The Elbow and Forearm: Common Injuries
Elbow fractures
Distal humerus
 More common in young athletes
 Proximal to the growth plate
 MOI:
or falling on flexed elbow
 Distal segment is forced posterior and superior
 May appear as a posterior elbow dislocation
Epiphyseal fractures
 Medial epicondylar epiphysis

force
 “Little League Elbow”
 Distal humeral epiphysis
 Lateral epicondylar epiphysis
Avulsion fractures
 Medial epicondyle - Valgus force
 Lateral epicondyle - Varus force
Other fractures
 Forearm Fractures
 Radial Head, Radius, Ulna,
 Stress & acute
 Olecranon Fracture
 More common in
athlete
 Acute direct trauma
 Pain, crepitus, & deformity
 Swelling may be from injury or bursa
Fracture complications
Volkmann’s ischemic contracture
 Can become permanent
 May be loss of motor & sensory function
 Results from
& return
to forearm and hand
 Sx & Sy:
 Pain in forearm - ↑ w/ passive
of fingers
 Pain is followed by loss of brachial and
radial pulses, coldness in arm
 ↓ motion
 Management
 Remove elastic wraps or casts
 Close monitoring must occur
Osteochondritis dissecans
 Pathology
 Avascular necrosis of subchondral bone
 May result from increased valgus load
over time at capitulum
 Etiology is unknown (insidious onset)
 More common in __________ athletes
 Symptoms
 Elbow pain increasing with activity
 May suffer from elbow contracture
Notes
 Sites


Articulation of capitulum and radial head
Common at epiphysis with compression
or shear
○ Medial or lateral epicondyles
Dislocations & subluxations
Dislocations
 Mechanism: FOOSH
 Etiology:
through forearm;
often slight flexion

dislocations are most common
 Common in athletes (gymnastics)
 Cubital __________ makes one more susceptible
 Pathology
 Stretch or tear of joint capsule
 Often result in articular surface damage
 Possible fractures (coronoid process)
 “Terrible Triad” = Post. Dislocation, Fx of
radial head & coronoid process
 Typically involves deformity
 Look for posterior triangle or overly
prominent
 Potential medical emergency
 Possible nerve/circulatory complications
 Be aware of rapid swelling
 Check for
 Check for distal function
 Do NOT reduce
 We DO want reduction done ASAP
 Re-check neurovascular function
following reduction
Neurological pathologies
Ulnar nerve
 Contusion
 Subluxation
 MOI: chronic
stress
 Pathology: irritation of ulnar nerve
 Unstable supporting structures for nerve
 Usually occurs with
 May feel or hear “pop”
 Cubital tunnel syndrome
 MOI: compression and tensile forces
within cubital tunnel
 _________ collateral ligaments
 Pathology: entrapment, irritation,
compression of ulnar nerve,
 Sx & Sy

and
in
dermatome
○ May increase with hyperflexion
 Motor deficits in myotome (abduction of
5th digit)
The Elbow and Forearm: Common Injuries
Notes
○ Chronic conditions may prevent
 MOI: rotational forces, varus stress, chronic
patient from making a fist
valgus stress
Median nerve
 Pathology: stretch or tear to LUCL
 Trauma complications
 Radius & ulna will act as a
 Impingement and/or compression
& will “rock” away from humerus

most common
 Sx & Sy:
 “Pronator Teres syndrome”
 Laxity/Instability
 MOI: compression from pronator teres
 Inability to push themselves out of chair
on median nerve
 Apprehension w/ ”weight-bearing”
 Pathology: entrapment, irritation,
activities
compression of median nerve
 Pain w/full extension
 Sx & Sy
Anterior structures
○ Pain and paraesthesia in
 MOI:
dermatome
 Pathology: stretch or tear to anterior joint
○ Weakness with
w/elbow
capsule
flexion
 Common in athletes
Radial nerve

makes one more
 Trauma complications
susceptible
 Radial tunnel syndrome
Strains
 MOI: compression at two heads of
Flexor-pronator group
supinator muscle origin
 MOI:
stress
 Pathology: compression of radial nerve
 Overuse: Repeated, forceful flexion or
 Sx & Sy
pronation of wrist (or both)
○ Pain and paraesthesia in
 Etiology: acute/chronic (epicondylitis)
dermatome
overhead/forehand motions
○ Weakness with
 Pathology:
○ Mimics “tennis elbow”
 Stretch/tear to origin of wrist
○ Can last 6 months or longer
flexor/pronator group
Sprains
 Possible avulsion fx (medial epicondyle)
Medial structures
 Common in throwing athletes
 MOI:
stress (acute or chronic)
 Can be very debilitating and long lasting
 Pathology: stretch or tear to UCL
 Usually TTP and __________ may be felt
 Common in athletes
 Painful ROM and may lose strength in
 Complains of medial elbow pain
wrist muscles
w/motion
 Referred to as “golfer’s elbow,” “thrower’s arm”,
 May also suffer from neurological sy
“Little League Elbow”, etc.
 May involve avulsion fx
Extensor-supinator group
 Acute injury often involves “
” or
 MOI:
stress
“
”
 Overuse: Repeated forceful eccentric
Lateral structures
contractions of wrist extensors
 MOI:
stress
 Etiology: acute/repetitive (epicondylitis)
 Pathology: stretch or tear to RCL
backhand/wrist extension
 Not common in athletes
 Pathology
 May lead to disruption between radial head &
 Stretch/tear to origin of wrist
capitulum
extensor/supinator group
 May also involve damage to Annular
 Possible avulsion fx (lateral epicondyle)
Ligament & other LCL ligaments
 Most common in tennis (
)
 Laxity may increase weakness during pronation
 Can be very debilitating and long lasting
and supination
 Pain with gripping & may lose strength
The Elbow and Forearm: Common Injuries
 May be referred to as “tennis elbow”
 Affects more than 50% of tennis players
 Usually older than 40
Elbow flexors
 MOI: elbow flexion or
 Usually involves eccentric loading
 Etiology: acute or repetitive elbow flexion
 Pathology
 Stretch/tear to origin of elbow flexors
○ Biceps brachii most common
 Possible rupture at distal biceps tendon
(
)
 Suffers immediate pain and loss of strength
 May hear “pop” with Grade III
 Palpable defect
 Improper
in throwing
 Excess
by weightlifters
 More common in patients > 40 w/history of
smoking
Elbow extensors
 MOI: varus extension
 Etiology: acute or repetitive elbow extension
 Pathology
 Stretch/tear to
 Possible rupture (grade III)
 Football linemen (blocking)
 Excess extensions by weightlifters
 Throwers
Other pathologies
Contusions
 Olecranon bursitis
 Pathology: Weakening of wall of bursa 
rupture
 Often dramatic swelling
 Very susceptible to
 Ulnar nerve
 Very common
 “Funny bone”
 Immediate paraesthesia to dermatome
Compartment syndrome
 Relatively rare in athletics
 Sx & Sy:
 ↑ pressure in forearm
 ↓ sensation & strength
 Pain during __________ elongation of
involved muscles
 Muscular weakness – more common in
flexors
 Mechanism:
 Trauma/Hemorrhage, Fracture, Voluntary
hypertrophy
 Can be acute or ______________
Notes