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What is Valgus Extension Overload (Pitcher’s Elbow)?

Valgus extension overload, also known as pitcher's elbow, is a clinical syndrome which is commonly seen in overhead throwing athletes secondary to repetitive forces generated by the throwing motion on the elbow joint.

This syndrome may involve one or a combination of injuries to the following structures in the elbow joint:

  • Ulnar collateral ligament (UCL), a stabilizing ligament on the inner side of the elbow.
  • Radiocapitellar joint, which connects the radius bone in the forearm to the upper arm bone (humerus).
  • Ulnohumeral joint, which connects the ulnar bone in the forearm to the humerus.

Who is at Risk for Valgus Extension Overload?

Overhead athletes such as baseball players or javelin throwers are at high risk of valgus extension overload (Pitcher’s Elbow). It can also be seen in non-throwing athletes such as swimmers, volleyball players, gymnasts, racquet-sport athletes, and golfers.

How does Valgus Extension Overload occur?

Valgus extension overload can occur in the following ways:

  • Extreme tensile stress applied on the anterior band of the ulnar collateral ligament during throwing action can injure the ligament either immediately or due to chronic micro trauma. 
  • Excessive force applied during the pitch can create a high shear stress in the posterior compartment of the elbow, leading to cartilage injury of the olecranon bone in the elbow.
  • Compressive force applied on the radiocapitellar joint may cause osteonecrosis resulting in valgus extension overload, particularly in skeletally immature athletes.

Symptoms of Valgus Extension Overload (Pitcher’s Elbow)

Symptoms of valgus extension overload includes:

  • Severe posterior elbow pain
  • Pain in the posteromedial(inner)elbow at full extension or during the acceleration or deceleration phases of overhead throwing
  • Restriction of full elbow extension
  • Limited throwing ability or a decrease in throwing speed
  • Focal tenderness on palpation over inner elbow joint and crepitus
  • Swelling and numbness in the elbow

Diagnosis of Valgus Extension Overload (Pitcher’s Elbow)

Your doctor will do a thorough physical examination  and medical history will be noted. Further to confirm the diagnosis of pitcher’s elbow, imaging studies such as x-ray, CT scan and MRI scans may be ordered.

Treatment of Valgus Extension Overload (Pitcher’s Elbow)

Treatment of valgus extension overload includes both non-surgical and surgical options based on your condition. Non-invasive treatments such as NSAIDs, activity modification, steroid injections, physical therapy and rehabilitation to relieve symptoms and improvements are the first line of treatment.

If conservative treatments fail after 3 months, that may indicate surgical intervention in necessary such as ulnar nerve decompression, arthroscopic osteophyte resection and UCL reconstruction with graft, also known as Tommy John surgery.

Prevention of Valgus Extension Overload (Pitcher’s Elbow)

Valgus extension overload (Pitcher’s Elbow) can be avoided by following a few safety measures:

  • Perform warm up and cooling down exercises before throwing activities
  • Avoid excess pressure on the elbow
  • Consume high calcium and mineral supplements
  • Maintain adequate hydration
  • Consume protein-rich food