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Published byColleen Doble
Modified over 2 years ago
Elbow injuries and the throwing athlete Michael J. Kissenberth MD Orthopaedic Surgery, Sports Medicine SHCC, Greenville Hospital System
First Question What sport do you play?
Most sport related elbow injuries are caused by repetitive microtrauma…
And the underlying pathology is directly related to the biomechanics of the sport.
The rest of sport related elbow injuries are caused by acute macrotrauma…like an elbow dislocation.
Second Question 2.Where does it hurt? Anterior Medial Posteromedial Posterior Lateral
Third Question 3. When does it hurt?
1 st Critical Instant Andrews
2 nd Critical Instant Andrews
Restraint to Valgus Torque at 90 Degrees Flexion UCL54% RC Articulation33% Capsule10%
Healthy Throwers Elbow -Physiologic adaptations to imposed demand
Effects of Valgus Torque Medial Tension –ME injury –Sigmoid rim fx –FP mass injury –UCL lesions –UN neuritis Lateral Compression –RC joint injury –Synovitis
History Medial Pain Late Cocking, Early Acceleration Recurrent Symptoms Pop on Single Throw Swelling, Stiffness Lost Performance!!!
Previous Treatment Lost Playing Time Rehabilitation Injections Diagnostic Studies Surgery (VEO)
Examination Medial Swelling Motion Loss UCL Tender Valgus Stress Painful Valgus Laxity Associated Findings
Kids ME Apophysitis ME Fragmentation ME Avulsion
ME Apophysitis With Fragmentation Without Fragmentation
14 y/o BB Player No prior symptoms Pop!
The flexor pronator muscles provide varus torque MEUlna FPM UCL Flesig AJSM 95, Werner JOPST 93 FP Muscles - UCL
Decreased FCR activity in throwers with an UCL injury
FPM / ME Injury
Pronator Muscle Tear 27 y/o RHP Conjoined Tendon
Severe FPM / ME ThinkUCLInjury!!!
ME FPM Rarely inject Deep Massage ModalitiesRehabilitationRepair
Treatment Relative / Active Rest Ice, NSAID Local Modalities Prevent Atrophy Treat Associated Conditions NO Steroid Injections!!!
Treatment Strengthen FCU, FDS Trunk, Scapula, Cuff Stab. PNF, Plyometrics Sport Specific Exercise Review Throwing Mechanics Interval Throwing Program
UCL Complex Anterior Bundle –Strongest portion –Insertion on sublime tubercle 18 mm posterior to coronoid tip –Origin is inferior and posterior to rotation axis Tighter in flexion
2 Anterior Bands UCL Extension Flexion
Milking Maneuver UCL Tests Static Valgus Stress
Moving VST ODriscoll Likely best test
Modified UCL Recon
Medial Antebrachial Cutaneous Nerve
6 – 8 Millimeter Bridge
Three Incision Harvest
Glajchen AJR 1998 Avulsion Fracture Sublime Tubercle
Sublime Tubercle Fracture Rest Bone Growth Stimulator Direct Repair Suture Anchors ORIF with Screw Ligament Reconstruction
Rehabilitation Initial Immobilization Relieve Pain Resolve Arm Swelling Recover Range of Motion Prevent Muscle Atrophy Restore Aerobic Condition Maintain/develop core stability
Avoid Valgus Torque Until 2 Months
Toss4 - 5 Months Mound6 - 8 Months Game Months Prevent Shoulder Injury
Sublime Tubercle Fracture
Ulnar Nerve Injury ME
Fibrosis Compression Tension UN subluxation Elbow valgus laxity Ulnar Nerve Injury
UN Subluxation 16% McGowan
Non-operative Care Night Splint NSAIDs Oral Steroids Activity Modification Desensitization / Soft tissue release
Decompression ME 1324
Fascia Sling ME
Lateral Compression Injuries Rad-Cap arthrosis Stress fracture OCD Lateral synovium
Kids – Lateral Elbow 1.Panners Disease <10 yo, self limited 2.OCD Capitellum Progressive!!!
OCD capitellum 5-10yo Self limited Tx conservatively –Rest, ice, nsaids –Gradual RTP. Must be able to throw without sx Panners Disease
Posterior blood supply peds lateral elbow Repetitive injury to epiphysis may alter blood flow = osteochondrosis
Osteochondritis Dissecans Age Years Old Progressive Remove loose bodies
Lateral Plica Syndrome RH Ulna Humerus
VEO Syndrome 2nd Critical Instant
History Pain- posteromedial at ball release and in follow through Past history pain Past history UCL injury Stiffness Performance, warm-up
Examination Local Tenderness Motion Loss Extension Painful Extension Plus Valgus Painful
Posterior & Medial Andrews
Olecranon Tip Resection
KJOC / Mayo - Ostectomy …removal of > 3 mm of bone and cartilage places the UCL at risk for injury. ElAttrache, Rosen, Morrey ElAttrache, Rosen, Morrey
Olecranon Tip Osteophytes
Kids Olecranon Apophysis Injury
Olecranon Apophysis NU LeftRight 16 y/o RHP
10 Days Post-Op 3 Months Post-Op
Tip Stress Fracture
The treatment plan is based on the players history, examination and response to conservative care.
SUMMARY When evaluating elbow injuries pay attention to age of athlete and location of pain. Acute injuries with pop require full evaluation. Most respond to conservative treatment
Our Goals Not to operate on elbows If we have to – results pretty good at getting pitchers back to play Use the down time to fully evaluate the rest of the body (shoulder / hips / core)
HAWKINS THROWING ACADEMY TEAM APPROACH TO THROWING INJURIES SHCC, Proaxis therapy, ASI One of a kind in the Southeast Focused on performance and prevention
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