Orthopaedic Sports Medicine
This patient is experiencing posteromedial olecranon osteophytosis (also known as VEO syndrome), a common cause of elbow pain in young adolescent baseball players. Repetitive throwing leads to impingement of the tip of the olecranon in the olecranon fossa during the acceleration phase of a pitch, the stage when valgus stress on the elbow is greatest. Olecranon impingement is often exacerbated in young athletes because of the intrinsic ligament and joint laxity seen during adolescence. Impingement can lead to the formation of an olecranon osteophyte that can compress the ulnar nerve, which can cause pain and loss of sensation in the ulnar nerve territory. It should not affect wrist extension strength, which is controlled by the radial nerve. The VEO test can help to make a definitive diagnosis: valgus stress is maintained while the elbow is passively flexed, eliciting pain along the posteromedial aspect of the olecranon. In cases in which the patient experiences mechanical locking with evidence of a loose body, surgical excision of the loose body and the olecranon osteophyte is warranted and is often curative.4
- The VEO test is a helpful diagnostic aid.
4. Ahmad CS, ElAttrache NS. Valgus extension overload syndrome and stress injury of the olecranon. Clin Sports Med 2004;23:665-76..
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