Arthroscopic treatment of posterior impingement of the elbow in athletes.

Elbow pain in athletes who engage in contact sports and in overhand throwing is fairly common. Its cause can be myotendinous (medial or lateral epicondylitis), articular surface (loose bodies or chondromalacia), stability (ligamentous insufficiency), or apophyseal in young athletes. Posterior impingement of the elbow can arise from a repetitive microtraumatic process or a single traumatic event. Posterior impingement of the elbow is a mechanical abutment of bony and soft tissues in the posterior compartment, producing pain, locking, and crepitation, especially at the limits of elbow extension. Extension loss of varying degrees can exist. Often, pathologic changes are not limited to the posterior compartment of the elbow and can include anterior compartment loose bodies and degenerative chondromalacia of the radiocapitellar joint. Not all patients with posterior elbow pain have posterior impingement, however; for example, posterior pain can arise because of triceps tendinitis or olecranon stress fractures. 21 Posterior impingement of the elbow in athletes can be separated into two broad categories, even though this is a somewhat artificial classification. Posterior impingement can occur in stable elbows (with intact, functional collateral ligaments) owing to hyperextension forces and in unstable elbows owing to functionally lengthened collateral ligaments that, in turn, cause bony abutment of the olecranon and the humerus. Posterior impingement of the elbow can be the primary cause leading to clinical presentation or it can be a minor part of a symptom complex that should be addressed as part of a global treatment plan. 11