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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 treatments Ulnar 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
