The Elbow

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The Elbow

• Denisha Fergusson, ATC, LAT
• Primary Lab Instructor
• Florida International University
• Acute Care and Injury Prevention

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Ligaments of the elbow
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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

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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

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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

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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

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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

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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

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Elbow Injuries Ulnar Collateral Ligament Injuries

• MOI valgus force from repetitive trauma
• Secondary injuries may include
• Ulnar nerve inflammation
• Wrist flexor tendonitis
• Joint instability

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Elbow Injuries UCL Injuries

• Signs and Symptoms
• Pain along medial aspect of elbow
• Point tenderness over UCL
• Associated paresthesia (Reason?)

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Elbow Injuries UCL Injuries

• Management
• Conservative treatment
• PRICE and NSAIDs
• 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

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Elbow Injuries Lateral Epicondylitis (Tennis
Elbow)

• MOI repetitive microtrauma to insertion of
  wrist extensor muscles

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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

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Elbow Injuries Lateral Epicondylitis (Tennis
Elbow)

• Management
• PRICE
• NSAIDs 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

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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

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Elbow Injuries Medial Epicondylitis

• Signs and Symptoms
• Pain with AROM and RROM wrist flexion
• Point tenderness and mild swelling at medial
  epicondyle

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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

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Elbow Injuries Little League Elbow

• MOI repetitive microtraumas that occur from
  throwing motion (Not due to the type of pitch)

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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

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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

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Elbow Injuries Little League Elbow

• Management
• PRICE
• NSAIDs and analgesics
• Stop throwing until
• Pain resolved
• Full ROM is regained
• Gentle ROM exercises
• Gentle triceps strengthening exercises
• Analysis of throwing motion

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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

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Elbow Injuries Osteochondritis Dissecans

• Panners disease
• Occurs in children (age lt10)
• Osteochondrosis of capitellum due to localized
  avascular necrosis

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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

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Elbow Injuries Osteochondritis Dissecans

• Management
• Activity restriction for 6-12 weeks
• NSAIDs
• Splint and cast applied in severe cases of
  deterioration
• If repeated locking of the elbow joint occurs,
  loose bodies are removed surgically

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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

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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

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Elbow Injuries Cubital Tunnel Syndrome

• Management
• Rest, immobilization for 2 weeks
• NSAIDs
• Splinting, surgical decompression or
  transposition of subluxating nerve may be
  necessary
• Avoid hyperflexion and valgus stresses

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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

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Elbow Dislocation
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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

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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

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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

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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

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Elbow Injuries Volkmanns 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

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Elbow Injuries Volkmanns 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