Valgus Extension Overload

Abstract

Posterior elbow pain is a common problem in the throwing athlete due to adaptive bony and soft tissue changes in response to valgus extension overload (VEO) syndrome. The injury accounts for 2.9% of all injuries to players at the professional level. A thorough patient history and physical examination with appropriate diagnostic imaging is required to correctly identify the etiology of the elbow pain. It is important to recognize that VEO may occur in combination with other injuries in the elbow and specifically, an injury to the ulnar collateral ligament (UCL) with resultant micro or macro instability must be ruled out as the underlying cause. Osteophytes on the posteromedial olecranon that do not respond to rest and rehabilitation may require surgical excision, a procedure that may be performed arthroscopically with a low complication rate. The amount of olecranon tip that can safely be resected without placing additional stress on the UCL is thought to be less than 3 mm. Removing the least amount of olecranon tip while still adequately addressing the impingement lesions may offer the lowest risk of overloading the ulnar collateral ligament. With proper attention to anatomical landmarks for portal placement and meticulous surgical technique, arthroscopic evaluation and treatment of posterior elbow pain can be safely accomplished in the throwing athlete with minimal risk. Return to previous level of competition can be expected in a high percentage of cases; however, the incidence of additional future surgical procedures is as high as 30–40%.