Nerve injuries in the throwing elbow

The thrower's elbow is a unique setting in which elbow pathoanatomy is magnified because of the repetition and stresses that are generated with throwing. The soft tissues about the elbow are placed under tremendous loads with each throw, and it is common for the athlete to throw almost daily year-round for many years. This leads to bone and soft-tissue adaptive changes (such as ligamentous laxity, muscular hypertrophy, and neural fibrosis) that increase the risk for entrapment neuropathies about the elbow. The broad spectrum of neuropathies that can occur are usually responsive to nonsurgical management, but this is varies with the nerve involved. When these problems occur in the competitive thrower, a vigorous course of conservative management must be undertaken after the appropriate diagnosis has been made. If appropriate nonoperative treatment has failed, the authors advocate an aggressive approach to surgical release in the competitive thrower who cannot continue to perform at the desired level. The surgeon and thrower must understand the root of the problem, and associated pathology such as ulnar collateral ligament instability must be addressed.