Current Exam and Treatment for Elbow Problems in the Throwing Athlete

In this review article, orthopedic surgeons give up-to-date information on the exam and treatment of elbow problems in throwing athletes. The advice offered is based on work they have done with professional football players.

Elbow anatomy is reviewed first. The ulnar collateral ligament (UCL) on the inside of the elbow is affected most often with throwing sports. The UCL is also called the medial ligament complex. It has three separate parts. Each one resists force on the elbow at different times in the throwing sequence.

Bone, ligaments, and muscles all work together to prevent too much force on the elbow during overhead throwing activities. Injury occurs when the stress on a ligament is greater than the strength of the ligament.

Symptoms of pain, weakness, and numbness bring the patient to the doctor's office. Sometimes the player reports a pop or sharp pain on the inside of the elbow during a pitch. They may not be able to keep pitching after that.

The surgeon examines the elbow looking for specific patterns of tenderness to identify the problem. The authors review specific tests used to detect UCL instability. Photos and a description are provided for the milking sign, the moving valgus stress test, and the valgus impingement overload test.

X-rays, CT scans, or MRI may be ordered. Each test has its own specific purpose. CT scans will show bone spurs that don't show up on X-rays. MRIs reveal deep tears under the surface.

Treatment is discussed with the emphasis on conservative or nonsurgical care. Rest and strengthening exercises are the first approach. The program is gradually progressed from absolute rest to return to sports.

Patients with UCL sprains or tears must rest at least one full month to start. Splinting or bracing may be needed at night to protect the elbow during the healing phase. The authors provide a sample throwing program based on distances from 30 feet up to 90 feet.

Even with a proper rehab program, there's no promise that the athlete will always get back to competitive play. It's still not clear which athletes won't benefit from rehab and who should just have surgery done right away. More studies are needed to help guide the diagnosis and treatment of this complex problem.

References: Arthur C. Rettig, MD, and Paul Mieling. Managing Elbow Problems in Throwing Athletes. In Journal of Musculoskeletal Medicine. March 2007. Vol. 24. No. 3. Pp. 129-135.