Download Chapter 23: The Elbow - Florida International University

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