Editorial Commentary: It's the Fracture, Not the Fragment, That Causes the Pain: Posteromedial Elbow Impingement in Baseball Players.

Abstract

Posterior impingement pain in baseball players is typically due to a fractured olecranon osteophyte. Computed tomographic (CT) scanning is the imaging of choice when evaluating posterior or posteromedial elbow pain in athletes who have subjected the elbow to excessive stresses such as occur in overhead throwing and weightlifting. Sometimes the fracture fragment can be so small that it might not be detected on plain radiographs, magnetic resonance imaging, or even at the time of arthroscopy. Symptomatic fractured olecranon osteophytes can be diagnosed clinically with the extension impingement test or arm bar test. Posteromedial osteophytes are often part of a generalized hypertrophic osteoarthritic response to overload and/or wear in the joint, which are best seen on CT scans.