After learning her diagnosis, Jessica was puzzled, unable to recall a specific fall or incident that would have caused osteochondritis dessicans to develop. Dr. Cohen said this reaction is common among patients who develop the condition.

"Typically, this injury is caused by repetitive stress on the joint, rather than from one specific event. That is why these athletes don't commonly recall a specific injury but the elbow just starts hurting one day," Dr. Cohen said.

When rest and anti-inflammatory medication did not heal Jessica's injury, Dr. Cohen performed surgery to remove the damaged portion of cartilage and replace it with new cartilage. Since her surgery, Jessica has undergone physical therapy and was surprised with the mobility she had. The "locking" she once experienced as often as 15 times each day has not occurred since undergoing surgery. Just recently, Jessica was cleared to return to playing tennis. Until now, her pain had kept her from participating in many conditioning exercises, which she and her mom both knew were crucial for improving her game.

"When you're in junior high and you can't do push-ups or pull-ups, that's fine. But when you get to high school and you are going out for cut sports, they want you to perform or you won't make the team," Jessica's mother, Kristin, said. "Sports are such a big part of our life so we needed to figure out what was wrong because this wasn't within the realm of what you'd expect a normal 10-year-old to experience. There's no reason anybody, especially a 10-year-old, should have to live with daily pain."

Though both Jessica and Dr. Cohen are satisfied with her recovery, Dr. Cohen said the increase in this injury is alarming.

"We're concerned about the future condition of young athletes' elbows," Dr. Cohen said.

"Many competitive athletes are performing and practicing at levels that put their bodies at risk for over-use injuries, and that's why we see an increase of osteochondritis dessicans. High school sports are much more competitive that they used to be."

Dr. Cohen suggests athletes watch for the following symptoms of osteochondritis dessicans:

  • Three-to-six months of progressive elbow pain
  • Tenderness or sensitivity in the elbow, most noticed when it is bent
  • Locking of the elbow
  • Restricted range of motion

Early intervention can prevent the need for surgery, so Dr. Cohen recommends anyone with persisting pain to seek advice from an experienced orthopedic physician.

Click to make an appointment with Dr. Cohen or please call 312-243-4244.