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% Packages
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\usepackage{seqsplit}           % Splits long words.
%\usepackage{opensans}          % Can't make this work so far. Shame. Would be lovely.
\usepackage[normalem]{ulem}     % For underlining links
% Most of the following are not required for the majority
% of cheat sheets but are needed for some symbol support.
\usepackage{amsmath}            % Symbols
\usepackage{MnSymbol}           % Symbols
\usepackage{wasysym}            % Symbols
%\usepackage[english,german,french,spanish,italian]{babel}              % Languages

% Document Info
\author{Siffi (Siffi)}
\pdfinfo{
  /Title (little-league-elbow.pdf)
  /Creator (Cheatography)
  /Author (Siffi (Siffi))
  /Subject (Little League Elbow Cheat Sheet)
}

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% Commands
\newcommand{\SetRowColor}[1]{\noalign{\gdef\RowColorName{#1}}\rowcolor{\RowColorName}} % Shortcut for row colour
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% Header and Footer
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\fancyhead[L]{
\noindent
\begin{multicols}{3}
\begin{tabulary}{5.8cm}{C}
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    \vspace{-7pt}
    {\parbox{\dimexpr\textwidth-2\fboxsep\relax}{\noindent
        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
    }
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\columnbreak
\begin{tabulary}{11cm}{L}
    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{Little League Elbow Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{Siffi (Siffi)} via \textcolor{DarkBackground}{\uline{cheatography.com/122609/cs/26273/}}}
\end{tabulary}
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\fancyfoot[L]{ \footnotesize
\noindent
\begin{multicols}{3}
\begin{tabulary}{5.8cm}{LL}
  \SetRowColor{FootBackground}
  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}Siffi (Siffi) \\
  \uline{cheatography.com/siffi} \\
  \end{tabulary}
\vfill
\columnbreak
\begin{tabulary}{5.8cm}{L}
  \SetRowColor{FootBackground}
  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Not Yet Published.\\
   Updated 23rd January, 2021.\\
   Page {\thepage} of \pageref{LastPage}.
\end{tabulary}
\vfill
\columnbreak
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  \vspace{-5pt}
  %\includegraphics[width=48px,height=48px]{dave.jpeg}
  Measure your website readability!\\
  www.readability-score.com
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\end{multicols}}




\begin{document}
\raggedright
\raggedcolumns

% Set font size to small. Switch to any value
% from this page to resize cheat sheet text:
% www.emerson.emory.edu/services/latex/latex_169.html
\footnotesize % Small font.


\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Anatomy}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{17.67cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/siffi_1611424450_download.png}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{- In LLE, MCL is affected (binds ulna to humerus, consists of : Anterior oblique, posterior oblique and transverse) - provides support against valgus stress woith the flexor-pronator muscles}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{MCL}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{17.67cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/siffi_1611424541_download.jpg}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{- LLE is a traction apophysitis, meaning a traction injury of the tendon/ligament occurs at the apophysitis due to excessive loading and repetitive microtrauma}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Terminology}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{17.67cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/siffi_1611425010_download (1).png}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{17.67cm}}{{\bf{Physis:}} Cartilaginous growth plate - near end of a long bone \newline {\bf{Epiphysis:}} Cap of a bone - located between growth plate and joint cartiliage \newline {\bf{Apophysis:}} Outgrowth - attachment for tendons/ligaments - attached to the host bone via growth plate}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Growth plates of the elbow}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Capitellum:}} appears at 1-2 years old, fuses at 10-15} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Radial Head:}} Appears at 2-5  years old - fuses at 12-16} \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Trochlea:}} Appears at 8-10 years old - fuses at 10-18} \tn 
% Row Count 6 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Olecranon:}} Appears at 8-10 years old - fuses at 13-16)} \tn 
% Row Count 8 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Lateral epicondyle:}} Appears 8-13 years old - fuses at 12-16} \tn 
% Row Count 10 (+ 2)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{{\bf{Medial Epicondyle:}} Appears at 2-8 years old - fuses at 15-17 (last to close)} \tn 
% Row Count 12 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Causes}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Usually child athletes (throwers)} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Overhead pitching (compressive stress on lateral elbow and valgus stress on medial)} \tn 
% Row Count 3 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Softball, tennis, racquetball, handball, javelin, water polo, gymnastics and weight lifting} \tn 
% Row Count 5 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Presentation}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Young athlete complaining of medial elbow pain in their throwing arm} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- often mid-late season - busy} \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Point tenderness over medial epicondyle} \tn 
% Row Count 4 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Swelling, elbow stiffness, inability to achieve full extension} \tn 
% Row Count 6 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- +ve valgus stress test \seqsplit{(Apprehension/discomfort)}} \tn 
% Row Count 7 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Neuro should be normal - Ulnar nerve should be checked} \tn 
% Row Count 9 (+ 2)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Core and hip instablity can affect biomechanics of elbow} \tn 
% Row Count 11 (+ 2)
% Row 7
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Check - scapular dyskinesis, dysfunction breathing, spinal instability, hip abductor weakness} \tn 
% Row Count 13 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Imaging}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Imaging only if unresponsive to conservative care/ another pathology is suspected, signigicant swelling and fixed flexion positioning should be imaged (avulsion/epicondylar f\#)} \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- MRI - occult osteocartilaginous pathology, ligament injury, and myotendinous findings} \tn 
% Row Count 6 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{DDx}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- F\#} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Avulsion} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Infection} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Neoplasm} \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Exotosis} \tn 
% Row Count 5 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Osteochondritis Dissecans} \tn 
% Row Count 6 (+ 1)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Meniscoid Lesion} \tn 
% Row Count 7 (+ 1)
% Row 7
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Cx radiculopathy (C8)} \tn 
% Row Count 8 (+ 1)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Ulnar neuropathy (CTS)} \tn 
% Row Count 9 (+ 1)
% Row 9
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Posteromedial impingement} \tn 
% Row Count 10 (+ 1)
% Row 10
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Sprain/strain - flexor/pronator tendon, MUCL, joint capsule} \tn 
% Row Count 12 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{17.67cm}{p{1.727 cm} p{1.727 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{17.67cm}}{\bf\textcolor{white}{Management}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Rest from offending activity - 4-6 weeks} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Encourage remaining active} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Splinting/wrist braces} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Ice for 10 minutes , 4 times per day} \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- NSAIDs/creams} \tn 
% Row Count 5 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Neurodynamic technique for ulnar and median nerves} \tn 
% Row Count 7 (+ 2)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Early strengthening of extension and supination until pt can tolerate flexion and pronation} \tn 
% Row Count 9 (+ 2)
% Row 7
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Progress to isotonic strengthening of wrist flexors, extensors, pronators and supinators (low resistance/high reps)} \tn 
% Row Count 12 (+ 3)
% Row 8
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Reverse Tyler Twist} \tn 
% Row Count 13 (+ 1)
% Row 9
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Strengthening of FCU and FDS} \tn 
% Row Count 14 (+ 1)
% Row 10
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Scpula stabilisation exercises (lower traps and serratus anterior)} \tn 
% Row Count 16 (+ 2)
% Row 11
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Shoulder external rotation and retraction exercises (Brugger, low row and lawmower)} \tn 
% Row Count 18 (+ 2)
% Row 12
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Core and hip exercises (Bridging, posterior lunges, semi-stiff deadlift, clams,)} \tn 
% Row Count 20 (+ 2)
% Row 13
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Gradual return to throwing when there is no longer point tenderness over medial elbow (no more than 10\%)} \tn 
% Row Count 23 (+ 3)
% Row 14
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Proper coach communication is important} \tn 
% Row Count 24 (+ 1)
% Row 15
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Pitchers should not : pitch on consecutive days/multiple games per day/on multiple teams with overlapping seasons} \tn 
% Row Count 27 (+ 3)
% Row 16
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{17.67cm}}{- Players should have 2-4 months breaks with no throwing} \tn 
% Row Count 29 (+ 2)
% Row 17
\SetRowColor{white}
\mymulticolumn{2}{x{17.67cm}}{- Consider surgical intervention if: Conservative care fails, MCL disruption, \textgreater{}2mm of medial epicondyle separation, avulsion f\# \textgreater{}5mm} \tn 
% Row Count 32 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}



\end{document}