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