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Most Docs spend 40 years in sports medicine and never see this.

I’ve looked at hundres of elbows. Pitchers, shortstops, catchers and outfielders complaining of their inner elbow with some form of pain or discomfort. For years, I did what everyone else did: chased the obvious and typical diagnosis. Low-to-High grade UCL sprain. Flexor-pronator strain or tendonitis. Primary ulnar neuritis. That being said, recently I encountered a new anomaly that I have not considered prior... the anconeus epitrochlearis.

it’s a rare, congenital muscle that spans the medial olecranon and medial epicondyle (right where Osborne's ligament is supposed to be). In 99% of people, it’s a harmless anatomical anomaly. But in high-performance overhead athletes? and thousands of repetitive valgus stress cycles it hypertrophies. It bulks up in an already cramped canal. And every single time that pitcher cocks his arm and accelerates forward, that extra mass doesn't just stretch the ulnar nerve... it compresses it dynamically.

As I was sitting in the office looking at the MRI I thought.... How many times did I miss this in the past? How many athletes did I rehab for a ulnar nerve injury when their real problem was a small muscle nobody taught us to look for?

That’s the difference between guessing and having a clear plan of action when seeing these players.

If you want to stop chasing ghosts, master complex elbow pathologies, and actually help your overhead athletes instead of spinning your wheels, you need a better diagnostic, screening and return to sport system.

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