This narrative review by Dugas defines the pathomechanics, diagnosis, and treatment of valgus extension overload (VEO) in the overhead athlete. VEO results from repetitive posteromedial olecranon impingement driven by UCL laxity during forced terminal extension. The paper covers the full management pathway from physical exam through arthroscopic resection and return-to-sport timelines.
When a pitcher describes posterior elbow pain specifically at ball release (not at acceleration), your first thought should be VEO, not UCL injury.
Confirm it at the exam table: valgus stress at 20-30° of flexion while forcing terminal extension. Posteromedial olecranon tenderness with symptom reproduction closes the diagnosis. The absence of osteophytes on X-ray does not rule it out — impingement precedes osteophyte formation.
For a first episode, pull them from throwing for 10-14 days, then begin an interval throwing program. Recurrent episodes warrant 4-6 weeks of rest. Corticosteroid injection adds nothing here.
When conservative care fails and you take them to the OR, the 8 mm resection limit is the number that protects the UCL. Remove more and you risk destabilizing the medial side. Which means a 12-month UCL reconstruction instead of a 3-6 month arthroscopic recovery.
VEO and UCL injury frequently coexist. In over 1200 UCL reconstructions, 23% required concomitant olecranon tip excision. Always assess for both before any surgical planning.
This narrative review by Dugas defines the pathomechanics, diagnosis, and treatment of valgus extension overload (VEO) in the overhead athlete. VEO results from repetitive posteromedial olecranon impingement driven by UCL laxity during forced terminal extension. The paper covers the full management pathway from physical exam through arthroscopic resection and return-to-sport timelines.
When a pitcher describes posterior elbow pain specifically at ball release (not at acceleration), your first thought should be VEO, not UCL injury.
Confirm it at the exam table: valgus stress at 20-30° of flexion while forcing terminal extension. Posteromedial olecranon tenderness with symptom reproduction closes the diagnosis. The absence of osteophytes on X-ray does not rule it out — impingement precedes osteophyte formation.
For a first episode, pull them from throwing for 10-14 days, then begin an interval throwing program. Recurrent episodes warrant 4-6 weeks of rest. Corticosteroid injection adds nothing here.
When conservative care fails and you take them to the OR, the 8 mm resection limit is the number that protects the UCL. Remove more and you risk destabilizing the medial side. Which means a 12-month UCL reconstruction instead of a 3-6 month arthroscopic recovery.
VEO and UCL injury frequently coexist. In over 1200 UCL reconstructions, 23% required concomitant olecranon tip excision. Always assess for both before any surgical planning.