This review covers the non-UCL elbow injuries seen in overhead throwing athletes. It explains the biomechanics of the six-phase throwing motion and the valgus extension overload mechanism. It walks through diagnosis and treatment of ulnar neuritis, flexor pronator injury, medial epicondyle apophysitis/avulsion, posterior impingement, olecranon stress fracture, and capitellar osteochondritis dissecans.
When a thrower presents with medial elbow pain, your first job is to localize it and rule out UCL injury before blaming the flexor pronator mass. Tenderness anterior to the medial epicondyle midline points to flexor pronator injury, while posterior tenderness suggests UCL pathology. MRI helps because these coexist, and combined injury in players over 30 has a dismal 12.5% return to play.
Understand valgus extension overload as the unifying model: medial tension attenuates the UCL, posterior shear drives olecranon osteophytes and impingement, and lateral compression injures the radiocapitellar joint and capitellum.
Two surgical pitfalls are high-yield. Resecting more than 3 mm of native olecranon unloads the impingement but overloads the UCL and can create instability, so debride only osteophytes. In the skeletally immature thrower, prognosis for capitellar OCD tracks with open physes and early-stage lesions, which guides whether you can trust nonoperative rest.
This review covers the non-UCL elbow injuries seen in overhead throwing athletes. It explains the biomechanics of the six-phase throwing motion and the valgus extension overload mechanism. It walks through diagnosis and treatment of ulnar neuritis, flexor pronator injury, medial epicondyle apophysitis/avulsion, posterior impingement, olecranon stress fracture, and capitellar osteochondritis dissecans.
When a thrower presents with medial elbow pain, your first job is to localize it and rule out UCL injury before blaming the flexor pronator mass. Tenderness anterior to the medial epicondyle midline points to flexor pronator injury, while posterior tenderness suggests UCL pathology. MRI helps because these coexist, and combined injury in players over 30 has a dismal 12.5% return to play.
Understand valgus extension overload as the unifying model: medial tension attenuates the UCL, posterior shear drives olecranon osteophytes and impingement, and lateral compression injures the radiocapitellar joint and capitellum.
Two surgical pitfalls are high-yield. Resecting more than 3 mm of native olecranon unloads the impingement but overloads the UCL and can create instability, so debride only osteophytes. In the skeletally immature thrower, prognosis for capitellar OCD tracks with open physes and early-stage lesions, which guides whether you can trust nonoperative rest.