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Medial Elbow Problems in the Overhead-Throwing Athlete

Dr. Chen is Sports Medicine Fellow, Department of Orthopaedic Surgery, University of Southern California School of Medicine, Los Angeles. Dr. Rokito is Associate Director, Sports Medicine Service, and Assistant Chief, Shoulder Service, Department of Orthopaedic Surgery, Hospital for Joint Diseases, New York, NY. Dr. Jobe is Associate, Kerlan-Jobe Orthopaedic Clinic, Los Angeles; and Clinical Professor of Orthopaedic Surgery, University of Southern California School of Medicine.

Reprint requests: Dr. Chen, USC Department of Orthopaedic Surgery, Suite 322, 1510 San Pablo, Los Angeles, CA 90033.

The elbow is subjected to enormous valgus stresses during the throwing motion, which places the overhead-throwing athlete at considerable risk for injury. Injuries involving the structures of the medial elbow occur in distinct patterns. Although acute injuries of the medial elbow can occur, the majority are overuse injuries as a result of the repetitive forces imparted to the elbow by throwing. Injury to the ulnar collateral ligament complex results in valgus instability. Valgus extension overload leads to diffuse osseous changes within the elbow joint and secondary posteromedial impingement. Overuse of the flexor-pronator musculature may result in medial epicondylitis and occasional muscle tears and ruptures. Ulnar neuropathy is a common finding that may be due to a variety of factors, including traction, friction, and compression of the ulnar nerve. Advances in nonoperative and operative treatment regimens specific to each injury pattern have resulted in the restoration of elbow function and the successful return of most injured overhead athletes to competitive activities. With further insight into the relevant anatomy, biomechanics, and pathophysiology involved in overhead activities and their associated injuries, significant contributions can continue to be made toward prevention and treatment of these injuries.

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