Posteromedial elbow impingement

Last revised by Daniel J Bell on 5 Mar 2021

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.

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. 

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