summary Olecranon Stress Fractures are rare elbow injuries that predominately affects throwing athletes. Diagnosis can usually be made with plain radiographs of the elbow but may require an MRI or CT scan to confirm the diagnosis in the early stages. Treatment is generally rest from pitching, pain control, and brief period of immobilization. Epidemiology Anatomic location predominantly involves the epiphyseal plate fractures line may propagate to be either transverse or oblique in orientation Etiology Pathophysiology mechanism of injury three commonly accepted theories olecranon posteriomedial impingement triceps traction force valgus extension overload Associated injuries with throwing movements ulnar collateral ligament tears medial epicondyle avulsion fracture Presentation Symptoms posteromedial olecranon pain of the throwing arm improves with rest worse with throwing movements Physical exam inspection mild swelling over olecranon localized tenderness motion valgus instability stress test may indicate associated UCL injury Imaging Radiographs recommended views AP, lateral, oblique views of elbow optional views valgus stress views contralateral elbow for comparison findings physeal widening, delayed fusion, or fragmentation widening of the medial joint space with UCL injuries CT views best seen on lateral views findings typical fracture pattern originates from the articular surface runs toward the dorsal-proximal direction MRI indications suspected UCL tear views coronal T2 fat-saturated views findings T-sign indicative of UCL tears Treatment Nonoperative short-term administration of NSAIDS, rest +/- temporary splinting indications first-line treatment modalities initial 4-6 weeks of rest (removal from sport for up to 3 months) progressive ROM exercises avoiding valgus loading forces (e.g. throwing) electrical bone stimulation may also be considered consider vitamin D and calcium supplementation Operative open internal fixation indications delayed fracture union modalities large compression screw tension band wire