Chebli, Caroline M; Murthi, Anand
Repetitive throwing imparts a high valgus and extension stress to the athlete’s elbow. Once the dynamic stabilizers of the elbow, the flexor pronator mass, are fatigued, the stresses are transferred to the ulnar collateral ligament. Attenuation of the ulnar collateral ligament, in turn, produces increasing loads to the posteromedial olecranon leading to osteophytes and the valgus extension overload syndrome. A history and physical in combination with elbow radiographs and magnetic resonance arthrography are used in the diagnosis of valgus extension overload. Initial treatment is nonoperative consisting of anti-inflammatories and a strict physical therapy regimen to regain strength and range of motion. If nonoperative treatment fails, surgical intervention is necessary. Elbow arthroscopy is used to debride the elbow joint and posteromedial olecranon osteophytes. If the integrity of the ulnar collateral ligament is compromised, then reconstruction must be undertaken to provide stability and prevent recurrence of the valgus extension overload syndrome. A regimented rehabilitation program must be followed. Return to sports is possible three months following arthroscopic debridement of the elbow. Waiting nine months to a year is often required if reconstruction of the ulnar collateral ligament is performed.
Current Opinion in Orthopedics. 15(4):311-315, August 2004.