Korean J Sports Med.  2017 Sep;35(2):86-90. 10.5763/kjsm.2017.35.2.86.

Elbow Impingement Syndrome in Athletes

• Hyun H
• Park I
• Lee J
• Shin SJ

• KMID: 2389647
• DOI: http://doi.org/10.5763/kjsm.2017.35.2.86

Abstract

Overhead athletes often suffer from elbow injuries due to repetitive throwing movements. In particular, in the baseball pitching motion, a high shear torque generated in the late corking and early acceleration stage causes tensile loads on the medial elbow and shear force on the posterior of the elbow. These repetitive movements can lead to valgus extension overload syndrome. The valgus extension overload syndrome mainly occurs in overhead athletes, and is characterized by limited elbow flexion and pain at the end of extension. It is necessary to differentiate from the stress fracture or the avulsion fracture of the olecranon which complain of posterior elbow pain through computed tomography. The treatment is primarily rehabilitation that restricts the elbow motion. If refractory or mechanical symptoms persist, arthroscopic surgery may be an effective treatment modality for the removal of the osteophytes. In the surgical field, it is desirable to reconstruct the medial collateral ligament when it is confirmed that the ligament is ruptured. Patients who underwent arthroscopic removal of olecranon osteophytes had immediate active elbow exercises and for 3 months were prohibited from pitching exercises. During this period, they were rehabilitated with the focus on strengthening muscles around the scapula, rotator cuff and shoulder. After 3 months, the pitching exercise is gradually started. Six months after the operation, the elbow strength should be restored to the level at which the game starts. Patients who underwent a combined ulnar collateral ligament reconstruction, half pitching are allowed at 6 months.

Keyword

Valgus extension overload syndrome; Ulnar collateral ligament; Baseball player; Pitcher

MeSH Terms

Acceleration
Arthroscopy
Athletes*
Baseball
Collateral Ligaments
Elbow*
Exercise
Fractures, Stress
Humans
Ligaments
Muscles
Olecranon Process
Osteophyte
Rehabilitation
Rotator Cuff
Scapula
Shoulder
Torque

Figure

• 

  Fig. 1 Valgus extension snap maneuver. (A) Examiner places valgus stress with elbow at 90° of flexion. (B) Elbow is quickly extended to approximately 30o with continuous valgus stress.

• 

  Fig. 2 Computed tomography imaging of valgus extension overload syndrome.

Reference

1. Posner M, Cameron KL, Wolf JM, Belmont PJ Jr, Owens BD. Epidemiology of major league baseball injuries. Am J Sports Med. 2011; 39:1676–1680.

2. Ahmad CS, Conway JE. Elbow arthroscopy: valgus extension overload. Instr Course Lect. 2011; 60:191–197.

3. Badia A, Stennett C. Sports-related injuries of the elbow. J Hand Ther. 2006; 19:206–226.

4. Gerbino PG. Elbow disorders in throwing athletes. Orthop Clin North Am. 2003; 34:417–426.

5. Vitale MA, Ahmad CS. The outcome of elbow ulnar collateral ligament reconstruction in overhead athletes: a systematic review. Am J Sports Med. 2008; 36:1193–1205.

6. Cain EL Jr, Dugas JR, Wolf RS, Andrews JR. Elbow injuries in throwing athletes: a current concepts review. Am J Sports Med. 2003; 31:621–635.

7. Morrey BF, An KN. Functional anatomy of the ligaments of the elbow. Clin Orthop Relat Res. 1985; (201):84–90.

8. Werner SL, Fleisig GS, Dillman CJ, Andrews JR. Biomechanics of the elbow during baseball pitching. J Orthop Sports Phys Ther. 1993; 17:274–278.

9. Pappas AM, Zawacki RM, Sullivan TJ. Biomechanics of baseball pitching: a preliminary report. Am J Sports Med. 1985; 13:216–222.

10. Fleisig GS, Andrews JR, Dillman CJ, Escamilla RF. Kinetics of baseball pitching with implications about injury mechanisms. Am J Sports Med. 1995; 23:233–239.

11. Ahmad CS, Lee TQ, ElAttrache NS. Biomechanical evaluation of a new ulnar collateral ligament reconstruction technique with interference screw fixation. Am J Sports Med. 2003; 31:332–337.

12. Regan WD, Korinek SL, Morrey BF, An KN. Biomechanical study of ligaments around the elbow joint. Clin Orthop Relat Res. 1991; (271):170–179.

13. van den Bekerom MP, Eygendaal D. Posterior elbow problems in the overhead athlete. Sports Med Arthrosc. 2014; 22:183–187.

14. Rossy WH, Oh LS. Pitcher's elbow: medial elbow pain in the overhead-throwing athlete. Curr Rev Musculoskelet Med. 2016; 9:207–214.

15. Bennett GE. Shoulder and elbow lesions distinctive of baseball players (1947). Clin Orthop Relat Res. 2012; 470:1531–1533.

16. Wilson FD, Andrews JR, Blackburn TA, McCluskey G. Valgus extension overload in the pitching elbow. Am J Sports Med. 1983; 11:83–88.

17. Andrews JR, Timmerman LA. Outcome of elbow surgery in professional baseball players. Am J Sports Med. 1995; 23:407–413.

18. Thompson WH, Jobe FW, Yocum LA, Pink MM. Ulnar collateral ligament reconstruction in athletes: muscle-splitting approach without transposition of the ulnar nerve. J Shoulder Elbow Surg. 2001; 10:152–157.

19. Park JY, Yoo HY, Chung SW, et al. Valgus extension overload syndrome in adolescent baseball players: clinical characteristics and surgical outcomes. J Shoulder Elbow Surg. 2016; 25:2048–2056.

20. Kamineni S, ElAttrache NS, O'driscoll SW, et al. Medial collateral ligament strain with partial posteromedial olecranon resection: a biomechanical study. J Bone Joint Surg Am. 2004; 86:2424–2430.

21. Levin JS, Zheng N, Dugas J, Cain EL, Andrews JR. Posterior olecranon resection and ulnar collateral ligament strain. J Shoulder Elbow Surg. 2004; 13:66–71.