Injury, Int. J. Care Injured 44 S3 (2013) S46–S48 Introduction Repetitive impact injuries to the elbow of goalkeepers caused by the ball hitting the fully extended distal part of a forearm have been well described during handball sporting activities. 1 Water polo also has strong similarities to handball. It was previously believed that such impact injuries to the elbow are caused by excessive hyperextension load. A newly published study found, through video analysis, that elbow valgus loading is a more likely cause of this injury. 2 Many authors have suggested that repetitive valgus force applied to the capitellum is the main etiological factor in osteochondritis disecans (OCD) of capitellum. 3,4 We report on 2 cases of acute hyperextension/valgus elbow injuries in two adult, male national team water polo goalkeepers. Both were healthy and had never had any major injuries to the elbow. The hypothesis of this paper is that incomplete cure of acute elbow injuries may result in OCD due to inadequate treatment. Case reports Case 1 An 18-year-old right-handed Caucasian male goalkeeper of the national water polo team sustained an impact injury to the right elbow caused by ball striking a fully extended distal part of the forearm. The injury occurred during training session. Because of sharp pain, predominantly in the posterior part of the elbow, he was taken out of the training session and examined by the team physician. Initially diagnosis was a hyperextension injury to the elbow. He was immediately treated by using RICE (rest, ice, compression, elevation) procedure and has been ordered to undergo a further medical examination the next day. The next day evaluation included a clinical examination and magnetic resonance imaging of the right elbow. The “chief complaint” was diffuse soreness of the elbow and minor loss of range of motion. The pain was not spread to another area, and was exacerbated by activity. He lost a few degrees to full extension of elbow for both active and passive movement. An attempt at a full ROM increased the pain in the antecubital fossa and posterior part of the elbow. Supination and pronation motion was approximately 80° in both directions. Elbow did not significantly swell and the area around it did not show any ecchymosis. Direct palpation of the antecubital fossa was slightly painful. All other findings were normal. Mayo Elbow Score was 85. Magnetic resonance imaging of the right elbow showed bone contusion to the posterior part of capitellum and a partial rupture of the anconeus muscle (Figure 1). The injured athlete did not have any previous similar elbow injury. He was healthy and he was not taking any medication. He was treated conservatively with cryotherapy, physical therapy and rehabilitation. During the first week with physiotherapy the soft tissue swelling was reduced with gentle lymphatic drainage, laser therapy, ice pack around the elbow (3-4 times per day for 5 min). He started to perform gentle passive, active-assisted and active exercise of the elbow (forearm pronation, supination, flexion) and wrist (flexion, extension). During the second week the athlete started with rapid progression of upper extremity muscle strengthening including shoulder concentric and forearms muscles isotonic exercise (concentric KEYWORDS Repetitive elbow injury Water polo Goalkeeper Osteochondritis disecans of capitellum Hyperextension ABSTRACT We report on 2 cases of hyperextension/valgus elbow injuries in two adult male national team water polo goalkeepers. Both were healthy and had never sustained any major injuries of the elbow. Mechanism and type of injury in both of them was identical. Different medical treatment protocols of these injuries possibly have led to different outcomes, with one of them developing osteochondritis dissecans (OCD). Inadequate medical treatment of acute impact elbow injuries could lead to osteochondritis disecans of the elbow in top-level adult male water polo goalkeepers. © 2013 Elsevier Ltd. All rights reserved. Acute hyperextension/valgus trauma to the elbow in top-level adult male water polo goalkeepers: a cause of osteochondritis disecans of the capitellum? Eduard Rod a, *, Alan Ivkovic a,b , Igor Boric a , Sasa Jankovic b , Andrej Radic a , Damir Hudetz a,b a St Catherine Specialty Hospital, Bracak 8, Zabok, Croatia b University Hospital “Sveti Duh”, Sveti Duh 64, Zagreb, Croatia * Corresponding author at: St Catherine Specialty Hospital, Bracak 8, Zabok, Croatia. Tel.: +385 49 204 867; Fax: +385 91 244 55 81. E-mail address: eduardrod1508@gmail.com (E. Rod). 0020-1383/$ – see front matter © 2013 Elsevier Ltd. All rights reserved. Contents lists available at SciVerse ScienceDirect Injury journal homepage: www.elsevier.com/locate/injury