Throwing athletes impart tremendous stress to the elbow joint that can result in an array of injuries to the musculoskeletal and ligamentous structures. Energy initially generated from the lower extremities and trunk is transferred and augmented by the powerful shoulder muscles and passed through the elbow on the way to generating velocity of a thrown object. The combination of compressive and tensile forces exerted across the elbow can lead to pathologic changes. Unaddressed, the cumulative effect of repetitive throwing can ultimately render athletes ineffective.

A thorough understanding of the anatomy and the biomechanics of throwing are required to avoid a delay in diagnosis. Clinicians also need to recognize that certain entities represent only a stage within a spectrum of disease. Early diagnosis and the institution of proper rehabilitation programs, with an emphasis on mechanics, endurance, and flexibility, can often save athletes from potentially career-ending injuries.

When conservative measures fail, operative intervention may be required to return athletes to competition. This can take many forms. Arthroscopic and open surgical techniques have been described to address the various pathologic conditions that afflict the throwing elbow. This article succinctly describes the pertinent anatomy and biomechanics of the elbow and the wide and varied spectrum of pathology encountered, including uncommon and overlapping diagnoses and the potential pitfalls of operative treatment. A discussion of specific operative techniques is beyond the scope of this article, and the authors refer the reader to the many excellent sources cited in the reference list.