Andrews J, Launer E. Valgus extension overload syndrome. Most athletes improve substantially with rest and nonoperative treatment, although some athletes may require surgical intervention to return to play. Despite these perceived advantages, some data suggest that early sport specialization does not lead to a competitive advantage over athletes who participate in multiple sports. Posterior elbow pain is a common problem in the throwing athlete due to adaptive bony and soft tissue changes in response to valgus extension overload (VEO) syndrome. With proper attention to anatomical landmarks for portal placement and meticulous surgical technique, arthroscopic evaluation and treatment of posterior elbow pain can be safely accomplished in the throwing athlete with minimal risk. Dugas JR(1). The most common diagnosis for posterior elbow pain was posteromedial elbow impingement. Ten cases returned to their own position. The primary purpose of this study was to determine the effects of UCL reconstruction on fastball accuracy, fastball velocity, and curveball movement in MLB pitchers. The term "high-level athlete" may include adolescents and high school students, collegiate athletes, and of course, the professional athlete. Study design: The importance of physical examination and provocative examination maneuvers must be stressed in a technologically advanced era where clinical diagnosis is too commonly attained solely by advanced imaging modalities. Early and accurate clinical diagnosis is the first step in the proper initiation of treatment modalities and improvement in overall patient outcome. Removal of loose bodies and resection of impinging olecranon osteophytes produced the best functional results. Accurate diagnosis and proper treatment of elbow injuries in the throwing athlete requires a thorough understanding of elbow function and anatomy, as well as an understanding of throwing mechanics and pathomechanics. After retrospectively reviewing the clinical records and imaging studies, 31 of the 47 players were diagnosed with PMOI by the criteria of posteromedial elbow pain with clinical consistency for PMOI and characteristic osteoarthrosis at the posteromedial ulnotrochlear articulation (posteromedial olecranon space, PMOS) detected by CT and/or MRI. It is essential for radiologists to understand the normal and abnormal imaging appearances after UCL reconstruction and ulnar nerve transposition, which is also commonly performed in overhead-throwing athletes. Thirteen biomechanical variables were calculated and extracted for regression analysis to investigate their associations with elbow valgus load. It is commonly seen in patients participating in throwing sports, such as baseball. Valgus extension overload (VEO) is a constellation of symptoms and pathology commonly seen in the overhead athlete. A total of 33 athletes underwent UCL reconstruction-30 baseball players and 3 javelin throwers. Results: Players who initiated trunk rotation before front-foot contact had significantly higher elbow valgus torques than did those who rotated afterward (P = .02). Players with abnormal results were advised to visit the hospital. The majority of shoulder injuries occur due to repetitive overhead movements, with baseball pitching being the most common mechanism for overuse injury. Valgus extension overload: diagnosis and treatment. Because tendinopathy, tendonitis, and tendon tears have an anatomic basis for their pathology, a targeted history and meticulous physical examination often yields an accurate clinical diagnosis. In conclusion, arthroscopy of the elbow is an effective diagnostic procedure and is effective in treating certain intraarticular problems with minimal morbidity and rapid return to function. Of these, 27 (82%) returned to their sport at their previous level in an average of 12.25 months. History and physical examination are important for the accurate diagnosis and treatment of valgus extension overload (VEO) since many high-level throwers will have asymptomatic findings on imaging studies. This review presents the current knowledge about olecranon spur anatomy, pathophysiology, clinical presentation, diagnosis, treatment options and their outcomes, as well as clarification of the terms "spur" and "osteophyte". Elbow arthroscopy is commonly performed as a diagnostic and therapeutic procedure. The overhead throwing motion subjects the elbow to a predictable pattern of forces, including medial tension, lateral compression, and posterior shear, that in turn result in a predictable pattern of injuries. Olecranon stress fractures are a rare upper extremity fracture that primarily affects throwing athletes. Normally, as the elbow extends, stabilizers including the UCL and flexor pronator mass ensure conforming motion across the ulnotrochlear â¦ The PubMed and Google Scholar databases were searched using the terms "olecranon spur," "olecranon traction spur," and "olecranon osteophyte." Assessed were patient age, sex, ethnicity, insurance status, and associated procedures, as well as hospital volume. Emphasis on public education on the risks of overuse throwing injuries and the importance of adhering to preventative guidelines is essential in youth baseball today. Methods: Average preoperative extension, flexion, pronation and supination were 2.3°, 138.2°, 76.4°, and 69.1°. The mean presurgery fastball pitch-to-target distance was 32.9 cm. Removing the least amount of olecranon tip while still adequately addressing the impingement lesions may offer the lowest risk of overloading the ulnar collateral ligament. Before the first UCL reconstruction, performed by Frank Jobe in 1974, this injury was considered career ending in overhead athletes. If the UCL or dynamic flexorpronator musculature is incompetent, elbow extension and valgus torque, as seen in throwing, can result in posteromedial impingement with subsequent chondromalacia and osteophyte formation. The strength of these conclusions is limited by the quality of the available literature and inconsistencies in the reporting of outcomes. The excessive forces to which the elbow is exposed during the throwing motion comprise 64 Nm of valgus stress during the late cocking and acceleration phases, 300 N of medial shear force as the elbow extends at over 2300°/s during the acceleration phase and 900 N of lateral compressive force during the deceleration phase . Appropriate expectations with regard to both treatment and the possible return to sports are critical in providing successful treatment for these often complex injuries. Page: Tibial shaft stress fracture (OrthopaedicsOne Articles) Page: Head injuries (OrthopaedicsOne Articles) The mean ± SD age was 21.6 ± 8.89 years, and there was a significant trend for an increased frequency in UCL reconstruction in patients aged 17 to 18 and 19 to 20 years (P < .001). Using case examples and MRI–arthroscopy correlation, we demonstrate common wrist pathologies and discuss updates in surgical classification of wrist disorders such as Kienböck’s disease and intrinsic wrist ligament tears. This study investigates the quality, accuracy, and readability of online information regarding ulnar collateral ligament (UCL) injuries. The Skeletally Immature and Newly Mature Throwing Athlete, Classification of Olecranon Stress Fractures in Baseball Players, Correlation of Throwing Mechanics With Elbow Valgus Load in Adult Baseball Pitchers, Kinetics of Baseball Pitching with Implications About Injury Mechanisms, 17 Analysis of the Pitching Arm of the Professional Baseball Pitcher. Our hypothesis was that MLB pitchers who underwent UCL reconstruction would return to their presurgery fastball velocity, fastball accuracy, and curveball movement. Ulnar collateral ligament (UCL) tears and associated Tommy Johns surgical intervention from excessive and poor quality pitching has increased immensely-with more college and professional pitchers undergoing the surgery in 2014 alone than in the 1990s as a whole. Our study demonstrates consistent outcomes for UCL reconstruction using the KJOC shoulder and elbow score compared with previously reported data. All studies were of level 3 or 4 evidence, and the mean ± SD MINORS score was 14.4 ± 3.0, which indicates fair quality of evidence for nonrandomized studies. Our purpose is to investigate the additional value of CT imaging in the evaluation of PMOI. Rapid internal rotation in combination with these forces can produce a grinding injury factor on the labrum. A total of 576 Japanese high school baseball players who participated in baseball skill training camp during the off-season were enrolled in the study. The most frequent intra-articular findings are synovitis and lateral capitellar chondropathy, which correlate significantly with the presence of lateral ligamentous patholaxity. Athletes involved in sports that involve repetitive motion, such as throwing, hitting balls, or lifting weights repeatedly, can develop chronic overuse of supporting ligaments and musculotendinous structures around the elbow. Physical examinations related to posterior elbow injuries were positive in 13.2% of high school baseball players. Magnetic resonance imaging (MRI) is an excellent tool for the evaluation of joint pathology due to its high sensitivity as a result of high contrast resolution for soft tissues. Significantly more strain occurred on the ulnar collateral ligament at 90 degrees compared with 70 degrees of elbow flexion. Dieses Kapitel soll diesen Prozess transparenter machen, um die wichtigsten Pathologien erkennen und behandeln zu können. However, if just this posterior osteophyte is removed, the described lesion will be missed, with resultant persistent disability. Arthroscopy of the elbow appears to be a safe and efficacious procedure with a relatively low complication rate. After exclusion for lack of return to play (n = 14) and revision surgery (n = 3), 39 pitchers were included in the final analysis. Sidearm pitchers appeared to be more susceptible than overhand pitchers to reduced elbow valgus torque. Clin Sports Med. Those who were unable to return to play had a mean score of 69. Conclusions There were no statistically significant differences in characteristic factors or presurgery performance statistics between poor and non--poor performers. The more commonly identified posterior osteophyte was present in all cases. gus, and extension forces indicating valgus extension overload. We retrospectively reviewed a convenient sample of 172 patients who underwent 187 arthroscopies of the elbow over a 7-year period. Despite the increased incidence of UCL reconstruction, the rate of revision UCL reconstruction surgery has decreased, likely secondary to improved surgical techniques and rehabilitation protocols. Author information: (1)American Sports Medicine Institute, 2660 10th Avenue South, Suite 505, Birmingham, AL 35205, USA. The physeal type was further separated into stages 1 to 4 based on severity. Background: Characteristic factors and presurgery performance statistics were compared between poor performers (>20% decrease in fastball accuracy) and non—poor performers. Post-operative flexion was restrained in seven patients and extension in eight patients; 59% of patients reached full ROM at final follow-up. A significant correlation was found between the presence of lateral ligamentous patholaxity signs and capitellar chondropathy (p = 0.0409), as well as anteromedial synovitis (p = 0.0408). Of the 104 patients who were contacted, 6 patients felt that their symptoms had not improved after surgery. The purpose of this case study was to describe an innovative, multimodal approach to conservative management of a chronic UCL injury in a college-aged baseball pitcher. Careful history taking, thorough physical examination, and judicious diagnostic imaging allow clinicians to correctly diagnose ulnar collateral ligament (UCL) injury. One of the greatest challenges when examining an injured athlete is ensuring that the examination encompasses the whole patient and not just the obvious deformity. The mean age for each type identified was as follows: physeal, 14.1 years; classic, 18.6 years; transitional, 16.9 years; sclerotic, 18.0 years; and distal, 19.6 years. Wilson FD. Methods: It is important to recognize that VEO may occur in combination with other injuries in the elbow and specifically, an injury to the ulnar collateral ligament (UCL) with resultant micro or macro instability must be ruled out as the underlying cause.