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Elbow Ulnar Collateral Ligament Injury pp 17–25Cite as

Valgus Extension Overload

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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. 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 %.

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Authors and Affiliations

  1. Andrews Sports Medicine and Orthopaedic Center, 805 St. Vincent’s Drive, Suite 100, 35205, Birmingham, AL, USA

    David C. Gerhardt MD & E. Lyle Cain MD

Authors
  1. David C. Gerhardt MD
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  2. E. Lyle Cain MD
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Correspondence to E. Lyle Cain MD .

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Editors and Affiliations

  1. Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA

    Joshua S. Dines

  2. Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA

    David W. Altchek

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Gerhardt, D., Cain, E. (2015). Valgus Extension Overload. In: Dines, J., Altchek, D. (eds) Elbow Ulnar Collateral Ligament Injury. Springer, Boston, MA. https://doi.org/10.1007/978-1-4899-7540-9_3

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  • DOI: https://doi.org/10.1007/978-1-4899-7540-9_3

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