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Ulnar neuritis
11%
106/972
Excessive olecranon resection
61%
592/972
Osteochondritis dissecans of the capitellum
3%
28/972
Olecranon stress fracture
4%
35/972
Lateral ulnar collateral ligament injury
21%
201/972
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This patient has valgus extension overload secondary to overaggressive resection of the olecranon Valgus extension overload, also known as Pitcher's elbow and is a condition characterized by posteromedial elbow pain related to repetitive microtrauma in throwing athletes. The diagnosis is made clinically with posteromedial elbow pain that worsens with elbow extension, and confirmed with imaging revealing osteophyte formation in the posteromedial olecranon fossa. Treatment is usually nonoperative with rest, activity modifications, and injections. Operative resection of osteophytes and loose bodies are indicated in pitchers with persistent symptoms. Valgus instability may occur as a complication following overaggressive resection of leading to valgus instability. Kamineni et al. reviewed whether excessive olecranon resection would alter elbow kinematics. They noted that the posteromedial aspect of the olecranon process is a site of impingement and subsequent osteophyte development in throwing athletes. They reported that although no single critical amount of olecranon resection was identified, valgus angulation of the elbow increased in association with all resections, with a marked increase occurring in association with a 9-mm resection. They concluded that the implications for the professional throwing athlete are important, and we recommend that bone removal from the olecranon be limited to osteophytes, without the removal of normal bone. Bell et al. reviewed the effect of serial resections of the olecranon on elbow kinematics and stability. They reported that serial resection of the olecranon resulted in a significant increase in varus-valgus angulation. They concluded that valgus-varus angulation and ulnohumeral rotation progressively increase with sequential excision of up to 75% of the olecranon. Elbow stability is progressively lost with sequential excision, with gross instability noted at resection of > or = 87.5% of the olecranon. Illustration A demonstrates an axial cut of a right elbow MRI with arrow pointing to a posteromedial olecranon osteophyte. Illustration B is a drawing describing the valgus extension overload syndrome. Incorrect Answers: Answers 1,3-5: Valgus instability may occur as a complication following overaggressive resection of the olecranon leading to valgus instability in the throwing athlete
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