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