An otherwise healthy 16-year-old girl presented with medial arm pain after falling on her left elbow while skating. Robert P. Blereau, MD, and Timothy J. Haley, MD, of Morgan City, La, write that a radiograph of the left upper arm showed a spur projecting from the distal humerus; there was no fracture or dislocation.
A supracondylar process of the humerus (also known as supracondylar exostosis) is a normal developmental variant that affects approximately 1% of children. The bony spur develops on the medial aspect of the distal third of the humerus and looks like a beak that extends obliquely downward toward the elbow joint,unlike an osteochondroma, which points away from the joint.
Routine anteroposterior and lateral radiographs may not show the spur; an oblique radiograph provides the best view. The spur may be palpable.
No treatment is required. Rarely, patients may complain of pain that radiates from the shoulder to the median nerve distribution in the hand, especially with increased pronation of the extended forearm. In these patients, surgical resection of the spur may be necessary.
This patient's elbow pain was treated symptomatically with NSAIDs (acetaminophen and propoxyphene), rest, and hot soaks.