Elbow Injuries in Throwing Athletes: A Current Concepts Review

Abstract

Repetitive overhead throwing imparts high valgus and extension loads to the athlete's elbow, often leading to either acute or chronic injury or progressive structural change. Tensile force is applied to the medial stabilizing structures with compression on the lateral compartment and shear stress posteriorly. Common injuries encountered in the throwing elbow include ulnar collateral ligament tears, ulnar neuritis, flexor-pronator muscle strain or tendinitis, medial epicondyle apophysitis or avulsion, valgus extension overload syndrome with olecranon osteophytes, olecranon stress fractures, osteochondritis dissecans of the capitellum, and loose bodies. Knowledge of the anatomy and function of the elbow complex, along with an understanding of throwing biomechanics, is imperative to properly diagnose and treat the throwing athlete. Recent advantages in arthroscopic surgical techniques and ligament reconstruction in the elbow have improved the prognosis for return to competition for the highly motivated athlete. However, continued overhead throwing often results in subsequent injury and symptom recurrence in the competitive athlete.

Pitcher’s elbow: medial elbow pain in the overhead-throwing athlete

“…The ulno-humeral joint, namely the articulation between the olecranon and the olecranon fossa, is the primary stabilizer at the extremes of elbow motion-flexion less than 20°and greater than 120° [2]. Soft tissue restraints have been shown to provide the primary static and dynamic stability needed in the mid arc of elbow motion [3].…”

“…These modifications typically involve differing techniques on dealing with graft fixation, ulnar nerve management, and graft configuration. The most commonly used graft in UCL reconstruction is the palmaris longus autograft; however, other autograft options include gracilis, plantaris, or toe extensor tendon [2].…”

“…These symptoms may occur secondary to traction from excessive valgus stress, compression by nearby osteophytes, flexor muscle hypertrophy, or irritation due to subluxation [2].…”

“…These injuries typically occur during the acceleration and follow-through phases of the throwing cycle with forceful extension of the elbow and pronation of the forearm. Injuries can range from mild muscular overuse to chronic tendinitis or acute muscle tears [2].…”

Goniometry of elbow carrying angle: a comparative clinical study on sexual dimorphism in young males and females

“…The olecranon coronoid angle shows high sexual dimorphism and it may be one of the causes of sexual difference observed in carrying angle. 8 Handling and monitoring of traumatic paediatric elbow injuries often require evaluation of the carrying angle. Forensic anthropologists may utilize knowledge of carrying angle to ascertain the sex of an individual from skeletal remains and biomechanical engineers may require knowledge of the same for designing a total elbow prosthesis.…”