Javelin Thrower’s Elbow

Javelin Thrower’s Elbow is an injury affecting the medial ulnar collateral ligament (UCL) of the elbow joint and is most frequently seen among javelin throwers. The condition is named after this athletic population, which is exposed to extreme valgus stresses during the throwing motion¹.

The injury occurs when the elbow experiences a valgus force that exceeds the tensile strength of the UCL. This typically happens when the javelin is thrown with poor technique, such as a low elbow position or insufficient shoulder abduction. The UCL, which serves as the primary stabilizer resisting valgus stress, becomes overloaded and damaged¹.

Cause and Mechanism

The most common cause of Javelin Thrower’s Elbow is overuse over time, although acute injuries can also occur. Repeated subthreshold forces on the UCL accumulate gradually, leading to microscopic and eventually structural damage³. This is often observed following intense training sessions or a high number of throws.

Two throwing techniques are described in the literature:

• Round arm: Produces high valgus stress on the medial collateral ligament

• Over arm: May lead to olecranon changes and, in some cases, avulsion injuries³

Among experienced athletes, another form of “javelin elbow” may develop due to hyperextension of the elbow during the final throwing phase. This results in pain at the olecranon tip and is often recurrent².

Symptoms and Clinical Presentation

Typical symptoms include:

• Pain on the medial side of the elbow, especially during throwing

• Tenderness on palpation of the medial epicondyle region

• Swelling and reduced range of motion

• Decreased throwing power and endurance

• Increased pain following repetitive use or high-intensity training¹ ⁴ ⁵ ⁶

Early diagnosis and management are crucial to prevent chronic pain and loss of performance.

Clinical Examination

Inspection and movement assessment are key in evaluation.

• Observe the resting position of the elbow and the carrying angle (normally around 11° in men, 13° in women)

• Look for swelling, scars, deformities, or signs of prior trauma

• Assess active and passive movement (flexion, extension, pronation, supination)

Specific findings:

• A soft end-feel in extension may indicate soft tissue contracture

• A hard end-feel in flexion can suggest osteophytes or loose bodies⁷

• The valgus stress test is the primary clinical test used to reproduce pain and assess UCL integrity

Other conditions, such as medial epicondylitis or avulsion injuries, must be ruled out.

Differential Diagnoses

• Medial epicondylitis (golfer’s elbow)

• Ulnar neuropathy

• Cervical radiculopathy

• Partial or complete UCL rupture

• Ulnohumeral osteoarthritis

• Medial osteophyte formation

• Medial epicondylar avulsion fracture

• Cubital tunnel syndrome¹ ⁶

Physiotherapy Treatment

Rehabilitation is divided into three main phases: acute, subacute, and advanced rehabilitation.

Acute Phase

• Apply the RICE principle (Rest, Ice, Compression, Elevation)

• Pain management: Paracetamol and NSAIDs as needed

• Unload the joint: Avoid throwing and valgus stress for at least 4–6 weeks⁶

• Support: Use of an elbow sleeve or brace if necessary

Subacute Phase

• Maintain muscle mass: Begin with isometric strengthening

• Mobilization and strength: Use light resistance, high repetitions for biceps, triceps, and forearm muscles

• General conditioning: Emphasize core stability and overall functional strength

• Ergonomics: Correct throwing mechanics, focusing on shoulder positioning and movement efficiency

Advanced Phase

• Gradually increase load tolerance

• Technique refinement: Increase shoulder abduction to 120°–130° to optimize throwing mechanics

• Controlled return to sport: Begin with low-intensity throws and progressively increase velocity⁴ ⁷

Rehabilitation is complete when the athlete can throw pain-free with full strength and mobility.

Surgical Treatment

Surgery is indicated when:

• The UCL is completely ruptured

• A partial tear fails to respond to 3 months of conservative rehabilitation

• There are loose bodies, osteochondritis dissecans, or avulsion fractures present

Common surgical procedures include:

• Direct ligament suture

• Ligament reconstruction, which is the most widely used and successful method⁸

Clinical Summary

Javelin Thrower’s Elbow is an overuse injury caused by valgus overload of the ulnar collateral ligament, most commonly seen in throwing athletes.Early diagnosis, rest, and structured rehabilitation are critical for recovery and prevention of chronic instability.Surgical reconstruction provides excellent outcomes in advanced or unresponsive cases.Physiotherapy focuses on restoring joint stability, throwing mechanics, and gradual return to sport.

Sources:

1. Javelin Thrower's Elbow. Progressive rehabilitation and perfection care. 2021. Available from: https://www.progressivecare.in/javelin-throwers-elbow/

2. Miller JE. Javelin thrower's elbow. The Journal of Bone and Joint Surgery. British volume. 1960 Nov;42(4):788-92.

3. J.E. Miller. (4 November 1960). Javelin throwers elbow. The journal of bone and joint surgery

4. James D. O’Holleran, MD& David W. Altchek, MD. (13 February 2006). The Thrower’s Elbow: Arthroscopic Treatment of Valgus Extension Overload Syndrome. HSS Journal pag 83-84

5. Michael J. Wells, MS; Gerald W. Bell, EdD, PT, ATC,R. (30 September 1995). Concerns on Little League Elbow. Journal of Athletic Training, volume 30, nummer 3, pag. 249 – 253 (level: A1)

6. Gjennomgått - Trukket

7. KYLE J. and AMELIA C. Childhood and Adolescent Sports-Related Overuse Injuries. Journal of the American Academy of Family Physicians2006.

8. P Langer, P Fadale, M Hulstyn. (17 February 2006). Evolution of the treatment options of ulnar collateral ligament injuries of the elbow. British Journal of Sports Medicine pag 499 – 506