Elbow Injuries and Treatments
Elbow injuries can occur in most sports, especially those involving throwing or swinging, such as volleyball, golf, tennis and baseball. The elbow also can be injured in contact sports such as hockey and football, and from falls sustained during gymnastics and wrestling. This article offers an overview of the elbow and common elbow injuries.
Anatomy.
The elbow is a hinge joint that helps connect the three bones of the arm: the radius and ulna of the forearm and the humerus of the upper arm. The bones are held together by ligaments. The primary ligament of the elbow is the medial collateral ligament (MCL) on the inside of the elbow and the lateral collateral ligament (LCL) on the outside. Several muscles surrounding the joint are responsible for movement. The tendons attach the muscle to the bone, the cartilage covers and protects the ends of the bones, and bursa sacs provide lubrication and protection of the joint.
Injury types and treatments.
Fracture and Dislocation.
Fractures of the elbow joint can occur in any sport. Signs of fracture may include pain, swelling, deformity and loss of motion. The ability to move a joint does not always mean the absence of a fracture. A suspected fracture should be immobilized and examined by a physician. A dislocation is usually the result of a fall on an outstretched arm. (When the ends of the bones are forced from their normal position in the joint, this is a dislocation.) Most elbow dislocations are the posterior type, meaning that injury involves bone and ligament at the back of the elbow. Signs of injury include obvious deformity, pain and swelling. The joint should be immobilized in the position in which it is found. No attempt should be made to reposition the bone or "put it back in the socket." A sprain is an injury to a ligament and a strain is an injury to a muscle. Sprains are commonly seen in athletes who throw. Signs of a sprain include point tenderness, joint laxity, general joint pain and swelling.
Effective management of elbow dislocation includes rest and use of ice packs and anti-inflammatory medications. When pain subsides, the individual can begin gentle stretching and strengthening exercises. Strains are treated similarly to sprains.
Tendonitis.
Tendonitis is inflammation of the muscle tendon. Common forms of tendonitis are tennis elbow, golfers elbow or little league elbow. Tennis elbow is an overuse injury often caused by a bad backhand technique or racquet grip that is too small. Signs of tennis elbow include pain on the outside of the elbow, weakness in the wrist, pain with extension of the wrist or fingers against a resistance, and tenderness on the bone of the outside of the joint. Treatment includes ice, rest, bracing for support, and gentle stretching and strengthening exercises. Tips for prevention include correcting any problems with technique, proper warm-up before play and proper strengthening. Golfer's elbow or little league elbow affects the inside of the elbow. Signs include pain on the inside of the elbow, weakness in the wrist, and pain on the inside of the elbow when the athlete uses a strong grip. Treatment includes rest, ice, bracing, and stretching and strengthening exercises. A gradual return to physical activity is recommended for people with tendonitis.
Bursa sac injuries.
A bursa is a small fluid-filled cushion or sack that serves as a gliding surface to reduce friction between tissues of the body. In the center of the arm, the bursa allows the skin to slide over the bony prominence of the elbow. Bursa injuries are common in sports in which the risk of falling on the tip of the elbow is high. Bursa injuries can be chronic or acute. Acute bursitis (inflammation of the bursa) is usually caused by direct trauma to the elbow. Signs include pain, swelling, and limited motion. Treatment includes ice, compression wrap, and possible aspiration (withdrawing excess fluid) if the swelling does not subside. Chronic bursitis results from repetitive trauma and fluid build up. The area around the bursa may feel thick to the touch. Treatment includes rest, ice and anti-inflammatory medication.
Elbow Fractures in Children
Description
Whether your child is an active athlete or just a toddler jumping on the bed, there's a good possibility that he or she will take a spill at home or on the field or court at some time. These falls are usually harmless; but when a child falls on an outstretched arm, the velocity of the fall combined with the pressure of hitting the ground could be enough to break a bone. That's how most fractures around the elbow joint occur. These fractures account for about 10 percent of all fractures in children.
If your child complains of elbow pain after a fall and refuses to straighten his or her arm, see a doctor immediately. The doctor will first check to see whether there is any damage to the nerves or blood vessels. X-rays will help determine what kind of fracture occurred and whether the bones moved out of place. Because a child's bones are still forming, the doctor may request X-rays of both arms for comparison.
Types of fractures.
A child can experience a fracture in several places about the elbow, including:
- Above the elbow (supracondylar): The upper arm bone (humerus) breaks, slightly above the elbow. These fractures usually occur in children younger than 8 years of age. This is the most common elbow fracture, and one of the more serious because it can result in nerve damage and impaired circulation.
- At the elbow knob (condylar): This type of fracture occurs through one of the bony knobs (condyles) at the end of the upper arm bone. Most occur through the outer (lateral) knob. These fractures require careful treatment, because they can disrupt both the growth plate (physeal) and the joint surface.
- At the inside of the elbow tip (epicondylar): At the top of each bony knob is a projection called the epicondyle. Fractures at this point usually occur on the inside (medial) epicondyle in children between 9 and 14 years of age.
- Growth plate: The upper arm bone and both lower arm bones have growth plates located near the end of the bone. A fracture that disrupts the growth plate can result in arrested growth and/or deformity if not treated promptly.
- Forearm: An elbow dislocation can break off the head of the thumb-side lower arm bone (radius), and excessive force can cause a compression fracture to the bone as well. Fractures of the tip (olecranon) of the other lower arm bone (ulna) are rare.
- Fracture dislocation:A fracture of the inside bone (ulna) can be combined with the top of the thumb-side bone (radius) coming out of the socket at the elbow. This is called a Monteggia fracture. If the dislocation is not seen, and only the fracture is treated, this can lead to permanent impairment of elbow joint function.
If your child is an active athlete, make sure that he or she wears the proper protective equipment. Elbow guards and pads can help reduce the risk of a fracture about the elbow.
Symptoms
Regardless of where the break is, the symptoms of a broken elbow are similar:
- Acute pain
- Tenderness
- Swelling (may be severe or mild)
- Limited movement
Treatment depends on the type of fracture and the degree of displacement. If there is little or no displacement, the doctor may immobilize the arm in a cast or splint for 3 to 5 weeks. During this time, another set of X-rays may be needed to determine whether the bones are staying properly aligned.
If the fracture forced the bones out of alignment, the doctor will have to manipulate them back into place. Sometimes, this can be done without surgery, but more often, surgery will be needed. Pins, screws or wires are used to hold the bones in place. The child will have to wear a cast for several weeks before the pins are removed. Range of motion exercises can usually begin about a month after surgery.