The Elbow Sports Medicine 2
The Elbow
Sports Medicine 2
The Elbow Humerus, radius, ulna Muscles- Biceps, Brachialis,
Brachioradialis, Triceps, Pronator Teres
Observation Deformities and swelling? Carrying angle
• Cubitus valgus versus cubitus varus Flexion and extension
• Cubitus recurvatum Elbow at 45 degrees
• Isosceles triangle (olecranon and epicondyles)
Contusion Etiology
• Vulnerable area due to lack of padding• Result of direct blow or repetitive blows
Signs and Symptoms• Swelling (rapidly after irritation of bursa or synovial
membrane) Management
• Treat w/ RICE immediately for at least 24 hours• If severe, refer for X-ray to determine presence of
fracture
Olecranon Bursitis Etiology
• Superficial location makes it extremely susceptible to injury (acute or chronic) --direct blow
Signs and Symptoms• Pain, swelling, and point tenderness• Swelling will appear almost spontaneously and w/out
usual pain and heat Management
• In acute conditions, compression for at least 1 hour• Chronic cases require superficial therapy primarily
involving compression• If swelling fails to resolve, aspiration may be necessary• Can be padded in order to return to competition
Strains Etiology
• MOI is excessive resistive motion (falling on outstretched arm), repeated microtears that cause chronic injury
• Rupture of distal biceps is most common muscle rupture of the upper extremity
Signs and Symptoms• Active or resistive motion produces pain; point
tenderness in muscle, tendon, or lower part of muscle belly
Management• RICE and sling in severe cases• Follow-up w/ cryotherapy, ultrasound and exercise• If severe loss of function encountered - should be
referred for X-ray (rule out avulsion or epiphyseal fx
Unlar Collateral Injuries Etiology
• Injured as the result of a valgus force from repetitive trauma
• Can also result in ulnar nerve inflammation, or wrist flexor tendinitis; overuse flexor/pronator strain, ligamentous sprains; elbow flexion contractures or increased instability
Signs and Symptoms• Pain along medial aspect of elbow; tenderness over
MCL• Associated paresthesia, positive Tinel’s sign• Pain w/ valgus stress test at 20 degrees; possible end-
point laxity• X-ray may show hypertrophy of humeral condyle,
posteromedial aspect of olecranon, marginal osteophytes; calcification w/in MCL; loose bodies in posterior compartment
Ulnar Collateral Ligament Injuries (cont.)
Management• Conservative treatment begins w/ RICE and
NSAID’s• W/ resolution, strengthening should be
performed; analysis of the throwing motion (if applicable)
• Surgical intervention may be necessary (Tommy John procedure)
• Throwing athlete can return to activity 22-26 weeks post surgery
Lateral Epicondylitis (Tennis Elbow)
Etiology• Repetitive microtrauma to insertion of
extensor muscles of lateral epicondyle Signs and Symptoms
• Aching pain in region of lateral epicondyle after activity
• Pain worsens and weakness in wrist and hand develop
• Elbow has decreased ROM; pain w/ resistive wrist extension
Lateral Epicondylitis (continued)
Management• RICE, NSAID’s and analgesics• ROM exercises and PRE, deep friction
massage, hand grasping while in supination, avoidance of pronation motions
• Mobilization and stretching in pain free ranges
• Use of a counter force or neoprene sleeve• Mechanics training
Medial Epicondylitis Etiology
• Repeated forceful flexion of wrist and extreme valgus torque of elbow
Signs and Symptoms• Pain produced w/ forceful flexion or extension• Point tenderness and mild swelling• Passive movement of wrist seldom elicits pain, but active
movement does Management
• Sling, rest, cryotherapy or heat through ultrasound• Analgesic and NSAID's• Curvilinear brace below elbow to reduce elbow stressing• Severe cases may require splinting and complete rest for
7-10 days
Dislocation of the Elbow Etiology
• High incidence in sports caused by fall on outstretched hand w/ elbow extended or severe twist while flexed
• Bones can be displaced backward, forward, or laterally• Distinguishable from fracture because lateral and
medial epicondyles are normally aligned w/ shaft of humerus
Signs and Symptoms• Swelling, severe pain, disability• Complications w/ median and radial nerves and blood
vessels• Often a radial head fracture is involved
Elbow Dislocations (CONT.) Management
• Cold and pressure immediately w/ sling• Refer for reduction• Neurological and vascular fxn must be assessed prior to
and following reduction• Physician should reduce - immediately• Immobilization following reduction in flexion for 3 weeks• Hand grip and shoulder exercises should be used while
immobilized• Following initial healing, heat and passive exercise can be
used to regain full ROM• Massage and joint movement that are too strenuous
should be avoided before complete healing due to high probability of myositis ossificans
• ROM and strengthening should be performed and initiated by athlete (forced stretching should be avoided
Fractures of the Forearm Etiology
• Fall on flexed elbow or from a direct blow• Fracture can occur in any one or more of the bones• Fall on outstretched hand often fractures humerus
above condyles or between condyles• Condylar fracture may result in gunstock deformity
• Direct blow to ulna or radius may cause radial head fracture as well
Signs and Symptoms• May not result in visual deformity• Hemorrhaging, swelling, muscle spasm
Forearm Fractures (continued)
Management• Decrease ROM, neurovascular status must
be monitored• Surgery is used to stabilize adult unstable
fracture, followed by early ROM exercises• Stable fractures do not require surgery
• Removable splints are used for 6-8 weeks
Volkmann’s Contracture Etiology
• Associate w/ humeral supracondylar fractures, causing muscle spasm, swelling, or bone pressure on brachial artery, inhibiting circulation to forearm
• Can become permanent Signs and Symptoms
• Pain in forearm - increased w/ passive extension of fingers• Pain is followed by cessation of brachial and radial pulses,
coldness in arm• Decreased motion
Management• Remove elastic wraps or casts • Close monitoring must occur