Valgus extension overload in the pitching elbow.

Five baseball pitchers, three college and two professional, with an average age of 24 years, exhibited pain between the acceleration phase and follow-through phase of the pitching motion. This caused the players to be unable to continue at the level of competition necessary to play. A significant osteophyte on the posteromedial aspect of the olecranon process was identified in all pitchers. This caused impingement with the articular wall of the olecranon fossa and often created an area of chondromalacia. The more commonly identified posterior osteophyte was present in all cases. However, if just this posterior osteophyte is removed, the described lesion will be missed, with resultant persistent disability. Surgical excision of the posteromedial osteophyte through a relatively atraumatic posterolateral approach allowed early return of function without morbidity. With an average follow up of 1 year, all of the pitchers returned for one full season at maximum effectiveness.