Piraino Andrew B, Davis Brent M
Houston Methodist Clear Lake Orthopedics & Sports Medicine, Friendswood, TX, USA; University of Southern California Division of Biokinesiology and Physical Therapy, Los Angeles, CA, USA.
Houston Methodist Clear Lake Orthopedics & Sports Medicine, Friendswood, TX, USA.
Int J Sports Phys Ther. 2022 Oct 1;17(6):1156-1169. doi: 10.26603/001c.38168. eCollection 2022.
Valgus extension overload syndrome (VEOS) of the elbow is a condition associated with overhead athletes. However, the non-surgical management of these individuals is not well documented.
To discuss the unique presentation, management, and outcomes of an adolescent baseball player with a chronic history of VEOS experienced during hitting.
A 15-year-old right-handed high school baseball catcher presented with a six-month history of right-sided ulnar elbow pain. Elbow MRI w/ contrast was consistent with VEOS. The initial examination demonstrated excessive resting right-sided humeral external rotation compared to his left. Valgus stress testing in the subject's hitting position reproduced symptoms, which were alleviated with retest while correcting excessive humeral external rotation. Weakness of the humeral internal rotators and stiffness/shortness of the posterior shoulder were found and thought to relate to the humeral contribution to his elbow movement dysfunction. Rehabilitation emphasized addressing impairments contributing to excessive humeral external rotation with reintegration into batting.
After five weeks of physical therapy, the subject returned to soft toss hitting at approximately 75% velocity for the first time since symptom onset, without pain. At seven months after discharge, a phone conversation confirmed that the subject had returned to baseball without limitations.
Despite the concept of 'regional interdependence', common proximal impairments are often assumed to contribute to elbow pain without a clear biomechanical rationale. Future research demonstrating the specific biomechanical effects of the shoulder on the elbow is needed, in addition to more accessible examination strategies to assess their relationship.
肘部外翻伸展超负荷综合征（VEOS）与从事过头运动的运动员有关。然而，这些患者的非手术治疗方法尚无充分记录。
探讨一名有慢性VEOS病史的青少年棒球运动员在击球时的独特表现、治疗及结果。
一名15岁右利手的高中棒球接球手，有右侧尺侧肘部疼痛6个月的病史。肘部增强MRI与VEOS相符。初始检查显示，与左侧相比，其右侧肱骨在休息时的外旋角度过大。在该受试者的击球姿势下进行外翻应力测试会重现症状，而在纠正肱骨过度外旋的同时再次测试时，症状会减轻。发现该受试者肱骨内旋肌力量薄弱，后肩部僵硬/缩短，认为这与肱骨对其肘部运动功能障碍的影响有关。康复治疗重点是解决导致肱骨过度外旋的功能障碍，并使其重新融入击球训练。
经过五周的物理治疗，该受试者自症状出现以来首次能够以约75%的速度进行软式投球击球，且无疼痛。出院七个月后的电话随访证实，该受试者已无限制地重返棒球运动。
尽管存在“区域相互依存”的概念，但通常认为常见的近端功能障碍会导致肘部疼痛，却没有明确的生物力学原理。除了需要更易于实施的检查策略来评估肩部与肘部的关系外，未来还需要开展研究来证明肩部对肘部的具体生物力学影响。
5级。
