Valgus extension overload syndrome (VEOS) is a constellation of problems and pains within the elbow due to overuse and repetitive throwing forces. The ulnar collateral ligament (UCL) on the inner side of the elbow is a structure that helps keep the normal relationship of the humerus (arm bone) and the ulna (one of the forearm bones). This ligament may be stretched over time with repeated hard throwing. The stretching of the ligament results in gapping of the inner side of the elbow. This stretches the ulnar nerve on the inner elbow, causing symptoms in the hand or particularly the ring and little fingers. The outer part of the elbow and the back of the elbow develop increased pressure from the loose UCL, resulting in cartilage injury, bone spurs, and eventually loose pieces of bone floating within the elbow joint.
Frequent Signs and Symptoms
- Pain and tenderness around the elbow especially when trying to throw or straightening the elbow
- Occasionally, locking or catching of the elbow
- Swelling of the elbow
- Inability to throw at full speed; loss of ball control
- Elbow stiffness; inability to straighten the elbow
- Numbness or tingling in the ring and little fingers
- Clumsiness and weak hand grip
Etiology (Causes)
Force that exceeds the strength of the ligament results in stretching of the unar collateral ligament of the elbow. This injury usually is the result of throwing repetitively or particularly hard, which produces stretching of the unar nerve and increased pressure of the cartilage on the outer portion of the elbow, as well as the back of the elbow. This causes bone spurs and loose bodies within the elbow joint.
Risk Factors
- Sports in which the arm is used to throw or straighten forcefully (baseball, javelin, hockey slap shot, tennis serve, volleyball)
- Poor physical conditioning (strength and flexibility)
- Improper throwing mechanics
- Sports in which there is a valgus force on an extended elbow (gymnastics) or hyperextension of the elbow (boxing, weightlifting)