Valgus extension overload syndrome in adolescent baseball players: clinical characteristics and surgical outcomes.

BACKGROUND: Little is known about the clinical characteristics and surgical outcomes of valgus extension overload syndrome (VEOS) in adolescent athletes. We evaluated posteromedial compartment pathology, including combined lesions, and reported the surgical outcomes in adolescent baseball players. METHODS: We retrospectively reviewed the medical records of 13 male adolescent baseball players (mean age, 15.4 years) who underwent arthroscopic olecranon tip resection (n = 9) or staged operations (arthroscopic olecranon tip resection, followed by medial collateral ligament reconstruction 2 weeks later; n = 4). The shape of the tip fragment was used to classify the olecranon into 2 types: type 1, dot-like fragment (n = 3); type 2, triangular-shape fragment (n = 10). Four outcome measures were analyzed: range of motion, visual analog scale (VAS) pain score, rate of return to play, and Conway scale score. RESULTS: At a mean follow-up of 3.3 years (range, 2-6 years), the mean VAS pain score decreased from 4.1 preoperatively to 1.1 postoperatively (P < .05). Preoperative mean extension and supination were 4.2° and 70.0°, which improved to 1° (P < .05) and 76.2° (P < .05), respectively. The overall rate of return to play was 85% (11 of 13). On the Conway scale, 8 of 13 patients (62%) were classified as excellent. Patients who underwent isolated arthroscopic surgery reported less pain postoperatively and achieved a higher grade on the Conway scale than patients who underwent staged operations. CONCLUSIONS: Arthroscopic resection of olecranon tip yielded favorable outcomes at a minimum of 2 years of follow-up. Patients with concomitant ulnar collateral ligament insufficiency had less optimal outcomes than those with isolated posteromedial impingement.

Case report: Thoracic outlet syndrome in an elite archer in full-draw position.

BACKGROUND: One possible pathomechanism of thoracic outlet syndrome (TOS) is shoulder abduction and extension inducing backward motion of the clavicle which causes compression on the brachial plexus. This position occurs during the full-draw stage of archery, by drawing and holding the bowstring. CASE DESCRIPTION: A 28-year-old elite archer presented with a feeling of weakness and dull shoulder pain, and experienced decreased grip power and hypoesthesia in the ulnar nerve dermatome in the full-draw position. On CT angiography, the cross-sectional area of the subclavian artery in the costoclavicular space decreased to 40% compared with that of the subclavian artery in a noncompressed state. This patient had first rib resection through the supraclavicular approach with a clavicle osteotomy. At 3.5 years postoperatively, the patient maintained his job as a professional coach and did not have any specific complaints when teaching and demonstrating archery skills. LITERATURE REVIEW: A literature review revealed numerous causes of TOS, ranging from congenital abnormalities to repetitive postures related to sports activities. The abduction and external rotation (ABER) position (shoulder at 90° abduction and external rotation) has been suggested for detecting TOS and is a documented cause of compression of the brachial plexus and subclavian vessels. We present the case of an archer with TOS association with repeated use of the ABER position. PURPOSE AND CLINICAL RELEVANCE: TOS should be suspected when athletes repeatedly use shoulder extension and abduction for their sports if other pathologic conditions can be ruled out.