Age / Sex : 19 / M

Age / Sex : 19/M

Chief complaint : Elbow pain, College tennis athlete

olecrenon impingement syndrome

Discussion

Findings:

Posterior elbow fat pad edema

Osteophytes of the olecranon tip and the medial wall of the olecranon fossa

Hypertrophy of the olecranon

Olecranon process ossicles

Chondromalacia

Loose bodies

Joint effusion

Differential Diagnosis:

Olecranon stress fracture

Triceps tendinosis

Medial Elbow Instability

Radiocapitellar synovial plica

Diagnosis:  

Olecranon impingement syndrome

Discussion:

History

•      Athletes with olecranon impingement syndrome often complain of posterior elbow pain, with locking or snapping when throwing.

•      The athlete's pain is the worst when the elbow is extended.

•      Throwers often complain of loss of velocity and control, and these individuals feel as if their elbow is unstable.

Physical

•      Olecranon impingement is often exacerbated by forced extension on the physical examination. Many times, testing shows some degree of valgus instability.

•      The examiner can often feel crepitus, which blocks full extension of the elbow.

•      On occasion, loose bodies can be palpated around the olecranon fossa.

•      Many times, the posterior elbow is inflamed and has point tenderness.

Cause

•      Olecranon impingement syndrome is caused by repetitive elbow extension, in which a valgus stress is applied to the elbow.

•      This syndrome often occurs with overhead throwing and tennis strokes

Treatment

•      Posterior impingement syndrome of the elbow is often treatable with non-operative management.  A rehabilitation program to improve strength, flexibility and elbow range of motion may be helpful.  Injections into the posterior compartment (back) of the elbow are often useful to reduce the inflammation and swelling, either Cortico- steroids or Hyaluronons may be used.  When non-operative measures have failed or particularly if there is locking and catching due to loose bone fragments within the joint and spurs, arthroscopic (keyhole) surgery is required to remove them.  Return to sports after this surgery may take up to 3 months.

References:

Micheli LJ, Luke A, Mintzer AC, Mintzer CM, Waters PM. Elbow arthroscopy in the pediatric and adolescent population. Arthroscopy: The Journal of Arthroscopic & Related Surgery 2001; 17(7):694-699

Chen FS, Rokito AS, Jobe FW. Medial elbow problems in the overhead-throwing athlete. J Am Acad Orthop Surg 2001; 9(2):99-113