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

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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

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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

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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

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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 endpoint laxity
• X-ray may show hypertrophy of humeral condyle, posteromedial aspect of olecranon, marginal osteophytes; calcification w/in MCL; loose bodies in posterior compartment

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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

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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

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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

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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

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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

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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

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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

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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

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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