Diagnosis and Treatment of Posteromedial Elbow Impingement in the Throwing Athlete

Abstract

Purpose of review: Posteromedial elbow impingement is a common pathological entity in the throwing athlete. The posteromedial articulation of the elbow is a significant stabilizer to medial elbow forces and valgus stress noted during repetitive throwing. This current review investigates recent literature regarding the relevant anatomy, diagnosis, and treatment of posteromedial impingement in the thrower.

Recent findings: Improvements in advanced imaging have provided accurate and detailed diagnostic capability for the assessment of the throwers' elbow. After failure of conservative measures, arthroscopic treatment of posteromedial elbow impingement with posteromedial osteophyte removal has demonstrated excellent outcomes with a reliable return to play in the competitive thrower. In addition to a thorough history and physical examination, MRI, MR arthrogram, CT, and dynamic ultrasound imaging modalities are useful in the assessment of a presumed diagnosis of posteromedial impingement. Arthroscopic decompression with posteromedial osteophyte removal provides effective clinical results and return to play. The surgeon should be careful to avoid creating medial ulnar collateral instability by means of over-resection of the posteromedial olecranon.

Keywords: Elbow arthroscopy; Elbow impingement; Posteromedial impingement; Thrower’s elbow; Valgus extension overload.

Fig. 1

Lateral elbow X-ray, with fractured posteromedial osteophyte

Fig. 2

Coronal view, MR arthrogram, revealing posteromedial osteophyte of olecranon (arrow)

Fig. 3

Sagittal view, MR arthrogram, revealing fragmented posteromedial olecranon osteophyte (arrow)

Fig. 4

Modified supine positioning for elbow arthroscopy

Fig. 5

Arthroscopic posterior compartment assessment via posterolateral portal

Fig. 6

Posteromedial osteophyte noted at diagnostic arthroscopy

Fig. 7

Status post arthroscopic posteromedial osteophyte resection with a motorized bur