Mark S. Cohen, MD

The patient is a 15-year-old right-hand dominant high school sophomore who plays catcher for his varsity baseball team. He presented to our clinic with a history of right posterior elbow soreness associated with overhead throwing. Three months prior to presentation, he reported hearing a “pop” in the right elbow while throwing from the outfield. He felt subsequent pain in the posterior aspect of his elbow and had increased pain with the next throw.

Ulnar collateral ligament injuries of the elbow are occurring with increased frequency among overhead athletes. These injuries are thought to be due to an acute-on-chronic mechanism of microtrauma of overuse. Although most commonly seen in pitchers, ulnar collateral ligament injuries can also occur in javelin throwers, gymnasts, quarterbacks and other overhead athletes who exert a valgus stress across the elbow. The injury occurs more frequently in men, and is diagnosed by history and physical exam using primarily the milking maneuver and the moving valgus stress test. Radiographs are typically normal, but advanced imaging, including ultrasound and MRI (Figure 1), play a role in confirming the diagnosis.

Lateral epicondylitis, commonly referred to as tennis elbow, is the most common etiology of elbow pain and occurs in 1% to 3% of adults. Degenerative tendinosis of the origin of the extensor carpi radialis brevis has been proposed as the central pathology (Figure 1).

A 33-year-old machinery operator presented to the office with a right elbow “clunk” and pain with motion following an elbow injury and surgery 5 months prior. At the time of his injury, he sustained an anterior Monteggia fracture-dislocation of his right elbow after his arm was caught in a pulley at work (Figure 1). He was seen and evaluated by an outside surgeon, who performed an open reduction and internal fixation (ORIF) of the ulna the day after the injury. At the time of surgery, reduction of the radiocapitellar joint was achieved after fixation of the ulna, and the ulnohumeral joint was reportedly stable through a range of motion.