Recognition and Management of Elbow Injuries

• Olecranon bursitis

Cause: result of direct blow; superficial location makes it prone to injury

S&S: Care: ice packs,

compression, padding, possible aspiration

• Elbow strains

Cause: excessive resisted motion such as a fall on outstretched hand with elbow in extension that forces joint into hyperextension

S&S: pain with active and resistive movement, point tenderness in muscle, tendon or muscle belly

Care: RICE; rehab, modalities, x-ray if loss of motion

• Ulnar Collateral Ligament Injuries

Cause: valgus force from repetitive trauma

S&S: medial elbow pain, tenderness over UCL, laxity

Care: Rest, rehab: strengthening, modalities, correct throwing mechanics, possible surgery “tommy john”

• Epicondylitis

Cause: repeated forearm flexion and extension movements; small micro-tears at muscle attachments

S&S: pain at epicondyles during forced wrist flexion/extension; radiating pain, point tenderness, mild swelling

Care: rest, modalities for pain, rehab, brace

• Elbow dislocation

Cause: fall on outstretched arm with elbow in hyperextension, twist with elbow in flexion

S&S: Care: call 9-1-1, referral for

reduction, sling, ice

• Little League Elbow

Cause: occurs in 10-25% young pitchers; caused by repetitive microtrauma that occurs from throwing and not from the type of pitch thrown; includes many disorders of growth in the pitching elbow that may include:

– an accelerated apophyseal growth region plus a delay in the medial epicondylar growth plate

– A traction apophysitis with a possible fragmentation of the medial epicondylar apophysis

– An avulsion of the medial epicondyle of the radial head– Osteochondrosis of the humeral capitellum– A nonunion stress fx of the olecranon epiphysis

S&S: onset is usually slow, in the beginning the athlete may have a flexion contraction, with tightness of anterior joint capsule and weakness of triceps muscle, complains of locking or catching, ROM of forearm supination/pronation

Care: RICE, NSAIDs, no throwing until full ROM, stretching, triceps strengthening, correct throwing techniques

The Forearm, Wrist, Hand and Fingers

Forearm Injuries • Colles Fracture

Cause: fall on outstretched hand, forcing forearm backward and upward into hyperextension

S&S: deformity of wrist, profuse swelling

Care: cold, splint wrist, forearm in sling, x-ray, immobilize for 1-2 months

Injuries to the Wrist • Sprains/Strains

Cause - sprain most common, most poorly managed; abnormal forced movements or falling on hyperextended wrist

S&S: generalized swelling, tenderness, limited range of motion

Care: RICE, modalities, rehab: strengthening, taping

• Scaphoid fractures– Most frequently fractured carpal bone – Without proper splinting, the scaphoid fx may

have difficulty healing due to inadequate blood supply

Cause: force on the outstretched hand

S&S: same as severe sprain; swelling and point tenderness in anatomical snuffbox

Care: ice, splinting, xray, immobilization usually 6wks, rehab

• Wrist ganglion

Cause: herniation of joint capsule or synovial sheath; usually appears slowly after wrist strains

S&S: lump, pain, feels soft, rubbery or very hard

Care: aspiration of cyst, chemical cauterization with a

pressure pad, surgical removal

Injuries to the Hand and Fingers

• Dislocations of the phalanges

Cause: force is directed upward from palmar side displacing either 1st or 2nd joint dorsally, resulting in tearing of supporting capsular tissue with hemmorhaging

S&S: deformity, pain, swelling

Care: reduction, xray, splinting

• Gamekeeper’s Thumb (UCL sprain of MCP joint)

Cause: forceful abduction combined with hyperextension

S&S: pain over UCL, weak and painful pinch, tenderness, swelling

Care: refer to orthopedic, splint usually 3wks, rehab, taping

• Mallet finger

Cause: force that strikes the tip of finger, avulsing the extensor tendon

S&S:

Care: RICE, xray, splint in extension

• Boutonniere deformity

Cause: trauma to tip of finger rupturing the extensor tendon dorsal to the middle phalanx

S&S: severe pain; inability to extend DIP joint; swelling; point tenderness; obvious deformity

Care: ice; splinting; xray