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Arthroscopic Posteromedial Decompression for Valgus Extension Overload
Valgus extension overload is a type of elbow arthritis that results from repetitive valgus stress in throwing athletes. High compression and shear forces are experienced when the posteromedial olecranon contacts the trochlea, resulting in posteromedial impingement. Patients have a history of throwing or repetitive overhead activity, and symptoms are often preceded by a decrease in pitch velocity, a decrease in control, and early fatigability. In patients with isolated valgus extension overload, elbow pain is localized to the posteromedial aspect of the olecranon when the elbow reaches terminal extension just after ball release in the deceleration phase of throwing Patients may experience limited extension, which results from posterior osteophyte impingement, or locking and catching, which results from the presence of loose bodies or chondral injury. Patients may have ulnar collateral ligament or flexor-pronator insufficiency as well as ulnar neuritis or subluxation. This chapter discusses the diagnosis, indications, contraindications, and results for arthroscopic posteromedial decompression in patients with valgus extension overload. A step-by-step description of the preferred surgical technique, postoperative care, as well as pearls and pitfalls are also discussed.