Posteromedial elbow impingement is a throwing-induced elbow injury caused by the mechanical bony or soft tissue abutment of the posteromedial elbow joint due to repetitive micro-trauma affecting the posteromedial fossa. It can occur in isolation or as one manifestation of valgus extension overload syndrome.
Classically it is seen in athletes who engage in frequent and repetitive overhead throwing. It is also reported in weightlifters, gymnasts, and football linemen 4. It is otherwise rare in the general population.
Signs and symptoms affecting the elbow include posteromedial and posterior pain, joint effusion, locking, crepitus, and a decrease in the range of motion, especially in extension.
Repetitive hyperextension, valgus, and supination of the elbow causes bony and soft tissue mechanical abutment in the posteromedial elbow, resulting in focal synovitis and spurring. If intra-articular loose bodies are formed from spurs, these can further worsen the impingement. Other contributing factors could be ulnar collateral ligament insufficiency or congenital laxity.
Plain 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.
Ultrasound is helpful to assess the integrity of the ulnar collateral ligament and laxity particularly allowing for real-time dynamic assessment.
CT is more sensitive in detecting osteophytes and intra-articular loose bodies.
MRI may be performed with or without intra‐articular contrast and can detect underlying chondral injury, synovitis or underlying edema-like lesions.
Treatment and prognosis
The initial management is generally conservative, with measures such as physiotherapy, icing, compression, joint elevation, non‐steroidal anti‐inflammatory medications, and steroid injections which can all give some analgesic relief. If conservative treatment fails, arthroscopic or open debridement and ulnar collateral ligament reconstruction can be considered.
- 1. Eygendaal D, Safran MR. Postero-medial elbow problems in the adult athlete. (2006) British journal of sports medicine. 40 (5): 430-4; discussion 434. doi:10.1136/bjsm.2005.025437 - Pubmed
- 2. Cohen SB, Valko C, Zoga A, Dodson CC, Ciccotti MG. Posteromedial elbow impingement: magnetic resonance imaging findings in overhead throwing athletes and results of arthroscopic treatment. (2011) Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 27 (10): 1364-70. doi:10.1016/j.arthro.2011.06.012 - Pubmed
- 3. Ko CC, Tai MH, Lin CH, Tzeng WS, Chen JH, Shu G, Da Wu C, Chen CKH. Posteromedial olecranon impingement of the pitching elbow: Additional findings provided by CT. (2016) European journal of radiology. 85 (1): 211-217. doi:10.1016/j.ejrad.2015.11.022 - Pubmed
- 4. Smith M. Chapter 30 - Rehabilitation of Musculoskeletal Conditions of the Upper Extremity. In: Mitra R. Principles of Rehabilitation Medicine. (2018) ISBN: 9780071793339