Posterior Medial Elbow Impingement

Posterior elbow pain may be caused by mechanical abutment of bone or soft tissues in the olecranon fossa which leads to osteophyte formation, loose bodies and is often associated with UCL instability. This overuse condition is generally caused by repetitive hyperextension, valgus and supination and is characterized by posteromedial olecranon osteophytes, chondromalacia of the medial wall of the olecranon fossa, tension on the medial ulnar collateral ligament and compression of the radiocapitellar joint. This valgus extension overload syndrome is commonly found in tennis players, boxers, weightlifters, gymnasts, martial arts and football lineman, but the most common diagnosis is in baseball players.

Removal of Osteophytes and Loose Bodies

Arthroscopic treatment of posteromedial impingement utilizes a straight posterior and posterolateral portals. The posterolateral portal is used as a working portal and the straight posterior portal is used for insertion of the arthroscope. After thorougharthroscopic evaluation of the posterior compartment and removal of any loose bodies, the posteromedial osteophyte is removed with a small osteotome taking care to remove bone fragments with a grasper. The remaining tip is finished with a small burr or shaver, only removing enough bone to allow full extension without impingement. Chondromalacia of the fossa is debrided of any unstable cartilage flaps and abrasion chondroplasty is performed if necessary.