Posterior Impingement Syndrome of elbow Symptoms & Treatment
Posterior impingement syndrome of the elbow occurs when repeated extension of the elbow joint causes compression at the back of the elbow. Over time, this can lead to inflammation, pain, and the formation of bone spurs (extra bone growth along the edge of existing bone). The condition often results in difficulty or inability to fully straighten the elbow, limiting athletic performance and daily function.
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Posterior impingement syndrome is most common in athletes who repeatedly extend their elbows, such as baseball pitchers, tennis players, and volleyball athletes. It involves the compression of the bony tip of the elbow (the olecranon) against the posterior fossa of the humerus, causing tissue irritation and chronic pain.
Without proper management, the condition can worsen, potentially leading to permanent loss of motion or joint degeneration.
What causes Posterior Impingement Syndrome of elbow?
Repeated throwing, serving, or overhead motions force the olecranon to repeatedly press against the posterior fossa, causing wear and tear and inflammation of the tissues at the back of the elbow. Over time, this repetitive stress can result in olecranon impingement, bone spur formation, and persistent pain during elbow extension.
Athletes at highest risk include those engaged in sports requiring repetitive elbow extension, such as:
- Baseball: Frequent pitching motions place continuous stress on the posterior elbow.
- Softball: Repetitive overhead throwing in pitchers can lead to similar stress patterns.
- Tennis and other overhead racket sports: Serving and smashing motions repeatedly extend the elbow, contributing to tissue irritation and posterior impingement syndrome.
Other repetitive overhead or forceful elbow activities, even outside sports, can contribute to this condition.
Symptoms
Signs and symptoms of posterior impingement syndrome of the elbow typically develop gradually and may worsen over time:
- Pain at the back of the elbow: Often aggravated by throwing, serving, or fully extending the arm.
- Stiffness: Difficulty straightening the elbow joint after activity or rest.
- Loss of range of motion: The elbow may feel “locked” or unable to fully extend.
- Catching or locking sensations: Bone spurs or tissue irritation can cause the elbow to temporarily catch during motion.
Swelling or tenderness: Mild inflammation may be present around the olecranon.
When to see a doctor
If you experience persistent pain, stiffness, or inability to fully extend your elbow, you should consult a doctor promptly. Early evaluation allows for proper diagnosis and management, preventing worsening of posterior impingement syndrome and associated complications.
During a physical examination, your doctor will check for:
- Swelling and tenderness at the back of the elbow
- Range of motion and ability to fully extend the elbow
- Signs of bone spurs or catching during extension
Diagnostic imaging may include:
- X-rays: To identify bone spurs or structural changes
- MRI: To evaluate soft tissue damage or rule out other causes of pain, particularly in athletes with throwing injuries
Non-operative treatment
For most cases, conservative treatment is recommended before considering surgery. Key approaches include:
- Rest: Avoid activities that place repetitive stress on the elbow. Athletes should temporarily discontinue throwing, serving, or other movements that fully extend the elbow.
- Ice Therapy: Apply ice packs for 15–20 minutes, 3-4 times per day, to reduce inflammation and relieve pain.
- Medication: Over-the-counter NSAIDs such as ibuprofen or naproxen can help manage pain and swelling.
- Physical Therapy: Stretching and strengthening exercises can restore mobility, improve joint stability, and prevent recurrence. Your doctor may provide a tailored exercise program to strengthen the triceps, forearm muscles, and surrounding tissues.
You can also try these exercises at home to stretch and strengthen the muscles surrounding the elbow:
Surgical Treatment
If conservative measures fail or bone spurs significantly limit motion, surgical treatment may be necessary. Arthroscopic surgery is the preferred minimally invasive approach, allowing the surgeon to:
- Remove bone fragments or spurs contributing to impingement
- Smooth the olecranon tip or posterior fossa
- Restore normal motion and reduce pain during extension
Surgery is generally recommended for athletes or individuals who require full elbow function for sports or work.
Recovery
Recovery depends on the severity of the condition and whether surgery was performed:
- Conservative Treatment: Mild cases usually allow return to sports or activity within 6 weeks. Consistent exercises and avoiding aggravating motions are critical.
- Post-Surgical Recovery: Healing may take 3–6 months. A splint may be worn initially, followed by guided physical therapy to restore range of motion, strength, and stability. Return to full activity is gradual and closely monitored.
Dr. Jay Kimmel is a board-certified orthopedic surgeon specializing in sports medicine, arthroscopic surgery, and shoulder and knee disorders. He completed his orthopedic training at New York-Presbyterian/Columbia University Medical Center and a Sports Medicine Fellowship at Temple University.
Dr. Kimmel previously served as the Director of the Connecticut Sports Medicine Institute at Saint Francis Hospital and has held faculty appointments as Clinical Assistant Professor in the Departments of Orthopedics and Family Medicine at the University of Connecticut. He has extensive experience caring for athletes as a team physician for high school and collegiate programs and continues to teach in the athletic training departments at Westfield State University and Springfield College.
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/MonthFrequently Asked Questions
Which athletes are most likely to develop posterior elbow impingement?
This condition is most common in athletes who perform repetitive overhead or throwing motions, such as baseball and softball pitchers, tennis players, volleyball players, and other overhead athletes.
What are the early warning signs of posterior impingement syndrome?
Early symptoms often include pain at the back of the elbow during or after activity, stiffness with elbow extension, and a feeling that the elbow cannot fully straighten. Symptoms typically worsen gradually rather than appearing suddenly.
Can posterior impingement syndrome heal without surgery?
Yes. Most cases improve with non-operative treatment, including rest, activity modification, anti-inflammatory medication, and physical therapy. Surgery is usually only considered if symptoms persist or bone spurs significantly limit motion.
How long does recovery take from posterior impingement syndrome?
Recovery time depends on severity and treatment. With conservative care, many athletes return to activity within 4–6 weeks. After surgery, full recovery and return to sports may take 3–6 months with guided rehabilitation.