What is Valgus Extension Overload (VEO)?
Valgus Extension Overload is an over-use injury of the elbow, most common in baseball and cricket bowlers and other overhead throwers. Each hard throw bends the elbow inwards (a valgus force) and then snaps it straight. Over time, this repeated stress can:
- Inflamed tendons and the ulnar collateral ligament (UCL)
- Damage the smooth joint cartilage
- create small bone spurs at the back of the elbow
- Irritate the ulnar nerve (the “funny-bone” nerve)
Early recognition prevents long-term damage and allows you to continue playing.
Typical Signs & Symptoms
Symptom | What you might notice |
Sharp or aching pain | Felt on the inner-back edge of the elbow, worse when straightening the arm or after a heavy throwing session |
Loss of full straightening | The elbow won’t quite “lock out” |
Swelling or catching | A grinding or clicking sensation (called crepitus) |
Drop in performance | Slower throws, less accuracy, or the ball sailing high |
Tingling in ring & little fingers | Caused by irritation of the ulnar nerve |
How the Condition Is Diagnosed
- Medical history & examination
Your clinician checks for movement, strength, and pinpoint areas of tenderness, and then performs a valgus stress test. - Imaging
- X-ray – detects bone spurs or stress fractures.
- MRI (with or without dye) – shows ligaments, cartilage wear, and early bone stress.
- Ultrasound – quick pitch-side look at tendons and the UCL.
Treatment – Step-by-Step
Phase | What it involves | Typical time-scale* |
Rest & activity change | 2–6 weeks off high-stress throwing; continue lower-body/cardio work | Week 0–6 |
Targeted physiotherapy | • Restore full elbow extension | Begins during rest phase |
Pain control | Short course of anti-inflammatory tablets; ice after training | As needed |
Injections (selected cases) | Platelet-rich plasma (PRP) for partial UCL tears; steroid only when strictly indicated | Case-by-case |
Return-to-throw programme | Gradual build-up with pitch-count limits | Week 6–12 |
Surgery (if needed) | • Keyhole removal of bone spurs | Only if symptoms persist |
*Times vary with age, sport, and injury severity.
Frequently Asked Questions
Is this the same as Little League Elbow?
No. Little League Elbow affects the growth plate on the inner elbow of younger children, whereas VEO involves impingement at the back of the joint and is seen in older teens and adults.
Will I need surgery?
Most athletes (approximately 80%) recover with rest, rehabilitation, and technique changes. Surgery is reserved for stubborn pain, large bone spurs, or a proven UCL tear.
When can I play again?
Uncomplicated VEO can often be managed without surgery, allowing for a return to whole competition within three months.
Can I keep working out?
Yes. Lower-body, core, and general fitness work are encouraged. Your physiotherapist will guide safe upper-limb exercises.
What happens if I keep pitching through pain?
Ignoring symptoms can lead to loose cartilage fragments, permanent stiffness, or a torn UCL—problems that may sideline you for a year or more.
Prevention Tips
- Follow pitch-count limits and rest days – use MLB Pitch Smart or equivalent guidelines.
- Build shoulder & core strength – strong legs and trunk share the load.
- Warm up properly, cool down, and stretch – focus on posterior shoulder flexibility.
- Vary your sport – participating in multiple sports and taking at least three months off from throwing each year can help reduce injury risk.
- Listen to pain and fatigue – early soreness is your warning light.
Evidence-Based Sources
- American Academy of Orthopaedic Surgeons – Elbow Injuries in the Throwing Athlete (2021)
- NICE Clinical Knowledge Summary – Tendinopathies (2024)
- MLB & USA Baseball – Pitch Smart Guidelines (2025)
Need Personal Advice?
If you have similar problems, book an appointment to be reviewed by Prof Imam or another member of our specialist team at The Arm Clinic. Early specialist care helps prevent long-term issues. Visit www.TheArmDoc.co.uk or book your consultation today. Phone: 020 3384 5588 | Email: Info@TheArmDoc.co.uk
Early assessment means a quicker and safer return to sport.
This page provides general information and should not be used as a substitute for individual medical advice. Always consult a qualified healthcare professional for guidance on your condition.