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Keywords

Clinical Practice in Athletic Training

Abstract

Background: A 21-year-old, male, collegiate baseball player reported to the athletic training staff complaining of pain along the posteromedial aspect of the right elbow. The patient reported a previous history of a grade I ulnar collateral ligament sprain that had been rehabilitated until he was able to return to full pain free activities. The patient could not recall a specific mechanism of injury. Physical examination revealed a loss of terminal elbow extension, and pain along the posteromedial aspect of the elbow. The patient reported no neurological symptoms during or after throwing. Valgus Stress, Milking, and Posterolateral Rotary Drawer tests were all negative for pain or laxity. Differential Diagnosis: Triceps Tendinopathy, Osteophyte, Ulnar Collateral Ligament Sprain, Ulnar Nerve Irritation. Treatment: The patient began treatment and rehabilitation with a working diagnosis of triceps tendinopathy. The rehabilitation protocol consisted for forearm and elbow resistance exercises with 50% blood flow restriction. Treatment consisted of cupping therapy and dry needling to address adhesions in the triceps muscle belly. Following two weeks of treatment, the patient reported no significant improvement in symptoms. At this time, the patient was referred to the team physician for further evaluation. Point of care ultrasound findings were consistent with valgus extension overload, leading to the patient discontinuing throwing while continuing rehabilitation and treatment. 10 days after discontinuing throwing, the patient was experiencing no pain when moving suddenly into terminal elbow extension. At this time, the patient began a return to throwing program while wearing an external dynamic arm stabilizer (K2 Sleeve, Kinetic Arm, Chamblee, GA) as pictured in. Over the next two months, the patient progressed his throwing program in terms of frequency, volume, and intensity, while continuing to hit and field with no limitations. At the end of the two-month period, the patient was able to return to full team activities without the external dynamic arm stabilizer. Uniqueness: While valgus extension overload has been described in the currently available literature, the overall prevalence is unknown. This appears to be the first case study describing the use of an external dynamic arm stabilizer during rehabilitation for a baseball player suffering from valgus extension overload. While surgery may be indicated for valgus extension overload presenting with prolonged symptoms, current surgical outcomes are mixed. This places an increased emphasis on exhausting all nonoperative interventions prior to surgery. Conclusions: While there is a need for further research, this case describes the use of an external dynamic arm stabilizer in a baseball player to allow the patient to throw with reduced discomfort during the return to play process. When caring for patients with musculoskeletal injuries, it is crucial to exhaust all nonoperative interventions prior to recommending surgery. Further research is needed to determine the magnitude of effect for the use of an external dynamic arm stabilizer for decreasing forces at the elbow.

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