Posteromedial impingement occurs when the bony tip of the elbow, the olecranon, is forced against the humerus bone during rapid arm straightening. This compression often leads to inflammation, cartilage damage, or the formation of bone spurs. It is frequently seen in overhead athletes, such as baseball pitchers and javelin throwers, as part of valgus extension overload syndrome.
Symptoms often appear gradually and are most noticeable during the follow through phase of a throw or when locking the arm straight.
Back of Elbow Pain: Sharp pain localized to the inner back part of the elbow joint.
Extension Block: Difficulty or pain when attempting to fully straighten the arm.
Locking or Catching: Sensations of the joint getting stuck, often caused by loose fragments of bone or cartilage.
Crepitus: A grinding or popping sound during movement.
Swelling: Fluid buildup at the back of the joint.
Because this condition often coexists with ulnar collateral ligament (UCL) issues, a detailed evaluation is necessary.
Physical Exam
X-rays: Used to identify bone spurs (osteophytes) or loose bodies within the joint.
MRI or CT Scan: These provide high resolution images of the bone and soft tissue to check for cartilage wear, stress fractures, or hidden bone fragments.
The goal of treatment is to reduce inflammation and restore a pain free range of motion.
Typical Methods
Conservative: Rest from throwing, anti-inflammatory medication, and physical therapy to strengthen the triceps and forearm muscles. In many cases, an athlete must also work on throwing mechanics to prevent the elbow from snapping into full extension too forcefully.
Surgical: Arthroscopic debridement to remove bone spurs or loose bodies if symptoms persist after several months of therapy. If the impingement is caused by a loose UCL, the ligament may also need to be addressed to provide long term relief.