Ulnohumeral Chondral and Ligamentous Overload

The dynamic process of ulnohumeral chondral and ligamentous overload (UCLO) describes the phenomenon that occurs in the posteromedial elbow in association with ulnar collateral ligament (UCL) insufficiency throughout the entire throwing motion arc. This concept expands upon the previously defined problem of valgus extension overload and potentially helps to delineate the sources of posteromedial elbow symptoms reported in overhead-throwing athletes. In the setting of valgus insufficiency throughout the throwing arc, posteromedial impingement of the olecranon upon the posteromedial trochlea results in abnormal contact forces with subsequent degenerative changes, including chondromalacia and osteophyte formation. This condition can result in substantial disability in the posteromedial compartment of the elbow leading to the inability to play in throwing athletes. Treatment for UCLO should be geared toward prevention through avoiding overuse situations, optimizing pitching mechanics, and rehabilitating lower extremity, core, trunk, scapula, and upper extremity strength, flexibility, and kinematics. If the throwing athlete experiences symptoms consistent with UCLO, the health care provider should be knowledgeable about the pathology and treatment of this disorder to successfully allow for return to play through a focused nonoperative or operative management plan that addresses UCL insufficiency and/or all associated changes, such as presence of osteophytes and chondromalacia.