Arthroscopy of the thrower’s elbow

Introduction

Arthroscopy of the throwing elbow offers the advantages of being less invasive and having a faster recovery. As equally important in the case of the athlete, elbow arthroscopy has good functional results and excellent rates of returning to sport, even superior to those of commonly treated throwing injuries in the shoulder such as superior labrum anterior-posterior (SLAP) lesion repair and rotator cuff repair. Additionally, arthroscopy of the elbow can be used for both the diagnosis and treatment of throwing injuries. Arthroscopy enables the direct visualization of the elbow joint, evaluation and classification of the intra-articular pathology, and definitive treatment of these lesions at the time of surgery.

Indications for elbow arthroscopy in the throwing athlete have expanded over time to include a wider array of conditions. Some of the main throwing conditions traditionally identified and treated with elbow arthroscopy include posteromedial olecranon osteophytes, intra-articular loose bodies, osteochondritis dissecans (OCD) of the capitellum, medial ulnar collateral ligament (MUCL) injuries, and ulnar neuritis. Additional conditions more recently shown to be amenable to arthroscopic treatment include valgus extension overload (VEO), lateral ligament repair, and fracture work. Increasing understanding of accessible elbow pathology and arthroscopy techniques has led to expanded indications for elbow arthroscopy. However, as with all techniques, expertise can only be ascertained with a complete three-dimensional understanding of the pertinent anatomy, continued practice, and appropriate patient selection.

A myriad of sports employ throwing mechanics that can cause an injury pattern suitable for arthroscopic intervention, including baseball, softball, tennis, football, lacrosse, track and field, and other overhead activities. While much of this chapter specifically focuses on throwing injuries encountered in baseball, the principles and injury patterns are widely applicable to all overhead athletes, making elbow arthroscopy a valuable tool for the diagnosis and management of injuries in throwing athletes and those due to overhead motion activities ( Fig. 45.1 ).

This chapter begins with a discussion of the biomechanics of throwing. Then, we discuss important history, examination, imaging, and general arthroscopy principles for throwing athletes, followed by specific conditions including MUCL tears, VEO, OCDs, and plicae. Finally, we discuss some general postoperative considerations, complications, and our conclusions on the effectiveness of elbow arthroscopy in the throwing athlete.