The Elbow Denisha Fergusson, ATC, LAT Primary Lab Instructor Florida International University Acute Care and Injury Prevention
Ligaments of the elbow
Elbow Injuries • Subject to injury due to… • Broad range of motion • Weak lateral bone structure • Exposure of soft tissue • Many sports place excessive stress on joint • Locking motion of some activities • Throwing motion
Elbow Injuries: Contusion • MOI = direct blow or repetitive blows • Vulnerable area due to lack of padding • Signs and Symptoms • Rapid swelling due to irritation of bursa or synovial membrane • Management • RICE immediately, for at least 24 hours • If severe, refer for X-ray to rule out fracture
Elbow Injuries: Olecranon Bursitis • MOI = direct blow • Superficial location: extremely susceptible to injury • Signs and Symptoms • Pain, swelling, and point tenderness • Swelling will appear almost spontaneously without the pain and heat
Elbow Injuries:Olecranon Bursitis • Management • Acute: compression for at least 1 hour • Chronic: requires superficial therapy primarily involving compression • If swelling fails to resolve, aspiration may be necessary • May be padded to return to competition
Elbow Injuries: Muscle Strains • MOI = overstretching or too forceful a contraction • Falling on outstretched arm • Repeated microtears may cause chronic injury • Rupture of distal biceps is most common
Elbow Injuries: Muscle Strains • Signs and Symptoms • Pain with AROM and RROM • Point tenderness in muscle, tendon, or lower part of muscle belly • Management • PRICE • Sling in severe cases • Follow-up treatment • Modalities, ROM and PRE exercises • If severe loss of function, refer for X-ray to rule out avulsion or epiphyseal fracture
Elbow Injuries: Ulnar Collateral Ligament Injuries • MOI = valgus force from repetitive trauma • Secondary injuries may include… • Ulnar nerve inflammation • Wrist flexor tendonitis • Joint instability
Elbow Injuries: UCL Injuries • Signs and Symptoms • Pain along medial aspect of elbow • Point tenderness over UCL • Associated paresthesia (Reason:?)
Elbow Injuries: UCL Injuries • Management • Conservative treatment • PRICE and NSAID’s • ROM and PRE exercises as pain decreases • Analysis of the throwing motion (if applicable) • Surgical intervention may be necessary • Tommy John Procedure • Throwing athlete may be able to return to activity approximately 22-26 weeks post surgery
Elbow Injuries: Lateral Epicondylitis (Tennis Elbow) • MOI = repetitive microtrauma to insertion of wrist extensor muscles
Elbow Injuries: Lateral Epicondylitis (Tennis Elbow) • Signs and Symptoms • Aching pain at lateral epicondyle after activity • Decreased elbow ROM • Pain with AROM and RROM wrist extension • Pain and weakness in wrist and hand develop
Elbow Injuries: Lateral Epicondylitis (Tennis Elbow) • Management • PRICE • NSAID’s and analgesics • Mobilization and stretching in pain free ranges • Deep friction massage • Hand grasping while in supination • Avoid pronation motions • Use of neoprene sleeve • Mechanics and skills training in order to avoid recurrence of injury
Elbow Injuries: Medial Epicondylitis • MOI = repeated forceful wrist flexion and extreme valgus torque on the elbow • May involve common flexor tendons • Can be associated with ulnar nerve neuropathy
Elbow Injuries: Medial Epicondylitis • Signs and Symptoms • Pain with AROM and RROM wrist flexion • Point tenderness and mild swelling at medial epicondyle
Elbow Injuries: Medial Epicondylitis • Management • PRICE • NSAID's and analgesics • Sling in severe cases • Severe cases may require splinting and complete rest for 7-10 days • Cryotherapy, Ultrasound • Curvilinear brace • Below elbow to reduce stress at the elbow joint
Elbow Injuries: Little League Elbow • MOI = repetitive microtraumas that occur from throwing motion (Not due to the type of pitch)
Elbow Injuries: Little League Elbow • Linked to: • Accelerated apophyseal growth and delayed medial epicondyle epiphysis growth • Traction apophysitis with possible fragmentation of medial epicondylar apophysis • Avulsion fracture at medial epicondyle or radial head • Osteochondrosis of humeral capitellum • Non-union stress fracture of olecranon epiphysis
Elbow Injuries: Little League Elbow • Signs and Symptoms • Onset is slow • Slight flexion contracture • Tight anterior joint capsule • Weakness in triceps • “Locking” or “Catching” sensation • Decreased ROM • Especially forearm pronation and supination
Elbow Injuries: Little League Elbow • Management • PRICE • NSAID’s and analgesics • Stop throwing until… • Pain resolved • Full ROM is regained • Gentle ROM exercises • Gentle triceps strengthening exercises • Analysis of throwing motion
Elbow Injuries: Osteochondritis Dissecans • MOI = Repetitive microtrauma • Injurious movements include elbow rotation and extension • Excessive valgus stresses causes compression of the radial head, which adds shearing forces at the radiocapitular joint • Impairment of blood supply may result, which causes degeneration of articular cartilage creating loose bodies
Elbow Injuries: Osteochondritis Dissecans • Panner’s disease • Occurs in children (age <10) • Osteochondrosis of capitellum due to localized avascular necrosis
Elbow Injuries: Osteochondritis Dissecans • Signs and Symptoms • Sudden pain at radiohumeral joint • Swelling, creptitus • Decreased ROM (full extension) • ROM usually returns in a few days • Grating with pronation and supination • Locking of the joint • X-ray • May show loose bodies in joint
Elbow Injuries: Osteochondritis Dissecans • Management • Activity restriction for 6-12 weeks • NSAID’s • Splint and cast applied in severe cases of deterioration • If repeated locking of the elbow joint occurs, loose bodies are removed surgically
Elbow Injuries: Cubital Tunnel Syndrome • MOI = narrowing of cubital canal or irregularity of cubital tunnel • Pronounced cubital valgus may cause deep friction contributing to injury • Ulnar nerve injury may result
Elbow Injuries: Cubital Tunnel Syndrome • Signs and Symptoms • Pain on medial aspect of elbow • Pain may be referred proximally or distally • Point tenderness in cubital tunnel • Pain with hyperflexion • Intermittent paresthesia in 4th and 5th fingers
Elbow Injuries: Cubital Tunnel Syndrome • Management • Rest, immobilization for 2 weeks • NSAID’s • Splinting, surgical decompression or transposition of subluxating nerve may be necessary • Avoid hyperflexion and valgus stresses
Elbow Injuries: Dislocation • MOI = fall on outstretched hand with elbow extended or severe twist while elbow flexed • High incidence in sports • Dislocation may be posterior, anterior, or lateral
Elbow Dislocation
Elbow Injuries: Dislocation • Signs and Symptoms • Swelling, severe pain, disability • Median and radial nerves may be compromised • Blood vessels may be compromised • Often a radial head fracture is involved
Elbow Injuries: Dislocation • Management • Immobilize and ice immediately • Refer for reduction immediately • Rehabilitation includes • Heat and PROM exercises to regain full ROM • ROM and PRE exercises should be initiated by athlete
Elbow Injuries: Fractures • MOI = fall on flexed elbow or direct blow • May occur in one or more of bones in elbow joint • Signs and Symptoms • May not result in visual deformity • Hemorrhaging, swelling, muscle spasm
Elbow Injuries: Fractures • Management • Monitor neurovascular status • Non-surgical treatment • Appropriate for stable fractures • Immobilize with cast or removable splint for 6-8 weeks • Surgical treatment • Used to stabilize unstable fractures in adults • ROM exercises initiated early to prevent frozen elbow
Elbow Injuries: Volkmann’s Contracture • MOI = impaired circulation or ischemia • Associate with humeral supracondylar fractures • Compromises the brachial artery and inhibits circulation to forearm • May be loss of motor and sensory function • Classic case involves median nerve
Elbow Injuries: Volkmann’s Contracture • Signs and Symptoms • Pain in forearm which increases with PROM finger extension • Cessation of brachial and radial pulses • Coldness in arm • Decreased ROM • Management • Monitor neurovascular integrity
