Evaluation and management of elbow injuries in the adolescent overhead athlete

Abstract

With an increased interest in youth sports, the burden of overhead throwing elbow injuries accompanying early single-sport focus has steadily risen. During the overhead throwing motion, valgus torque can reach and surpass Newton meters (N m) during the late cocking and early acceleration phases, which exceeds the tensile strength (22.7–33 N m) of the ulnar collateral ligament. While the ulnar collateral ligament serves as the primary valgus stabilizer between and degrees of elbow flexion, other structures about the elbow must contribute to stability during throwing. Depending on an athlete’s stage of skeletal maturity, certain patterns of injury are observed with mechanical failures resulting from increased medial laxity, lateral-sided compression, and posterior extension shearing forces. Together, these injury patterns represent a wide range of conditions that arise from valgus extension overload. The purpose of this article is to review common pathologies observed in the adolescent overhead throwing athlete in the context of functional anatomy, osseous development, and throwing mechanics. Operative and non-operative management and their associated outcomes will be discussed for these injuries.

Systematisches Rehaprogramm für Handballtorhüter mit chronischen Ellenbogenproblemen

“…Ein wichtiger Unterschied zwischen den früheren Studien und dem Sommerprogramm besteht darin, dass sowohl Tyrdal et al als auch Aggeliki et al als Ursache der Beschwerden nur die häufige Hyperextension beim Abwehren des Balls in Betracht zogen und den Einfluss der Valgusbelastung nicht berücksichtigten 2 , 20 . Stattdessen wurde bei den Teilnehmern des Sommerprogramms besonderes Augenmerk auf die Kräftigung des M. flexor carpi ulnaris (FCU), des M. flexor digitorum superficialis (FDS) und des M. pronator teres (PT) gelegt, da diese Muskeln bekanntermaßen für die aktive Stabilität des Ellenbogens sorgen, wenn es darum geht, die Valgusbewegung zu hemmen und somit das mediale Seitenband (MCL) zu unterstützen 1 , 2 , 8 , 9 , 11 , 20 .…”

“…2 ). Das Training genau dieser Muskelstrukturen kann daher von großem Wert für die aktive Stabilisierung des Ellenbogens sein 9 , 11 , 21 .…”

Intermediate Outcomes of Medial Ulnar Collateral Ligament Reconstruction Using Gracilis Allograft in Adolescent Patients

“…Early specialization in sports resulting in increasing incidences of medial ulnar collateral ligament (UCL) injuries in overhead throwing athletes and other sports—including wrestling, soccer, and gymnastics—has increased remarkably over the past 2 decades. 3 , 7 , 13 , 15 Young athletes aim to reach higher echelons of competition while skeletally immature. Youth also participate in various high-risk activities such as riding in all-terrain vehicles and participating extreme sports, resulting in accidental trauma that may involve the elbow.…”

Extra-articular core tunneling and local autogenous bone grafting for osteochondritis dissecans lesion of the capitellum with intact articular cartilage and subchondral bone deficiency

“…OCD most commonly occurs in the knee and is also seen in the dominant elbows of overhead-throwing athletes resulting from valgus loading associated with throwing. 9 , 13 Early stages present with poorly localized pain and tenderness over the lateral elbow, which resolves with rest, while later stages may present with loss of extension, catching, and locking of the elbow. 13 , 2 , 5 …”

“… 9 , 13 Early stages present with poorly localized pain and tenderness over the lateral elbow, which resolves with rest, while later stages may present with loss of extension, catching, and locking of the elbow. 13 , 2 , 5 …”