Adaptive pathology: new insights into the physical examination and imaging of the thrower’s shoulder and elbow

Kuhn, John E.

doi:10.1016/j.jse.2023.07.031

Cited by 5 publications

(1 citation statement)

References 122 publications

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“…Valgus extension overload (VEO) syndrome encompasses a variety of symptoms and clinical findings that occur in predictable patterns related to biomechanical changes occurring in the elbows of overhead throwing athletes [1][2][3][4][5]. Excessive forces are placed on the elbow during the throwing motion, resulting in tensile stresses along the medial elbow, compression forces on the lateral elbow, and shear forces on the posteromedial elbow [6,7].…”

Section: Introductionmentioning

confidence: 99%

Differences in Anatomic Adaptation and Injury Patterns Related to Valgus Extension Overload in Overhead Throwing Athletes

Stevens,

Chaudhari,

Kuhn

2024

Diagnostics

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The purpose of our study was to determine differences in adaptative and injury patterns in the elbow related to valgus extension overload (VEO) in overhead throwing athletes by age. A total of 86 overhead throwing athletes and 23 controls underwent MRI or MR arthrography (MRA) of the elbow. Throwing athletes were divided by age into three groups: ≤16 years (26 subjects), 17–19 years (25 subjects), and ≥20 years (35 subjects). Consensus interpretation of each MRI was performed, with measurements of ulnar collateral ligament (UCL) thickness and subchondral sclerosis at the radial head, humeral trochlea, and olecranon process. A higher frequency of apophyseal and stress injuries was seen in adolescent athletes and increased incidence of soft tissue injuries was observed in older athletes. Early adaptive and degenerative changes were observed with high frequency independent of age. Significant differences were observed between athletes and controls for UCL thickness (p < 0.001) and subchondral sclerosis at the radial head (p < 0.001), humeral trochlea (p < 0.001), and olecranon process (p < 0.001). Significant differences based on athlete age were observed for UCL thickness (p < 0.001) and subchondral sclerosis at the olecranon process (p = 0.002). Our study highlights differences in anatomic adaptations related to VEO at the elbow between overhead throwing athletes and control subjects, as well as across age in throwing athletes.

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