Valgus Extension Injuries of the Elbow in the Throwing Athlete

Valgus extension injuries of the elbow are common among throwing athletes. There is a wide spectrum of these injuries, ranging from early soft-tissue inflammatory changes to attenuation and incompetence of the ulnar collateral ligament, as well as bone changes, including chondromalacia, osteochondritis, and osteophyte formation. Early treatment should be directed toward decreasing pain and inflammation, followed by global strengthening and conditioning of the elbow with special emphasis on plyometric strengthening of the flexor-pronator musculature. In patients who remain symptomatic after an initial course of nonoperative treatment, arthroscopy of the elbow can address many of the later changes, including chondromalacia, osteochondritis, and osteophyte formation. Reconstruction of the ulnar collateral ligament should be reserved for those patients who wish to remain active at a highly competitive level and for whom rehabilitation and less invasive procedures have failed. Appropriate rehabilitation remains the cornerstone of successful treatment of these patients, facilitating their return to competitive play.