Valgus Extension Overload

What is valgus extension overload, and how is it treated?

Are you a throwing athlete primarily involved in baseball or other overhead sports? Have you noticed persistent elbow pain during or after throwing? If so, you might be dealing with a condition known as valgus extension overload.

In this article, we will delve into what valgus extension overload is, its causes, symptoms, diagnostic methods, and available treatment options.

If you’re experiencing elbow pain or suspect you might have valgus extension overload, OrthoNeuro is here to help. Our experienced team of orthopedic specialists across multiple locations in Columbus, Ohio can provide the care you need. Contact us today!

What is Valgus Extension Overload Syndrome?

As pitchers throw or during other overhead activities, the olecranon and humerus bones twist and are forced against each other. With repetitive friction between these bones, the protective cartilage on the olecranon can wear out. This will often lead to an abnormal growth of the bone called bone spurs or osteophytes. This condition is called valgus extension overload (VEO) syndrome.

Athletes with VEO will likely have some swelling and pain on the back of the elbow. An ulnar collateral ligament injury is often associated with this type of injury.

Elbow Medial Valgus Stress Overload Injury: What's Involved?

The throwing motion places significant demands on the elbow joint, particularly during the acceleration and follow-through phases. This motion involves a combination of valgus stress (sideways force) and extension overload, which can overwhelm the medial elbow stabilizers and lead to injury. The repetitive nature of throwing, especially with improper mechanics, can contribute to this condition.

Causes of Valgus Extension Overload

Several factors contribute to the development of valgus extension overload. They include the following:

Excessive Humeral External Rotation: A throwing motion that involves excessive humeral external rotation can increase stress on the medial elbow.
Elbow Movement Dysfunction: Incorrect elbow movement during the pitching motion can lead to abnormal forces on the joint.
Inadequate Conditioning: Inadequate strength and conditioning of the muscles involved in stabilizing the elbow can lead to overload. For example, if there is a weakness in the humeral internal rotators and stiffness/shortness of the posterior shoulder, there may be excessive strain on the elbow.
Poor Throwing Mechanics: Incorrect throwing mechanics can result in improper distribution of forces, leading to overloading of certain structures.

Symptoms of Valgus Extension Overload

Elbow Pain: Persistent pain on the inner side of the elbow (olecranon process), especially during and after throwing.
Limited Range of Motion: Difficulty fully extending or flexing the elbow.
Decreased Performance: Reduced throwing accuracy and velocity due to pain and instability.

Diagnosis of Valgus Extension Overload

Diagnosing this condition involves a thorough physical examination, which may include the valgus stress test, where the elbow is stressed to reproduce the pain. Other than valgus stress testing, the “arm bar test” or “bounce test” may be used to detect pain in elbow extension. Your doctor may also measure your elbow range.

Additionally, imaging techniques like X-rays and MRI scans can help evaluate the extent of the injury and rule out other possible causes of elbow pain.

Valgus Extension Overload Treatment

Treatment strategies for valgus extension overload can be divided into non-surgical and surgical approaches.

Non-Surgical Management

Non-surgical treatments are an effective way to treat valgus extension overload syndrome. The earlier you begin treatment, the more effective they will be. These conservative treatments include the following:

Rest and Activity Modification: Taking a break from throwing and modifying activities that aggravate the condition.
Physical Therapy: A structured rehabilitation program to improve strength, flexibility, and throwing mechanics. It may involve a period limited to soft toss hitting.
Pain Management: Non-steroidal anti-inflammatory drugs (NSAIDs) and other pain relief measures.

Surgical Intervention

Surgical intervention may be necessary if symptoms persist with no improvement after trying nonoperative treatments. This may include the following:

Arthroscopic Osteophyte Resection: Your surgeon will use minimally invasive surgery to remove the bone spurs from the olecranon.
Ulnar Nerve Release: If there are significant symptoms due to the ulnar nerve, a surgical procedure can be done to release pressure.

Book an Appointment at OrthoNeuro Today

Valgus extension overload is a condition that can significantly impact throwing athletes. Early diagnosis and appropriate management are essential to ensure a successful recovery and a return to optimal performance.

If you’re experiencing symptoms of valgus extension overload, reach out to the experienced orthopedic specialists at OrthoNeuro. Our offices are conveniently located throughout Columbus, OH. Contact our expert today!

Medically reviewed by B. Rodney Comisar, MD, FAAOS

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