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In the overhead athlete, medial ulnar collateral ligament (MUCL) insufficiency can develop from repetitive valgus loads across the elbow during the throwing motion. This injury can be potentially career ending for the athlete. Treatment options include conservative care or potential surgical intervention with ligament reconstruction. Given the prolonged recovery period after surgical intervention, other avenues for successful treatment of MUCL insufficiency have been explored, including potential injections into the ligament such as platelet-rich plasma (PRP) and autologous stem cells. Recently, PRP has drawn interest as a tool for biologic augmentation of tendon and ligamentous healing as it is an autologous concentration of platelets and growth factors including vascular endothelial growth factor, insulin-like growth factor-1, fibroblast growth factor-2, platelet-derived growth factor, and transforming growth factor-s. Despite some evidence that supports the use of PRP injections for partial MUCL tears, there is no current consensus regarding its use. Research into the use of stem cell therapy remains primitive and while initial animal studies appear promising, their true clinical utility is unclear. Although the current literature is limited regarding the true efficacy of these treatment options, continued interest into the field of biologic augmentation still exists due to the potential for tissue regeneration. More specifically, biologic agents are especially appealing in the young overhead athlete with acute damage to an isolated part of the MUCL and in those athletes who are unwilling or unable to undergo the extended rehabilitation required after surgical reconstruction of the ligament.

The anterior bundle of the ulnar collateral ligament (UCL) is the primary stabilizer against valgus stress in the elbow. However, when the UCL is compromised, the flexor-pronator mass becomes the primary dynamic valgus stabilizer of the elbow. Combined UCL and flexor-pronator mass injuries are a subset of medial elbow injuries sustained by overhead throwing athletes. Compared to athletes who suffer isolated UCL injuries, the group with combined UCL and flexor-pronator mass injuries tend to be older and have worse outcomes after surgical reconstruction. There are few studies describing these injuries in the orthopedic literature, and it is unclear what causes them to fail surgical management at a higher rate than UCL injuries alone. Treatment of this group requires a thorough history and physical exam, as well as a magnetic resonance imaging (MRI) for surgical planning. Based on the amount of flexor-pronator mass injury, different operative approaches may be warranted. It is important to counsel these patients about their prognosis, especially elite baseball players regarding their chances of returning to their previous level of play.

Recurrent shoulder instability in the athlete is a difficult problem to deal with. There are many factors that must be taken into consideration when formulating the best treatment plan for these athletes including age, sport, amount of glenoid bone loss, etc. One other important factor is timing of the season and when to perform surgery if surgery is indicated. This chapter will discuss the case of a young, in-season, contact athlete with recurrent anterior shoulder instability following an arthroscopic stabilization.

Tennis continues to be one of the most popular sports in the world, and as interest grows, our understanding of the physiologic demands of the sport also increases. During the course of a standard tennis match, players are required to repetitively exert themselves in short, but explosive, bursts of energy several hundred times [1]. This is especially true during the serve, but all types of strokes place very unique demands on the upper extremity [2–4]. To better understand the physiologic processes occurring during the serve, it has been broken down into five distinct phases: (1) windup, (2) early cocking, (3) late cocking, (4) acceleration, and (5) follow-through [4, 5]. In order to successfully execute these phases, energy must be transferred efficiently and effectively along the entire kinetic chain of motion. Although the greatest stress to the shoulder occurs during the cocking and acceleration phases, disruption of the kinetic chain at any point in the process can place the shoulder at risk for injury [6].