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Injuries of the Throwing Elbow

- See: throwing injuries and throwing injuries of the shoulder

- Discussion: - phases of throwing:
          - windup
          - early cocking
          - late cocking
                - wrist begins to cock in preparation for the throw and final energy release.
                - begins when the pitcher's front foot touches the ground and terminates with maximal humeral
                  external rotation;
                - elbow remains flexed between 60 deg to 75 deg
                - ECRB and ECRL show relatively high levels of activity;
                - significant valgus force at elbow occurs at this stage (maximal MCL stress);
                - dynamic stabilizers include: FDS and FCU;
          - acceleration
                - starts with maximal humeral external rotation and ends with ball release;
                - elbow experiences a rapid combination of valgus and extension;
                - significant valgus force at elbow occurs at this stage but not as much as the late cocking phase
                - maximal activity in pronator teres, FCR and FCU;
                - extended wrist flexes at this stage;
                - dynamic stabilizers include: FDS and FCU;
                - ref: Functional anatomy of the flexor pronator muscle group in relation to the medial collateral
                  ligament of the elbow
.
          - deceleration  - shows the largest amount of muscle activity by the elbow flexors
          - follow through
          - other considerations:
                 - extension overload
                 - triceps muscle strain
                 - avulsion fracture tip of olecranon
                 - olecranon hypertrophy
                       - Olecranon stress fractures in throwers. A report of two cases and a review of the literature. 
                 - loose bodies in the olecranon fossa
                 - tears of brachialis and anterior capsule
                 - fixed flexion contracture;
                 - posterolateral instability
                 - ulnar nerve: (cubital tunnel syndrome)
                       - Ulnar nerve entrapment syndrome in baseball players.  
                         W Del Pizzo, et al.  Am J. Sports Med. Vol 5, 1977, 182-185.
                       - Traumatic ulnar neuropathy in adolescent baseball pitchers.
                          RW Godshall, CA Hansen. JBJS 53-A, 1971, 359-361.

- Diff Dx Pediatric Throwing Elbow(Radiology of Pediatric Elbow)

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