The electronic databases MEDLINE, EMBASE, and PubMed were searched for relevant studies, and pertinent data were abstracted. The majority of shoulder injuries occur due to repetitive overhead movements, with baseball pitching being the most common mechanism for overuse injury. The rates of return to any level of pitching after UCLR ranged from 79% to 100%. There was a statistically significant decrease in fastball accuracy after reconstruction, which was present up to 3 years postoperatively ( P = .007). We prefer the 4-mm, 30-degree-angled arthroscope. From July 2010 to December 2013, 47 baseball players with throwing-induced elbow pain received imaging studies (CT and/or MRI) of the elbow at our institution. Recent advances in both nonoperative and operative treatment, including arthroscopic techniques, have afforded the athlete a successful return to competition. Athletes involved in sporting activities can suffer acute injuries or can develop overuse injuries that affect the elbow. This condition can be treated with a variety of nonsurgical methods, including rest, ice, and physical therapy. Median post-operative flexion was 145°, and extension was 0°. Average postoperative extension, flexion, pronation and supination had been changed into 0.7°, 137.3°, 79.1°, and 77.3°. There were no statistically significant differences in characteristic factors or presurgery performance statistics between poor and non--poor performers. 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. In the adolescent baseball pitcher, the significant forces imparted on the elbow during the pitching motion can result in tensile stress at the medial elbow, compression at the lateral elbow, and shearing/impingement at the posterior elbow. Attention to detail, especially when establishing the portals, is essential in, Valgus extension overload (VEO) can cause significant morbidity in the throwing athlete. Although elbow dislocations can cause acute lesions to the UCL, the most common cause of UCL injury is chronic valgus stress from overhead activities, like baseball pitching and javelin throwing. The arm bar test 18 and valgus overload test (or posteromedial impingement test). The strength of these conclusions is limited by the quality of the available literature and inconsistencies in the reporting of outcomes. With a more detailed knowledge of the injury mechanisms and up-to-date treatment options for these patients, physicians will be able to prevent and better treat medial elbow pain in overhead athletes. As a result, radiologists will increasingly be asked to evaluate elbow imaging of patients presenting with pain who have had UCL reconstruction. We predict that the KJOC score in our general throwing population will provide an accurate assessment of postoperative outcomes consistent with previously published reports. After assessment 10 articles were included: six for distal biceps rupture, one for MCL insufficiency, two for PLRI and one for lateral epicondylitis. On the basis of these data, we conclude that the effect of medial olecranon osteotomy on ulnar collateral ligament strain may be small. A total of 200 baseball players (198 male, 2 female; mean age, 16.1 years; age range, 13-27 years) who were diagnosed with an OSF from January 1987 to July 2012 were studied. The average preoperative modified Figgie score was 27.7 points (range, 17-43) for all patients. Level 4. All surgeries were performed by fellowship-trained surgeons using either the docking (n = 12) or modified Jobe technique (n = 21). Results: Assessed were patient age, sex, ethnicity, insurance status, and associated procedures, as well as hospital volume. Conservative management remains the mainstay of treatment, but surgical intervention may be advantageous in the appropriate patient. Reduced elbow valgus torques were associated with increased elbow flexion (P < .01). Throwing sports [4] -baseball is most common Overhead sports. Methods In this article, we review indications and surgical setup for wrist arthroscopy. Differential diagnosis can be complex, and treatment of VEO in isolation can exacerbate underlying UCL insufficiency. Website quality and accuracy were lower with use of the search term "pitcher's elbow" as compared with "elbow ulnar collateral ligament injury" or "tommy john injury" (P ≤ .001). The surgical treatment involves posterior olecranon osteophyte resection. 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. This study suggests that at moderate quasistatic valgus loads, ulnar collateral ligament strain is not significantly increased with posterior olecranon resection. The relative incidence of each of these was calculated, and the correlation between patholaxity and intra-articular pathology was evaluated. Prompt imaging evaluation facilitates ac "Valgus extension overload syndrome" refers to the clinical syndrome which may be seen in adolescent or skeletally-mature athletes. A comprehensive knowledge of elbow anatomy and biomechanical function of the elbow complex is prerequisite in the assessment of patients with elbow injuries; however, a thorough understanding of alternative and confounding pathologies is essential for accurate diagnosis. Noticewala MS, Vance DD, Trofa DP, Ahmad CS. VEO results from repetitive extreme valgus forces across the elbow and comprises a constellation of injuries located at the posteromedial compartment (osteophyte formation, olecranon stress fractures, and impingement), the ulnar collateral ligament (UCL), and the radiocapitellar joint (lateral compartment, Elbow injuries in throwing athletes can be challenging from the diagnostic and management perspectives. Case series; Level of evidence, 4. Of the 104 patients who were contacted, 6 patients felt that their symptoms had not improved after surgery. Elbow pain in overhead sport athletes is not uncommon. ConclusionsR-LCL plication produces subjective satisfaction and positive clinical results in patients presenting with a symptomatic minor instability of the lateral elbow (SMILE) at 2-year median follow-up. The presence of a palmaris longus should be ascertained if MCL reconstruction is anticipated. Three methods of spur resection have been published, and all have good outcomes with small patient numbers and limited follow-up. Results: The ulnar nerve travels through several canals or tunnels, and, like the better-known carpal tunnel syndrome, these tunnels can cause entrapment. 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. PurposeLateral epicondylitis is generally considered an extra-articular condition. There is no substitute for a careful clinical history and physical examination in not only establishing the diagnosis but ensuring that a complete diagnosis with its subsequent prognostic outcome can be rendered. Five baseball pitchers, three college and two professional, with an average age of 24 years, exhibited pain between the acceleration phase and follow-through phase of the pitching motion. Posteromedial elbow impingement is a specific injury pattern which may be seen as a component of valgus extension overload syndrome. 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. Therefore, it is imperative to further evaluate the disease process, diagnosis, and treatment of this condition to best manage our patients. Valgus extension overload: diagnosis and treatment. CT imaging manifestations of PMOI have seldom been previously reported. Inability to generate sufficient elbow varus torque may result in medial tension, lateral compression, or posteromedial impingement injury. Recent Findings Players with abnormal results were advised to visit the hospital. Abstract Injury to the medial collateral ligament of the elbow (MCL) can be a career-threatening injury for an overhead athlete without appropriate diagnosis and treatment. Methods: Olecranon stress fractures are a rare upper extremity fracture that primarily affects throwing athletes. We present normal arthroscopic elbow joint anatomy with magnetic resonance imaging correlation. Arthroscopy of the elbow poses significant The strain on the ulnar collateral ligament was slightly higher after the 8-mm and 12-mm cuts but not statistically significant. Identifying the location of pain and timing during the pitching phase helps … 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 [1]. However, most studies showed that UCLR was associated with a prolonged recovery and significant decline in pitching performance as objectively measured by in-game statistics. In: Baker C Jr, Plancher K, eds. Background: Of the 4 studies reporting fastball velocity, 3 cited decreased pitching velocities after UCLR. Two critical instants were 1) shortly before the arm reached maximum external rotation, when 67 N-m of shoulder internal rotation torque and 64 N-m of elbow varus torque were generated, and 2) shortly after ball release, when 1090 N of shoulder compressive force was produced. This laxity may cause bony abutment and impingement within the olecranon fossa, which in turn create posteromedial osteophytes. Valgus Extension Overload: Diagnosis and Treatment. Whenever PMOI is diagnosed in the pitching elbow of a baseball player, CT should be considered prior to surgical intervention as it will often provide additional information to the surgeon that may alter surgical management. The most common diagnosis for posterior elbow pain was posteromedial elbow impingement. The primary endpoint was the yearly rate of UCL reconstruction over time; secondary endpoints included patient demographics, institution volumes, and concomitant procedures on the ulnar nerve. Conclusion: The act of overhead throwing is an eloquent full-body motion that requires tremendous coordination from the time of force generation to follow-through. A thorough patient history and physical examination with appropriate diagnostic imaging is required to correctly identify the etiology of the elbow pain. Conclusion: When conservative measures fail, minimally invasive or arthroscopic surgical procedures can be used to address the problem. Among baseball-related elbow disorders, the incidence of OSFs was 5.4%. The minimal follow-up was 6 months and the maximum was 4 years, for a mean of 2.3 years. … Repetitive valgus forces on the throwing elbow place significant stress on that joint. Primary to provide an overview of diagnostic accuracy for clinical tests for common elbow (sport) injuries, secondary accompanied by reproducible instructions to perform these tests. Ten cadaveric arms underwent posterior olecranon resection in 4-mm increments. The KJOC score was administered to assess final functional outcome. Discussion: Purpose: Objective: To early diagnose and adequately treat the valgus extension overload syndrome in athletes. Further work is needed before definitive guidelines for olecranon osteotomy can be formulated. Dry needling of both contractile and non-contractile tissue in combination with retraining of faulty mechanics may encourage chronically injured ligamentous tissue healing and encourage safe return to sport. The sample was made up of 8 male athletes aged 26 years as average (range of 22 to 29 years), who practiced baseball (five pitchers and one outfielder), weightlifting (one) and javelin throw (one). 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. Results: The secondary purpose of this study was to determine which factors, if any, were predictive of poor performance after UCL reconstruction. gus, and extension forces indicating valgus extension overload. None of the described tests can provide adequate certainty to rule in or rule out a disease based on sufficient diagnostic accuracy. Study design: Combined disorders as well as the direction and form of the fracture line were analyzed on plain radiographs, computed tomography, and magnetic resonance imaging. Elbow pain can cause disability, especially in athletes, and is a common clinical complaint for both the general practitioner and the orthopaedic surgeon. 3. Ulnar collateral ligament injuries, snapping triceps, medial epicondylitis, and ulnar nerve pathology are presented with key features of clinical exam, diagnostic tests, and current aspects of treatment. A comprehensive literature search was performed in MEDLINE via PubMed and EMBASE. Radial head ballottement was the most common sign of patholaxity (42.9%). Of these, 27 (82%) returned to their sport at their previous level in an average of 12.25 months. There has been an estimated 10-fold increase in UCLR since the turn of the 21st century. 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. While it Information quality depends on the search term used, website authorship, and commercial bias. Doing so will allow radiologists to provide accurate interpretations that appropriately guide patient management. The established phases of the throwing motion will be reviewed in a stepwise manner and the contributions of osseous and soft-tissue structures to the successful completion of each phase will be discussed. VEO is characterized by reproducible … Valgus extension overload (VEO) is a syndrome of symptoms and physical findings commonly seen in overhead athletes because of an alteration in throwing biomechanics []. PurposeMinor instability has been proposed as a possible aetiology of lateral elbow pain. This study investigates the quality, accuracy, and readability of online information regarding ulnar collateral ligament (UCL) injuries. Dugas JR(1). After identifying the articles, the methodological quality was assessed using the QUADAS-2 checklist. Interested in research on Fractures, Stress? Methods: Management of common sports injuries of the hand, wrist, and medial elbow should be reviewed with consideration of return to play. Wrist arthroscopy is commonly performed as a diagnostic and therapeutic procedure and its indications are expanding. Learn vocabulary, terms, and more with flashcards, games, and other study tools. We describe our technique—including pearls and pitfalls, as well as advantages and disadvantages—which combines the docking technique, through a flexor muscle-elevating approach with transposition of the ulnar nerve using a fascial sling. ResearchGate has not been able to resolve any references for this publication. Study Design Ice, anti-inflammatory medications, and even physical therapy can be helpful for early symptoms of valgus extension overload. Using case examples, we demonstrate common elbow pathologies and discuss newly emerging indications for elbow arthroscopy. Examination for valgus extension overload syndrome should be performed when there is posteromedial olecranon tenderness or concern for posterior injury in a throwing athlete. At the glenohumeral joint, compressive force, joint laxity, and 380 N of anterior force during arm cocking can lead to anterior glenoid labral tear. Conclusion: Am J Orthop 2016;45:144-151. Treatment options for valgus extension overload Initially treatment centers on rest or avoiding activities that recreate the pain. No patients were performed other operation for elbow pain. A retrospective review of 33 patients undergoing UCL reconstruction was carried out during a 5-year period between 2004 and 2009. Results: The most frequent intra-articular findings are synovitis and lateral capitellar chondropathy, which correlate significantly with the presence of lateral ligamentous patholaxity. Resources on Valgus extension overload and related topics in OrthopaedicsOne spaces. Retrospective Case Report. In this article, we review indications and surgical setup for elbow arthroscopy. Conclusions Tension in the biceps tendon, due to muscle contraction for both elbow flexion torque and shoulder compressive force, may tear the anterosuperior labrum. Methods The stress of repetitive throwing does predispose athletes to certain conditions with which treating clinicians need to be familiar. Injury to the ulnar collateral ligament (UCL) often results in valgus elbow instability requiring reconstruction. Rapid internal rotation in combination with these forces can produce a grinding injury factor on the labrum. The mean presurgery fastball pitch-to-target distance was 32.9 cm. Ulnar nerve entrapment can be a cause of elbow, wrist, and hand pain. After each bone resection, three different valgus loads were applied to the elbow at 70 degrees and 90 degrees of flexion. Valgus extension overload: diagnosis and treatment. The overall average KJOC score was 76. 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. It further details the arthroscopic surgical technique to successfully treat patients with VEO. © 2015 The Author(s). Subgroup analysis revealed that 79% to 87% of Major League Baseball (MLB) pitchers returned to preinjury levels of pitching. In this chapter, we included a discussion of the most common cases of posterior elbow pain, analyzed for biomechanics, history, clinical presentation, imaging, and treatment. Data sources The onset of trunk rotation, with other biomechanical variables that define sequential body motion, will significantly predict elbow valgus loading. The most common diagnoses were posteromedial olecranon osteophyte (65%), ulnar collateral ligament injury (25%), and ulnar neuritis (15%). Characteristic factors and presurgery performance statistics were compared between poor performers (>20% decrease in fastball accuracy) and non—poor performers. Players who visited the hospital were initially treated conservatively and underwent surgery if necessary. The biomechanical findings of this study offer scientific feedback for developing methods used to minimize the effects of valgus load on pitching-related elbow injuries. A revived dedication to the physical examination may enhance our ability to correctly diagnose various pathologies about the elbow. Cirurgia Ortopédica de Aumento do Desempenho Desportivo - Mito ou Realidade? When mandated by the presence of a loose body or areas of cartilage wear in the anterior compartment, especially medially, a … ResearchGate has not been able to resolve any citations for this publication. If conservative management including rest, nonsteroidal anti-inflammatory drugs, and steroid injections fail, arthroscopic evaluation with debridement and resection of the posteromedial olecranon osteophytes may be performed. Although much work has been done on injury prevention in youth who are pitchers, overuse injury in throwing sports constitutes an epidemic. © 2008-2020 ResearchGate GmbH. Physical examinations related to posterior elbow injuries were positive in 13.2% of high school baseball players. We retrospectively reviewed a convenient sample of 172 patients who underwent 187 arthroscopies of the elbow over a 7-year period. This new system was strongly influenced by the age at symptom onset. 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. A significant osteophyte on the posteromedial aspect of the olecranon process was identified in all pitchers. Valgus extension overload syndrome, also known as pitcher's elbow, refers to a constellation of symptoms and pathologies commonly seen in overhead throwing athletes secondary to high repetitive tensile, shear and compressive forces generated by the overhead throwing motion. Failure of. Medial elbow injuries in the throwing athlete are common and increasing in frequency. A condition of late trunk rotation, reduced shoulder external rotation, and increased elbow flexion appeared to be most closely related to valgus torque. Introduction: valgus extension overload (posteromedial shock) is a type of injure that is relatively frequent in throwing athletes and may require surgical procedures to be performed so that the athlete can keep on competing. Valgus extension overload (VEO) can cause significant morbidity in the throwing athlete. Appropriate diagnosis is necessary for appropriate treatment, and ulnar entrapment should be considered in patients with weakness or clumsiness of the hand. The functional results according to Conway's scale were excellent in 5 patients, good in two and unsatisfactory in just one patient. ... Sports injuries are a common cause of ulnar nerve entrapment (Tables 38.1 and 38.2). Am J Sports Med 1983; Outcome of Elbow Surgery in Professional Baseball Players, Bony Injuries Of The Wrist, Forearm, And Elbow, Arthroscopy of the elbow: A long-term clinical review, Relationship of Ulnar Collateral Ligament Strain to Amount of Medial Olecranon Osteotomy, Posterior olecranon resection and ulnar collateral ligament strain, Elbow injuries in the throwing athlete. R-LCL plication was performed in the presence of at least one sign of lateral ligamentous patholaxity and one intra-articular abnormal finding. Conventional DASH and Sport-Specific scale on the DASH and the numeric pain rating scale improved beyond both the minimally clinically important difference and minimal detectable change over the 12 week treatment(3,4) At 24-week follow up, conventional DASH scores decreased from 34.20% disability to 3.33% disability while sport-specific DASH scores decreased from 100% disability to 31.25% disability. Valgus extension overload (VEO) is a condition observed in overhead athletes that results from laxity of the ulnar collateral ligament (UCL). With an average follow up of 1 year, all of the pitchers returned for one full season at maximum effectiveness. Purpose: Valgus extension overload (VEO) is a constellation of symptoms and pathology commonly seen in the overhead athlete. Please check the hierarchy of the section headings and correct if necessary. 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