1. The Elbow Sports Medicine 2

2. The Elbow Humerus, radius, ulna Muscles- Biceps, Brachialis, Brachioradialis, Triceps, Pronator Teres

6. Observation Deformities and swelling? Carrying angle Cubitus valgus versus cubitus varus Flexion and extension Cubitus recurvatum Elbow at 45 degrees Isosceles triangle (olecranon and epicondyles)

7. Contusion Etiology Vulnerable area due to lack of padding Result of direct blow or repetitive blows Signs and Symptoms Swelling (rapidly after irritation of bursa or synovial membrane) Management Treat w/ RICE immediately for at least 24 hours If severe, refer for X-ray to determine presence of fracture

8. Olecranon Bursitis Etiology Superficial location makes it extremely susceptible to injury (acute or chronic) --direct blow Signs and Symptoms Pain, swelling, and point tenderness Swelling will appear almost spontaneously and w/out usual pain and heat Management In acute conditions, compression for at least 1 hour Chronic cases require superficial therapy primarily involving compression If swelling fails to resolve, aspiration may be necessary Can be padded in order to return to competition

9. Strains Etiology MOI is excessive resistive motion (falling on outstretched arm), repeated microtears that cause chronic injury Rupture of distal biceps is most common muscle rupture of the upper extremity Signs and Symptoms Active or resistive motion produces pain; point tenderness in muscle, tendon, or lower part of muscle belly Management RICE and sling in severe cases Follow-up w/ cryotherapy, ultrasound and exercise If severe loss of function encountered - should be referred for X-ray (rule out avulsion or epiphyseal fx

10. Unlar Collateral Injuries Etiology Injured as the result of a valgus force from repetitive trauma Can also result in ulnar nerve inflammation, or wrist flexor tendinitis; overuse flexor/pronator strain, ligamentous sprains; elbow flexion contractures or increased instability Signs and Symptoms Pain along medial aspect of elbow; tenderness over MCL Associated paresthesia, positive Tinel’s sign Pain w/ valgus stress test at 20 degrees; possible end- point laxity X-ray may show hypertrophy of humeral condyle, posteromedial aspect of olecranon, marginal osteophytes; calcification w/in MCL; loose bodies in posterior compartment

11. Ulnar Collateral Ligament Injuries (cont.) Management Conservative treatment begins w/ RICE and NSAID’s W/ resolution, strengthening should be performed; analysis of the throwing motion (if applicable) Surgical intervention may be necessary (Tommy John procedure) Throwing athlete can return to activity 22-26 weeks post surgery

12. Lateral Epicondylitis (Tennis Elbow) Etiology Repetitive microtrauma to insertion of extensor muscles of lateral epicondyle Signs and Symptoms Aching pain in region of lateral epicondyle after activity Pain worsens and weakness in wrist and hand develop Elbow has decreased ROM; pain w/ resistive wrist extension

13. Lateral Epicondylitis (continued) Management RICE, NSAID’s and analgesics ROM exercises and PRE, deep friction massage, hand grasping while in supination, avoidance of pronation motions Mobilization and stretching in pain free ranges Use of a counter force or neoprene sleeve Mechanics training

14. Medial Epicondylitis Etiology Repeated forceful flexion of wrist and extreme valgus torque of elbow Signs and Symptoms Pain produced w/ forceful flexion or extension Point tenderness and mild swelling Passive movement of wrist seldom elicits pain, but active movement does Management Sling, rest, cryotherapy or heat through ultrasound Analgesic and NSAID's Curvilinear brace below elbow to reduce elbow stressing Severe cases may require splinting and complete rest for 7-10 days

15. Dislocation of the Elbow Etiology High incidence in sports caused by fall on outstretched hand w/ elbow extended or severe twist while flexed Bones can be displaced backward, forward, or laterally Distinguishable from fracture because lateral and medial epicondyles are normally aligned w/ shaft of humerus Signs and Symptoms Swelling, severe pain, disability Complications w/ median and radial nerves and blood vessels Often a radial head fracture is involved

16. Elbow Dislocations (CONT.) Management Cold and pressure immediately w/ sling Refer for reduction Neurological and vascular fxn must be assessed prior to and following reduction Physician should reduce - immediately Immobilization following reduction in flexion for 3 weeks Hand grip and shoulder exercises should be used while immobilized Following initial healing, heat and passive exercise can be used to regain full ROM Massage and joint movement that are too strenuous should be avoided before complete healing due to high probability of myositis ossificans ROM and strengthening should be performed and initiated by athlete (forced stretching should be avoided

18. Fractures of the Forearm Etiology Fall on flexed elbow or from a direct blow Fracture can occur in any one or more of the bones Fall on outstretched hand often fractures humerus above condyles or between condyles Condylar fracture may result in gunstock deformity Direct blow to ulna or radius may cause radial head fracture as well Signs and Symptoms May not result in visual deformity Hemorrhaging, swelling, muscle spasm

19. Forearm Fractures (continued) Management Decrease ROM, neurovascular status must be monitored Surgery is used to stabilize adult unstable fracture, followed by early ROM exercises Stable fractures do not require surgery Removable splints are used for 6-8 weeks

21. Volkmann’s Contracture Etiology Associate w/ humeral supracondylar fractures, causing muscle spasm, swelling, or bone pressure on brachial artery, inhibiting circulation to forearm Can become permanent Signs and Symptoms Pain in forearm - increased w/ passive extension of fingers Pain is followed by cessation of brachial and radial pulses, coldness in arm Decreased motion Management Remove elastic wraps or casts Close monitoring must occur