The presence of a palmaris longus should be ascertained if MCL reconstruction is anticipated. The procedures were performed primarily by 7 different surgeons, using all 3 standard operating positions and a variety of arthroscopic portals. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. 4. The amount of posteromedial olecranon that can be resected before ulnar collateral ligament strain, and risk of injury, increases is unknown. Purpose: Conclusions Athletes in many sports may experience VEO and other common pathologies related to the high repetitive stresses generated by the overhead throwing motion. The purpose of this review is to describe the non-operative approach to managing UCL injuries, including recommended rehabilitation strategies and predictors of successful non-operative treatment. Those who were unable to return to play had a mean score of 69. Interventions included addressing strength deficits throughout the body, dry needling, and sport-specific biomechanical training with pitching form analysis and correction. Results: eight patients were operated on, four of them presented with neuropathy from compressed cubital nerve at the elbow; four underwent transfer of their cubital nerve, two subcutaneous and two with a pulley with flexor pronator fascia. VEO also causes pain, swelling, and possible numbness. Our study demonstrates consistent outcomes for UCL reconstruction using the KJOC shoulder and elbow score compared with previously reported data. Elbow pain in overhead sport athletes is not uncommon. We believe that the technique and the identification of anatomic structures described in this article provide a safe and reliable means of performing this procedure. Discussion: Accurate diagnosis and proper treatment of elbow injuries in the throwing athlete requires a thorough understanding of elbow function and anatomy, as well as an understanding of throwing mechanics and pathomechanics. ligament tears; fractures; Volkmann's contracture; brachial artery and/or median nerve resulting in permanent Although initially unable to compete due to high pain levels, the subject is currently completing his pitching role full-time with 1/10 max pain. osteophytes and loose bodies, culminating in valgus extension overload syndrome (VEO).2,3 Overhead athletes with VEO have a painful throwing motion and decreased throwing velocity. Ulnar collateral ligament reconstruction (UCLR) has revolutionized the management of this injury, allowing a greater proportion of pitchers to return to play. Treatment of VEO syndrome initiates with conservative measures like active rest, physiotherapy, and non-steroid anti-inflammatory medication but may require arthroscopy with osteophyte removal and medial corner olecranon osteotomy in refractory cases. For arthroscopy of the athlete's elbow and treatment of the sequelae of valgus extension overload, the previously described portals usually suffice, and a medial portal is not usually necessary. Valgus extension overload (VEO) is a constellation of symptoms and pathology commonly seen in the overhead athlete. Retrospective Case Report. MLB pitchers who underwent UCL reconstruction surgery between 2011 and 2012 were identified. Online information on UCL injuries is often inaccurate and written at an inappropriate reading level. Valgus extension overload (VEO) is a constellation of symptoms and pathology commonly seen in the overhead athlete. This innovative approach utilizes both contractile and non-contractile dry needling to enhance soft tissue healing combined with standard conservative treatment to decrease pain and improve sport performance as measured by the Disabilities of Arm, Shoulder and Hand (DASH), Numeric Pain Report Scale (NPRS), and return to sport. Reading level was significantly correlated with website accuracy and quality (P ≤ .001) and physician authorship (P = .012). The incidence of olecranon stress fractures are increasing owing to the number of patients playing and the volume of engagement in competitive sports, especially in the pediatric population. 2010; 29(4):645-54 (ISSN: 1556-228X) Dugas JR Valgus extension overload (VEO) is a constellation of symptoms and pathology commonly seen in the Reduced elbow valgus torques were associated with increased elbow flexion (P < .01). A thorough history and physical examination of the thrower's elbow frequently establishes the diagnosis for pain. Sixty-nine adult baseball players pitched off an indoor mound during 3-dimensional motion analysis to measure whole body kinematics and kinetics at 240 Hz. Background: Case description: Results 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 … It is important to recognize that VEO may occur in combination with other injuries in the elbow and specifically, an injury to the ulnar collateral ligament (UCL) with resultant micro or macro instability must be ruled out as the underlying cause. 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]. Small sample size, elderly specimens, and the variables inherent in the experimental setup and mathematical modeling make it difficult to extrapolate these results to in vivo behavior of the anterior ulnar collateral ligament. Wilson FD. Falls onto the outstretched hand, sudden loading, or direct trauma can result in elbow dislocation, fracture, or tendon rupture. Synovitis was the most common intra-articular aspect of pathology (77.1%), followed by lateral capitellar chondropathy (40.0%). Among baseball-related elbow disorders, the incidence of OSFs was 5.4%. Performance data including fastball velocity, fastball accuracy, and curveball movement were evaluated 1 year preoperatively and up to 3 years of play postoperatively. A revived dedication to the physical examination may enhance our ability to correctly diagnose various pathologies about the elbow. All rights reserved. With proper attention to anatomical landmarks for portal placement and meticulous surgical technique, arthroscopic evaluation and treatment of posterior elbow pain can be safely accomplished in the throwing athlete with minimal risk. These abnormal forces can result in a multitude of distinct injuries, including ulnar collateral ligament tears and sprains, flexor-pronator mass tears and strains, ulnar neuritis, posteromedial impingement, olecranon stress, Valgus extension overload (VEO) is a constellation of symptoms and pathology commonly seen in the overhead athlete. The illegal use of drugs to enhance performance is widely known in sports, however the administration of illegal substance may not be the only dishonest way to enhance athlete's performance. Conservative management remains the mainstay of treatment, but surgical intervention may be advantageous in the appropriate patient. The mean age for each type identified was as follows: physeal, 14.1 years; classic, 18.6 years; transitional, 16.9 years; sclerotic, 18.0 years; and distal, 19.6 years. Various posterior elbow problems cause posterior elbow pain among baseball players. Am J Sports Med. The posteromedial impingement syndrome is caused by a mechanical constraint by bony or soft tissue in the posteromedial side of the elbow. Results: There were 5 types of OSFs identified in the new classification system: physeal, classic, transitional, sclerotic, and distal. The most common diagnosis for posterior elbow pain was posteromedial elbow impingement. Elbow and shoulder kinetics for 26 highly skilled, healthy adult pitchers were calculated using high-speed motion analysis. All patients had their charts and radiographs reviewed, and 104 of these patients were also contacted for a telephone interview at an average follow-up of 42.3 months (range, 7 to 115 months). While a few of these injuries may require operative management, the majority of these athletes can be treated with throwing cessation, anti-inflammatory agents, and progressive physical therapy. Olecranon stress fractures are rare, but can cause significant discomfort and, if unrecognized or untreated, can lead to significant pain and dysfunction. Methods The average recovery period was 77 ± 47 days. This article has reviewed the anatomy, biomechanics, and spectrum of conditions that affect throwing athletes' elbows as well as the potential complications that can be associated with surgical management. Purpose: In this article, we review indications and surgical setup for elbow arthroscopy. Three search terms ("elbow ulnar collateral ligament injury," "tommy john injury," and "pitcher's elbow") were entered into 3 Internet search engines. It further details the arthroscopic surgical technique to successfully treat patients with VEO. 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. VEO is characterized by reproducible pain that is … The secondary purpose of this study was to determine which factors, if any, were predictive of poor performance after UCL reconstruction. Ulnar nerve entrapment can be a cause of elbow, wrist, and hand pain. Furthermore, the presence or absence of ulnar collateral ligament (UCL) injuries and avulsion fractures of the lower pole of the medial epicondyle was determined by imaging findings to calculate the combined percentage of OSFs. When conservative measures fail, minimally invasive or arthroscopic surgical procedures can be used to address the problem. These osteophytes frequently lead to pain and dysfunction during the acceleration phase of throwing and release of the ball. To examine the epidemiological trends of UCL reconstruction on a statewide level over a 10-year period. 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 chondrosis). 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. For arthroscopy of the elbow to be safe and effective, the arthroscopist must develop a systematic and reproducible arthroscopic examination technique. The mean presurgery fastball velocity of 91.82 mph did not significantly change after surgery ( P = .194). ... As many as 10% to 25% of active MLB pitchers report a history of UCL reconstruction, and there has been an estimated 10-fold increase in cases among professional players since 2000. 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. This report describes, in detail, arthroscopy of the elbow in the supine-suspended position and basic principles for arthroscopic decompression of the posterior elbow for valgus extension overload. There were 3 known surgical complications (1.6%) overall, 1 of which was a patient who had a transection of the ulnar nerve requiring microsurgical repair. A total of 14 studies and 1520 pitchers were included in this systematic review. Objective It provides the wide field of view necessary for both diagnostic and operative elbow arthroscopy. All rights reserved. The ulnar collateral ligament (UCL) of the elbow acts as the primary restraint to valgus force experienced in the late cocking and early acceleration phases of overhead throwing. 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. The methodological index for nonrandomized studies (MINORS) was used to assess study quality. ... 12 Literature review demonstrated that the majority of the research involving PRP focuses on tendon repair and healing with significantly less evidence existing concerning the benefits of PRP injections for ligament healing. Methods: a prospective, longitudinal and intervention study was conducted in high performance athletes operated on for valgus extension overload syndrome. The operative approach to elbow pathology, whether performed open or arthroscopically, should be completed by orthopedists who have experience with the clinical conditions and the appropriate technical facility to provide comprehensive care. Elbow arthroscopy for treatment of valgus extension Two primary sites are seen in ulnar nerve entrapments – cubital tunnel and Guyon’s canal. The surgical treatment involves posterior olecranon osteophyte resection. ResearchGate has not been able to resolve any citations for this publication. These abnormal forces can result in a multitude of distinct injuries, including ulnar collateral ligament tears and sprains, flexor-pronator mass tears and strains, ulnar neuritis, posteromedial impingement, olecranon stress fractures, osteochondritis dissecans (OCD) of the capitellum, and medial epicondyle apophyseal injuries. Average preoperative extension, flexion, pronation and supination were 2.3°, 138.2°, 76.4°, and 69.1°. The New York Statewide Planning and Research Cooperative System (SPARCS) database contains records for each ambulatory discharge in New York State. In addition, the prevalence of UCL injuries suggests that it is a major risk factor for the development of OSFs. We included studies reporting diagnostic accuracy and a description on the performance for elbow tests, targeting the following conditions: distal biceps rupture, triceps rupture, posteromedial impingement, medial collateral ligament (MCL) insufficiency, posterolateral rotatory instability (PLRI), lateral epicondylitis and medial epicondylitis. The combination of valgus and extension overload during overhead activities results in tensile forces along the medial stabilising structures, with … Specifically, baseball pitchers who underwent elbow ulnar colateral ligament reconstruction, after its rupture, could be able to throw with higher intensity in comparison to athletes with the non injured native ligament. 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. Repetitive throwing can lead to chronic overuse and/or acute injury to tendons, ligaments, bones, or nerves about the elbow. Pathologic changes from chronic repetitive trauma to the developing shoulder and elbow manifest as distinctly different injuries that can be predicted by the skeletal maturation of the patient. Website readability was ascertained with the Flesch-Kincaid score. The following chapter provides an overview of the relevant anatomy, biomechanics, and diagnosis of VEO. Athletes at risk for valgus extension overload are also at risk for tears of the anterior bundle of the ulnar collateral ligament. Valgus Extension Overload: Diagnosis and Treatment. Before the first UCL reconstruction, performed by Frank Jobe in 1974, this injury was considered career ending in overhead athletes. Interested in research on Fractures, Stress? Conclusion: Quality assessment showed high or unclear risk of bias in nine studies. Posteromedial elbow impingement is a specific injury pattern which may be seen as a component of valgus extension overload syndrome. Level of evidenceIII. Recent advances in both nonoperative and operative treatment, including arthroscopic techniques, have afforded the athlete a successful return to competition. Subgroup analysis revealed that 79% to 87% of Major League Baseball (MLB) pitchers returned to preinjury levels of pitching. Valgus extension overload in the pitching elbow. Injury patterns change depending on the athlete's skeletal maturation, and the spectrum of abnormalities is reviewed. Valgus extension overload (VEO) can cause significant morbidity in the throwing athlete. Methods: 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. Such information is essential for successful open reduction and internal fixation by ensuring that fixation pressure is perpendicular to the fracture plane, which will avoid the recurrence of stress fractures. 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). Most athletes improve substantially with rest and nonoperative treatment, although some athletes may require surgical intervention to return to play. Many factors contribute to the desire of parents and coaches to encourage early single sport specialization, including the desire to give the young athlete an edge in competition, pursuit of scholarships, and potential professional status, and the ability to label a young athlete as elite at an early age. To 100 % sports medicine surgeons occur at the elbow has been an estimated 10-fold in... 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