Chapter 11-Elbow Injuries

Subtitle

Anatomy-Bones• Hinge joint• Humerus

– Medial and lateral epicondyles

• Radius– Allows for pronation

& supination– Lateral or thumb side

• Ulna– medial or pinky side– Hooks to humerus

Anatomy-Ligaments• Ulnar collateral

– Helps stabilize medially

• Radial collateral– Lateral stabilization

• Annular – Helps hold radius and

ulna together

• Interossius membrane– Between radius and

ulna, runs length of the arm

Anatomy-muscles

• Triceps– Elbow extension

• Biceps– Elbow flexion

• Wrist Flexors• Wrist extensors

Elbow Injuries

• Prevention– Infrequent injury– Mostly overuse– Most common in racket sports– Stretching and strengthening important– Technique important– Equipment a factor (racket size, grip)– Proper rest

Common injuries and treatments• Ulnar collateral

ligament sprain– Caused by

overuse or direct blow (valgus stress)

– Possible swelling, point tender

– Possible joint laxity

Common injuries and treatmentsUlnar collateral ligament strains

• Treat with RICE

• May need to refer, rule out fractures or nerve damage

• Rehab should include wrist flexor strengthening

Common injuries and treatments

• Radial collateral ligament strains– Rare– Pain laterally– Rehab focus on extensors

Muscle and tendon injuries

• Most often caused by excessive resistive forces or overuse

• Mild, moderate, severe

• Can occur either proximal or distal to elbow joint

Muscle and tendon injuries

• Elbow flexor strain– Injury usually caused by a loaded

movement of shoulder and elbow– Minimal swelling– weakness and discomfort common with

resisted flexion– RICE, mild stretching and strengthening– Complete tears or ruptures need referral

Muscle and tendon injuries• Elbow extensor

strain– Caused by

excessive resistance (i.e.-attempting to break a fall)

– Triceps can avulse, assess carefully

– Pain with elbow extension

– Minimal swelling– Treat w/RICE, mild

stretching and strengthening

Muscle and tendon injuries

• Wrist flexor strain– Pain over medial epicondyle or front

forearm– Caused by excessive resistance during

wrist flexion or overuse– Treat with PRICE, modify activity– Mild stretching and strengthen flexors

Muscle and tendon injuries

• Wrist extensor strain– Pain usually over lateral epicondyle– Most often occur due to overuse– Treat with rice, modify activity– Mild stretching, reverse wrist curls for

strengthening

Medial Epicondylitis• Golfer’s elbow or little

league elbow– Chronic inflammation– Usually result of

repetitive throwing– Not as common as

lateral– Treat with PRICE, limit

throwing, and strengthen wrist flexors

– Can cause compression of ulnar nerve

Lateral epicondylitis• Tennis elbow

– Chronic inflammation– Causes-overuse and

poor mechanics– Can show minimal

swelling– Treat with PRICE,

tendon strap– Limit activity– Stretch and

strengthen extensors

Bone Injuries

Bone injuries

• Fractures to distal humerus rare

• Direct impact is most common cause of fracture

• Immediate referral due to possible nerve damage

Epiphyseal and Avulsion fractures

• Epiphyseal fracture– Most common on medial epicondyle– Suspect if there is pain, swelling, and loss

of movement– Young athlete more likely to injure growth

plate that a fx or ligament injury

• Avulsion fracture– Severe pain and deformity – Refer immediately for either injury

Ulnar dislocation• One of most

commonly injured joints in body

• Usually caused by violent hyperextension or sever blow to lateral aspect

• Most often dislocates posteriorly

• Splint immediately & refer

Other elbow injuries• Hyperextension

– Falling on outstretched arm or direct blow

– Can cause• Sprain to ligaments of

anterior elbow• Strain to muscles of

anterior elbow• Painful bony

compression of humerus by olecranon process

– Treat with PRICE, refer if severe

Bursae

• Bursae are fluid-filled cavities located at tissue sites where tendons or muscles pass over bony prominences near joints, such as the elbow. The function of a bursa is to facilitate movement and reduce friction between moving parts.

Other elbow injuries

• Contusions– Common, treat with

PRICE

• Olecranon bursitis– Irritation of bursa due

to direct blow to elbow… fluid build up

– Apply compression wrap, physician may drain

– Protect with padding