Valgus Extension Overload Syndrome
What Is Valgus Extension Overload Syndrome?
Valgus Extension Overload Syndrome (VEO) is an elbow condition caused by repetitive forceful extension of the joint, especially when the arm is in a valgus (outwardly angled) position. It most often affects throwing athletes — particularly baseball pitchers — due to the repetitive stresses placed on the inside (medial) and back (posterior) aspects of the elbow during high-velocity throws.
Over time, this overload can lead to impingement of soft tissues, wear of articular cartilage, and the formation of bone spurs or loose bodies, often resulting in pain, loss of extension, or even nerve compression.
Causes and Risk Factors
Repetitive overhead throwing
High-speed arm movements with forceful elbow extension
Underlying ulnar collateral ligament (UCL) laxity or damage
Poor throwing mechanics or insufficient warm-up
High pitch counts or inadequate rest in pitchers
History of elbow instability or trauma
Symptoms
Pain at the back or inner side of the elbow, especially during or after throwing
Loss of terminal extension (inability to fully straighten the arm)
Clicking, catching, or locking sensations
Swelling or tenderness near the olecranon tip
Potential ulnar nerve irritation (numbness or tingling in the ring/little fingers)
Decreased throwing velocity or endurance
Diagnosis
Clinical evaluation with stress testing of the medial UCL and assessment of range of motion
X-rays may show osteophyte formation or loose bodies in the posterior elbow
MRI evaluates soft tissues, including ligament integrity and inflammation
CT scan may be used to define bony impingement and assess joint space narrowing
Treatment
Non-Surgical Treatment
Rest from throwing and overhead activities
Use of ice and anti-inflammatory medications
Physical therapy to correct mechanics, improve flexibility, and strengthen stabilizing muscles
Gradual return-to-throwing programs
Corticosteroid injections may be used to manage inflammation in certain cases
Surgical Treatment
Indicated if non-surgical methods fail or if loose bodies and bone spurs cause mechanical symptoms
Arthroscopic debridement:
Removes bone spurs and inflamed soft tissue
Addresses impingement or locking symptoms
If UCL instability is identified, it may require surgical reconstruction (e.g., Tommy John surgery)
Recovery Outlook
Most athletes recover well with non-surgical management when addressed early
Arthroscopic procedures typically allow return to sport within 3 to 4 months
UCL reconstruction, if needed, requires a longer recovery timeline of 9 to 12 months
Early detection and technique correction are key to preventing long-term damage
Why Kerlan Jobe Institute?
The sports medicine team at Kerlan Jobe Institute is nationally recognized for treating throwing-related elbow conditions like VEO. With experience working with elite athletes, we provide specialized care that includes advanced diagnostics, minimally invasive surgery, and tailored return-to-play protocols.