Valgus Extension Overload Test

What is valgus extension overload syndrome?

Valgus extension overload (VEO) syndrome is a condition commonly seen in athletes, particularly those involved in repetitive overhead activities like baseball pitching (Cain et al., 2003). The repetitive throwing motion contributes to excessive valgus stress during extension, leading to pain at the posteromedial aspect of the elbow. Over time, this repetitive stress can damage the cartilage and bone, resulting in the formation of osteophytes (bone spurs), and in some cases, loose bodies within the joint's protective cartilage (Andrews & Launer, 2002).

Elbow movement dysfunction and excessive humeral external rotation are key factors contributing to the development of VEO syndrome (VEOS). Stiffness and shortness in the posterior shoulder muscles also contribute to excessive external rotation of the humerus, further impacting the elbow joint’s biomechanics. Weakness in the humeral internal rotators, such as the pectoralis major and latissimus dorsi, can also contribute to excessive humeral external rotation and elbow stress. If left untreated, valgus extension overload can lead to chronic pain and long-term complications, including reduced range of motion and functional limitations.

A thorough physical examination, including specific tests such as the valgus stress test, manual muscle testing, and assessments of symptom reproduction, is crucial for diagnosing this condition. Treatments may include rehabilitating the medial elbow stabilizers and the ulnar collateral ligament, which are essential in maintaining elbow stability during high-stress activities. Injuries to these structures can exacerbate the condition, making targeted rehabilitation essential.

Symptoms

When it comes to identifying VEOS, the symptoms can be fairly specific. Here are some common signs to look out for:

• Pain at the posteromedial elbow, especially during elbow extension
• Swelling around the elbow joint
• Loss of full elbow extension
• Locking or catching sensation in the elbow
• Tenderness over the medial epicondyle and olecranon
• Crepitus (a crackling sound) during elbow movement

Causes

VEOS typically develops due to repetitive stress and mechanical overload on the medial elbow. Here are some common causes:

• Repetitive overhead throwing motions (e.g., pitching in baseball)
• Excessive valgus stress during elbow extension
• Poor biomechanics during athletic activities
• Inadequate conditioning or warm-up
• Previous elbow injuries that destabilize the joint
• Overuse without sufficient rest or recovery time

Conditions like lateral epicondylitis can also exacerbate elbow pain and contribute to valgus extension overload syndrome.

What is the Valgus Extension Overload Test?

The Valgus Extension Overload Test is a clinical assessment to diagnose valgus extension overload syndrome. Although valgus stress testing is the most common method used to diagnose elbow conditions, the Valgus Extension Overload Test is still the most beneficial for identifying posteromedial elbow pain and potential osteophyte formation in athletes who engage in repetitive overhead activities.

The Valgus Extension Overload Test recreates the stresses applied to the elbow during throwing and hitting, aiding in identifying pain and potential joint instability in athletes (Piraino & Davis, 2022).

Pain or discomfort at the posteromedial elbow side indicates a positive result in the Valgus Extension Overload Test. This suggests that the patient may be suffering from valgus extension overload syndrome, warranting further investigation or intervention. On the other hand, a negative result, where the patient does not report pain, reduces the likelihood of this condition but does not entirely rule it out, especially in early or mild cases.

It is important to note that even though the VEO test has several similarities with the Moving Valgus Stress Test and the Elbow Valgus Instability Stress Test (also known as the Elbow Valgus Stress Test), they differ slightly in their procedures, focus, and conditions they aim to assess.

How to use our Valgus Extension Overload Test template

Our Valgus Extension Overload Test template is designed to streamline the assessment process, ensuring that healthcare professionals can efficiently and accurately diagnose valgus extension overload syndrome. Here's how to use the template effectively in five simple steps:

Step 1: Access the template

Begin by accessing our Valgus Extension Overload Test template by clicking "Use template," which opens it in the Carepatron app. The Carepatron app lets you customize it before printing or filling it out. Alternatively, you can save a non-customizable PDF version by clicking "Download," which you can still fill it digitally or print.

Step 2: Fill in patient information

Start by filling out the patient information section. This includes the patient’s name, date of birth, and the date of the test.

Step 3: Conduct the test procedure

To conduct the Valgus Extension Overload Test, follow the steps outlined in the template’s test procedure section. This ensures consistency in how the test is performed and that all necessary actions are taken to obtain reliable results.

Step 4: Document the test results

After conducting the test, use the template to document the results. Note whether the patient experienced pain during the test—this indicates whether it was a positive or negative test.

Step 5: Complete and review

Finally, fill in the healthcare professional information section, including your name, signature, and the date. Review the completed template to ensure all sections are correctly filled out, and the information is accurate before saving or printing it for the patient's records.

Benefits of using our template

Using our Valgus Extension Overload Test template offers significant advantages for healthcare professionals. This template ensures the test is conducted and documented consistently, providing clear guidance for each process step.

Streamlined documentation

Our template simplifies the documentation process by providing a structured format that covers all necessary information. This reduces the likelihood of errors or omissions, ensuring that all relevant details are recorded accurately and efficiently.

Enhanced patient care

By following a standardized template, healthcare professionals can ensure that the test is performed consistently and thoroughly for every patient. This leads to more reliable results, allowing for more accurate diagnoses and tailored treatment plans that meet each patient's needs.

Time efficiency

The use of a template saves valuable time during consultations. Healthcare professionals can focus more on patient care and less on administrative tasks, knowing that the documentation process is straightforward and comprehensive.

References

Andrews, J. R., & Launer, E. P. (2002). Valgus extension overload syndrome. In C. L. Baker & K. D. Plancher (Eds.), Operative Treatment of Elbow Injuries (pp. 123–130). Springer. https://doi.org/10.1007/0-387-21533-6_10

Cain, E. L., Dugas, J. R., Wolf, R. S., & Andrews, J. R. (2003). Elbow injuries in throwing athletes: A current concepts review. The American Journal of Sports Medicine (J Sports Med), 31(4), 621–635. https://doi.org/10.1177/03635465030310042601

Piraino, A. B., & Davis, B. M. (2022). The management of valgus extension overload syndrome experienced with hitting in a high school baseball player: A case report. International Journal of Sports Physical Therapy (Int J Sports Phys Ther), 17(6). https://doi.org/10.26603/001c.38168