64 - Elbow Throwing Injuries

Abstract

Elbow injuries in athletes whose sport involves throwing are often the result of high valgus and extension forces that act on the elbow during the throwing motion. These forces place tensile stress on medial structures, compression stress on lateral structures, and shear stress posteromedially. Identification of the disorder and provision of appropriate treatment requires an accurate history, a thorough physical examination, and adequate ancillary testing. Common diagnoses in athletes with medial elbow pain whose sport entails throwing include ulnar neuritis, ulnar collateral ligament (UCL) insufficiency or tear (valgus instability), flexor pronator strain or tendinopathy, and medial epicondylar apophysitis or avulsion (particularly in athletes whose skeletons are immature). Lateral elbow pain may result from osteochondritis dissecans of the capitellum, loose bodies, lateral epicondylitis, or radial nerve entrapment. Finally, posterior pain may indicate valgus extension overload (VEO) syndrome with posteromedial ulnohumeral osteophytes, trochlear chondromalacia, olecranon stress fracture, or distal triceps tendinopathy. A thorough understanding of the complex anatomy and function of the elbow joint as well as of throwing biomechanics is essential for physicians who treat overhead-throwing athletes. This chapter reviews elbow injuries in such athletes, focusing primarily on young skeletally mature adults, with an emphasis on pertinent anatomy and biomechanics where appropriate.