Posteromedial elbow impingement
Updates to Article Attributes
Posteromedial elbow impingement is mechanicalbony or soft tissue abutment of posteromedial elbow joint in a setting of repetitive micro trauma secondary to excessive valgus and extension forces in an overhead throw athlete causing focalsynovitis and posteromedial joint osteophytes and loose bodies which in turn can leads to symptoms.
Epidemiology
It is rare in general population but commonly seen in over head throwing athletes.
Clinical presentation
Posteromedial and posterior elbow pain, joint effusion, locking, crepitus, and a decrease in range of motion in particular incomplete extension are common findings.
Pathology
Ulnar collateral ligament insufficiency or congenital laxity along with repetitive hyperextension, valgus, and supination of the elbow causing bony and soft tissue mechanical abutment in the posteromedial elbow resulting in focal synovitis and spurring which can detach and form intra articular loose bodies that further worsen the impingement.
Radiographic features
X-ray Plain radiograph
Radiographs especially an axial view, shows osteophytes on the olecranon or on the borders of the posteromedial fossa. Dynamic radiographs with applying valgus forces may show instability of the joint.
SonographyUltrasound
USUltrasound is helpful to assess the integrity of the UCLulnar collateral ligament (UCL) and laxity particularly allowing for real time dynamic assessment.
Computed tomography (CT)
More sensitive in detecting osteophytes and loose bodies.
MRI
With or without intra‐articular contrast, with detect underlying chondral injury, synovitis or underlying oedema-like lesions.
Treatment
Initial choice of treatment is conservative measures such as physiotherapy, non‐steroidal anti‐inflammatory medications, ice, compression, and elevation (RICE), steroid injections can give some relief from pain especially if synovitis is predominant finding. If conservative treatment fails, arthroscopic or open debridement and UCL reconstruction if UCL insufficiency also present, should be considered.
-<p><strong>Posteromedial elbow impingement </strong> is mechanical bony or soft tissue abutment of posteromedial elbow joint in a setting of repetitive micro trauma secondary to excessive valgus and extension forces in an overhead throw athlete causing focal synovitis and posteromedial joint osteophytes and loose bodies which in turn can leads to symptoms. </p><h4>Epidemiology</h4><p>It is rare in general population but commonly seen in over head throwing athletes.</p><h4>Clinical presentation </h4><p>Posteromedial and posterior elbow pain, joint effusion, locking, crepitus, and a decrease in range of motion in particular incomplete extension are common findings.</p><h4>Pathology</h4><p>Ulnar collateral ligament insufficiency or congenital laxity along with repetitive hyperextension, valgus, and supination of the elbow causing bony and soft tissue mechanical abutment in the posteromedial elbow resulting in focal synovitis and spurring which can detach and form intra articular loose bodies that further worsen the impingement. </p><h4>Radiographic features</h4><h5>X-ray </h5><p>Radiographs especially an axial view, shows osteophytes on the olecranon or on the borders of the posteromedial fossa. Dynamic radiographs with applying valgus forces may show instability of the joint. </p><h5>Sonography</h5><p>US is helpful to assess the integrity of the UCL and laxity particularly allowing for real time dynamic assessment. </p><h5>Computed tomography (CT)</h5><p>More sensitive in detecting osteophytes and loose bodies.</p><h5>MRI</h5><p>With or without intra‐articular contrast, with detect underlying chondral injury, synovitis or underlying oedema-like lesions. </p><h4>Treatment</h4><p>Initial choice of treatment is conservative measures such as physiotherapy, non‐steroidal anti‐inflammatory medications, ice, compression, and elevation (RICE), steroid injections can give some relief from pain especially if synovitis is predominant finding. If conservative treatment fails, arthroscopic or open debridement and UCL reconstruction if UCL insufficiency also present, should be considered. </p>- +<p><strong>Posteromedial elbow impingement </strong> is mechanical bony or soft tissue abutment of posteromedial elbow joint in a setting of repetitive micro trauma secondary to excessive valgus and extension forces in an overhead throw athlete causing focal synovitis and posteromedial joint osteophytes and loose bodies which in turn can leads to symptoms. </p><h4>Epidemiology</h4><p>It is rare in general population but commonly seen in over head throwing athletes.</p><h4>Clinical presentation </h4><p>Posteromedial and posterior elbow pain, joint effusion, locking, crepitus, and a decrease in range of motion in particular incomplete extension are common findings.</p><h4>Pathology</h4><p>Ulnar collateral ligament insufficiency or congenital laxity along with repetitive hyperextension, valgus, and supination of the elbow causing bony and soft tissue mechanical abutment in the posteromedial elbow resulting in focal synovitis and spurring which can detach and form intra articular loose bodies that further worsen the impingement. </p><h4>Radiographic features</h4><h5>Plain radiograph</h5><p>Radiographs especially an axial view, shows osteophytes on the olecranon or on the borders of the posteromedial fossa. Dynamic radiographs with applying valgus forces may show instability of the joint. </p><h5>Ultrasound</h5><p>Ultrasound is helpful to assess the integrity of the ulnar collateral ligament (UCL) and laxity particularly allowing for real time dynamic assessment. </p><h5>Computed tomography (CT)</h5><p>More sensitive in detecting osteophytes and loose bodies.</p><h5>MRI</h5><p>With or without intra‐articular contrast, with detect underlying chondral injury, synovitis or underlying oedema-like lesions. </p><h4>Treatment</h4><p>Initial choice of treatment is conservative measures such as physiotherapy, non‐steroidal anti‐inflammatory medications, ice, compression, and elevation (RICE), steroid injections can give some relief from pain especially if synovitis is predominant finding. If conservative treatment fails, arthroscopic or open debridement and UCL reconstruction if UCL insufficiency also present, should be considered. </p>
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