Pitcher’s elbow: medial elbow pain in the overhead-throwing athlete

Abstract

Overhead athletes subject their elbows to significant valgus stresses throughout the throwing cycle. A steady rise in the number of medial-sided elbow injuries over the years has lead to increased awareness regarding the pathophysiology of the Bpitcher's elbow.^As our understanding of the functional anatomy and throwing biomechanics has become more sophisticated, we have seen a concurrent improvement in the outcomes associated with managing these injuries. Despite this improvement, continued anatomical and biomechanical research is still needed to further optimize outcomes and return to sport.

Elbow arthroscopy - Indications and technique

“…Valgus extension overload syndrome (VEOS) occurs mostly in the overhead throwing athletes and is also named 'Pitcher's elbow'. 2,[20][21][22] Laxity of the ulnar collateral ligament (UCL) leads to valgus instability of the elbow, ulnar nerve inflammation, tendinitis of the flexor pronator mass, apophysitis, OCD of the capitellum, trochlear chondromalacia, stress fractures of the olecranon and/or osteophyte formation and loose bodies in the posterior compartment of the elbow. 2,5,20e22 Osteophytes and loose bodies in the posterior compartment of the elbow may lead to posteromedial impingement (see Fig.…”

“…3). 20 Patients will complain of pain posterior or posteromedial, a feeling of instability on the medial side of the elbow during a throw, loss of extension and locking or catching. 20e22 Failure of nonoperative treatment for VEOS is an indication for arthroscopic surgery.…”

“…During arthroscopy, the UCL should also be evaluated for insufficiency and repaired if indicated. 2,5,20,22 After an intensive rehabilitation program, the return to sports at the same level in the motivated athlete is about 85%. 20…”

“…2,5,20,22 After an intensive rehabilitation program, the return to sports at the same level in the motivated athlete is about 85%. 20…”

Review of Jobe et al (1986) on reconstruction of the ulnar collateral ligament in athletes

“…Injuries to the UCL typically occur in the overhead throwing population, especially baseball pitchers and javelin throwers, but can also be found in other athletes, including gymnasts, quarterbacks, tennis players and wrestlers 8. The UCL is composed of three bundles, of which the anterior bundle is the main soft tissue restraint to valgus instability at 20°–120° of elbow flexion (figure 1).…”