What is Posteromedial Impingement Syndrome?
Posteromedial impingement syndrome is pain in the posterolateral recess of the elbow caused by impingement of the olecranon in the olecranon fossa on the back of the elbow. This condition is more common in sports that produce a significant valgus (outward) force on the elbow such as baseball or javelin. Increasing laxity of the medial collateral ligament results in increased contact pressure between the posteromedial facet of the olecranon and posteriomedial facet of the trochlea.
How is it diagnosed?
The diagnosis should be suspected in people whose sports or activities involve a lot of valgus force to the elbow. A history of posteromedial pain that is made worse by forced extension of the elbow would be typical. The patient may be found to have tenderness in the posteromedial recess and a positive elbow valgus supination extension test. Plain Xray may demonstrate a spur or osteophyte on the medial tip of the olecranon. MRI scan is the investigation of choice and may demonstrate increased signal in the posteromedial facet. Loose bodies may be seen. Synovitis in the posteromedial recess is often seen. Valgus stability of the elbow must be assessed.
What is the preferred treatment?
For mild symptoms the first line of treatment is physiotherapy to strengthen the triceps and anati-inflammatory analgesia. Local steroid injection may be of benefit. If symptoms fail to settle surgery may be indicated. Arthroscopic or open debridement may help but where there is clear valgus instability a reconstruction of the medial collateral ligament should be performed.
see also posterolateral impingement syndrome