Bony injuries about the elbow in the throwing athlete.

Tremendous valgus stress during the acceleration phase of pitching is the primary cause of elbow injury in the pitcher. Lateral compression injuries are usually found in pitchers in their early teens, and osteochondritis dissecans is the primary underlying cause. Severe flexion contractures and even partial ankylosis of the elbow may occur. Prognosis after surgery is generally poor. Medial tension injuries with either soft-tissue damage or bony damage usually require surgery. The medial collateral ligament should be considered the primary stabilizer against the valgus-vector overload. The medial collateral ligament or bony avulsion form the medial compartment of the elbow should be primarily corrected. Results of early surgical correction to these lesions should produce excellent results. Pitchers with extension block injuries are generally older, more experienced athletes than those without such injuries. These pitchers have had symptoms for some time with progressive loss of full extension of the elbow and increasing pain. Valgus extension overload can be surgically corrected by an open surgical approach or an operative arthroscopic approach. Basically these approaches are palliative, and progression of symptoms at a later date may be expected. Finally, the postoperative rehabilitation of any elbow problem is extremely important and should be preplanned for the specific lesion treated.