Surgery following failed conservative treatment effective in overhead throwers

SAN DIEGO — Arthroscopic debridement, olecranon spur excision and loose body excision can allow a return to throwing sports as well as excellent subjective and objective results for overhead throwing athletes suffering from posteromedial elbow impingement, according to a recent study.

Investigators retrospectively identified 10 throwing athletes over an 8-year period with posteromedial elbow impingement. They underwent an MRI and failed nonoperative treatment, thus requiring arthroscopy, Steven B. Cohen, MD, said at the 28th Annual Meeting of the Arthroscopy Association of North America, here.

The MRIs were reviewed by a fellowship-trained musculoskeletal radiologist blinded to the patients' clinical history other than age and gender. Arthroscopic treatment included debridement of posteromedial synovitis, loose body excision and the excision of any olecranon spur, according to the abstract.

All patients in the study were boys or men between the ages of 15 and 34 with an affected dominant arm. They underwent a physical examination and completion of the Andrews-Carson scale with a minimum follow-up of 12 months and a range of 12-73 months.

The researchers recorded the pathology at the articular surfaces of the posterior trochlea and the anterior medial olecranon in all patients, ranging from abnormal edema-like signals in the hyaline cartilage to partial thickness cartilage defects and subjacent, subchondral bone marrow edema.

Cohen and his colleagues reported that they found posteromedial synovitis and olecranon spurring in all patients during surgery, as well as loose bodies in three patients. Based on the Andrews-Carson scale, the study said, the subjective and objective outcome was considered "excellent" in eight patients and "good" in two.

"MRI is an extremely useful tool in the diagnosis of posteromedial elbow pain in overhead throwing athletes," Cohen said. "It yields characteristic findings that we typically find in posteromedial impingement. The surgical treatment after a failed nonoperative treatment does allow a return to sport."

Moderator Kevin D. Plancher, MD, seemed supportive of the study's findings, but questioned whether those findings led Cohen to change his established protocols.

"Have you changed anything in what you do, besides this added information?" he asked. "Has it changed ... your clinical protocol?"

"I think that you can reliably determine, based on these findings, that this is the condition that you're after, and that you should go ahead and treat that if [the patient] does not get better with nonsurgical treatment," Cohen responded.

For more information:

Steven B. Cohen, MD, is director of sports medicine research with the Rothman Institute in Philadelphia. He can be reached at 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107; (215) 992-4960; e-mail: steven.cohen@rothmaninstitute.com.

Reference:

Cohen, SB. Posteromedial elbow impingement: MRI findings in overhead throwing athletes and results of arthroscopic treatment. Presented at the 28th Annual Meeting of the Arthroscopy Association of North America. April 30-May 3, 2009.