Elbow Injuries in the Throwing Athlete

Elbow injuries in the throwing athlete have distinct injury patterns. They commonly develop medial elbow problems due to the tensile forces applied to the medial stabilising structures, combined with lateral compartment compression and posterior shear forces. Repetitive valgus stresses may lead to a selection of chronic overuse problems, but athletes can also present with acute and acute-on-chronic injuries. The spectrum of throwing injuries encompasses ulnar collateral ligament tears, flexor-pronator tendinopathy, medial epicondyle apophysitis, and valgus extension overload syndrome. Non-operative treatment begins with a period of rest from throwing, followed a rehabilitation programme promoting elbow range of motion, flexor-pronator strengthening, ultimately leading to retraining in throwing mechanics at approximately 3 months. Acute surgical repair of ulnar collateral ligament tears is indicated in cases of acute avulsion from the humeral origin or the coronoid insertion. Chronic insufficiency may warrant ulnar collateral ligament reconstructive surgery involving a free tendon graft, usually placed in bone tunnels in the humerus and ulna.