Physical Examination And Diagnosis

Because the injuries occurring in throwing athletes are complex and subtle, the treating physician needs to take a detailed history and complete a thorough physical examination of the injured athlete. Finding concomitant shoulder and elbow pain in the thrower is common. The patient may have only slight discomfort with throwing, but may have a subjective and documented decrease in velocity, distance, or control. Commonly, pitchers who have VEO report early release, high pitches, and pain during ball release.

Inspection of the elbow may reveal increased valgus alignment and usually reveals a flexion contracture ranging from 5° to 20°. Palpation of the posteromedial aspect of the elbow in full extension reveals tenderness on the olecranon tip and in the olecranon fossa. This tenderness is best appreciated with the elbow in 45° of flexion. Tenderness in the posterior region that is more proximal or distal to the olecranon tip is present in triceps tendinitis or in an olecranon stress fracture,18 respectively. Palpable loose bodies in the posterior compartment may be an additional finding. The examiner should palpate the ul-nar nerve along its course, checking for subluxation and positive signs of nerve compression. A valgus stress test at 20° and 30° of elbow flexion should be performed on both elbows and should be compared for subtle differences in UCL integrity. The VEO test, or valgus extension snap maneuver,19 reveals the most consistent finding. To perform this provocative test, the examiner places moderate valgus stress on the seated athlete's elbow and simultaneously palpates the posteromedial tip of the ole-cranon. Next, he or she moves the elbow from 30° of flexion to full extension (Fig. 10.2). This maneuver acts to simulate the impingement that occurs during the throwing motion and to reproduce the symptoms of posterior elbow pain.

Standard radiographs should include anteroposterior, lateral, and oblique views, as well as the axial view. The lateral view may demonstrate an osteophyte at the tip of the olecranon, and the axial view14 may reveal characteristic osteophytes at the posteromedial aspect of the ole-cranon (Fig. 10.3). To obtain the axial view (see Chapter 3) the elbow should be flexed to 110°, and the beam

FIGURE 10.1. (A) Posterior aspect of the elbow with valgus stress during acceleration. (B) Osteophyte breaks off to form a loose body. (Adapted from Andrews JR and Craven WM.2)

FIGURE 10.1. (A) Posterior aspect of the elbow with valgus stress during acceleration. (B) Osteophyte breaks off to form a loose body. (Adapted from Andrews JR and Craven WM.2)

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B
FIGURE 10.2. Technique for performing the VEO test.

should be directed 45° to the long axis of the ulna. The lesions may not be appreciated on radiographs in about 35% of these patients,3 and they are confirmed visually only at the time of surgery. Radiographic stress views of the elbow also are used frequently to assess the integrity of the UCL. Contrast-enhanced magnetic resonance imaging20 may be helpful when the diagnosis is unclear. It is highly specific for injuries of the ulnar collateral ligament and also can reveal cartilaginous loose bodies or articular surface defects that cannot be visualized on standard radiographs.

Cure Tennis Elbow Without Surgery

Cure Tennis Elbow Without Surgery

Everything you wanted to know about. How To Cure Tennis Elbow. Are you an athlete who suffers from tennis elbow? Contrary to popular opinion, most people who suffer from tennis elbow do not even play tennis. They get this condition, which is a torn tendon in the elbow, from the strain of using the same motions with the arm, repeatedly. If you have tennis elbow, you understand how the pain can disrupt your day.

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