HISTORY: A 32-year old right-handed experienced male weightlifter presented with a 4 month history of insidious posteromedial right elbow pain. There was no known macrotraumatic event. His typical training regimen included maximal cleans, overhead lifts, and tumbling. Pain was localized to posteromedial olecranon, radiating to the medial triceps. Symptoms were provoked with active elbow extension, especially at acute elbow angles. Bumping the olecranon was also painful. There was no history of swelling, paresthesia, or mechanical symptoms. Prior to presentation, symptoms had not improved with 3 months of rest, as well as trials of icing, NSAIDs, and iontophoresis. PHYSICAL EXAMINATION: No elbow deformity, swelling, or erythema. Focal tenderness at the olecranon tip. Motion asymmetric with extension block preventing 5 degrees of terminal extension. No crepitus. Moving valgus stress test negative for pain/laxity. Arm bar test reproduced pain at olecranon tip, but abated when force applied to forearm instead of triceps. Neurological exam normal with exception that resisted elbow extension reproduced pain. DIFFERENTIAL DIAGNOSIS: Olecranon impingement Triceps tendinopathy/enthesopathy Olecranon bursopathy Loose body TESTING: Elbow radiographs: _ Osseous body medial to trochlea and distal to medial epicondyle _ Olecranon osteophyte at distal triceps insertion Elbow CT: _ Smoothly corticated body distal to medial epicondyle, likely old flexor tendon avulsion _ Fractured nonunited olecranon enthesophyte at triceps insertion _ No joint loose bodies or osteophytes impinging olecranon fossa Ultrasound guided diagnostic block of fractured enthesophyte: _ No evidence of tendinopathy or bursopathy _ Full resolution of symptoms FINAL DIAGNOSIS: Fractured nonunited triceps insertional enthesophyte TREATMENT AND OUTCOMES: Surgical excision of enthesophyte and bursectomy for thickened bursa found during surgery. Olecranon tenderness resolved after surgery. Extension block suspected to be due to avoidance of terminal extension and subsequent biceps contracture. Full elbow extension achieved after 6 weeks of biceps stretching. Light resistance exercise initiated 2 months after surgery. Patient returned to pain-free heavy overhead lifting and tumbling 4 months after surgery.