The athletes elbow - PhD thesis
Posterior impingement of the elbow is an uncommon disorder in the general population; it is mainly seen in patients that overuse their elbow during specific sporting activities as such overhead throwing or tennis. The lesion is due to repetitive combined hyperextension, valgus and supination of the elbow resulting in a mechanical abutment of bony or soft tissues in the posterior fossa of the elbow. Posterior impingement can also be associated with ligamentous instability of the elbow, especially Ulnar Collateral Instability (UCL) insufficiency.
In a cadaver study, valgus torques of 1.25 and 2.0 Nm were applied and kinematic data were obtained with intact and transected UCL at different angles of flexion angle using a 3-dimensional digitiser. For a given load and flexion angle, the contact area decreased and the pressure increased with increasing medial ulnar collateral ligament insufficiency. The conclusion was that medial ulnar collateral ligament insufficiency alters contact area and pressure between the posteromedial trochlea and olecranon and helps explain the development of posteromedial osteophytes in cases of UCL insufficiency.
The athlete complains of pain posteriorly, joint effusion, locking, crepitus and a decrease in range of motion, most notably an extension deficit. If conservative treatment of posterior impingement is not successful, arthroscopic debridement of the elbow with removal of osteophytes and synovectomy can be used in these patients. In the treatment of posterior impingement, hyperextension of the elbow joint and insufficiency of UCL must be addressed > From: Rahusen, The Athletes Elbow - PhD thesis, University of Groningen (2013).
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