S T O P: Ports Rauma and Veruse Revention

Sports Trauma and Overuse
STOP Elbow Injuries

Prevention
DR.SHAFAQ SHAHID
LECTURER
DPT,MS-OMPT
Elbow Injuries
• Why are we so concerned about elbow injuries?

• Because elbow injuries are…
– Common: >50-75% of youth baseball players
– Increasing: Elbow surgery has increased 50% in
the past 5 years.
ELBOW JOINT.
• Elbow joint: hinged joint
• Flexion : 145 degree from fully extended position.
• Hyperelasticity-hyperextend few degrees beyond
neutral position.
• Joint articulations:
1. Humeroulnar
2. Humeroradial
3. Radioulnar
Elbow joint .
• Concave radial head articulates with the
convex surface of capitellum of the distal
humerus and is connected to the proximal
ulna via annular ligament.
• The proximal radioulnar joint consitutes the
forearm which when working in conjunction
with the elbow joint premits approx 90 degree
of pronation and 80 degree of supination.
Bones involved
Bone Development
• Bones develop in 3 distinct stages: during childhood,
adolescence, and young adulthood.
• When viewing a radiograph of a pediatric patient’s elbow, it
is important to understand the ossification centers or the
order in which the elbow joint and bones begin to develop.
The order of bone growth is the same for all pediatric
patients, and the commonly accepted mnemonic for this
order is CRITOE (capitulum, radial head, internal [medial]
epicondyle, trochlea, olecranon process, and external
[lateral] epicondyle).
The Painful Elbow
• Referred Pain: Cervical Spondylosis
• Joint Disorders:
– Rheumatoid Arthritis
– Gout + Pseudo gout
– Osteoarthritis
• Periarticular Disorders:
– Olecranon Bursitis
– Lateral Epicondilitis
– Medial Epicondilitis
– Nerve Compression
– Tendinitis
Elbow Disorders: Olecranon Bursitis
• student’s elbow because the condition can be caused by
leaning excessively on the elbow.
• Chronic olecranon bursitis is seen in people who throw
repetitively, such as baseball pitchers.
• acute cases usually occur after a direct fall onto a hard
surface.
Olecranon Bursitis
• Causes
– Trauma
– Infection
– Prolonged Pressure
– Medical Conditions
• Rheumatoid Arthritis
• Gout
• Sx
– Redness / swelling and pain
– Decreased ROM
• Tx
– R.I.C.E.
– Anti-Inflammatory Drugs
– Padding of the elbow
Cubital Bursitis
• Cubital bursitis also is known as bicipitoradial bursitis, and
symptoms include cubital fossa swelling and tenderness.
Overuse or Repetitive Strain
Disorders
• Tennis Elbow
• Golfer’s Elbow
• Distal Biceps Tendinitis
• Triceps Tendinitis
• Lateral Epicondylitis (tennis elbow)
Lateral epicondylitis is the most common sports-related

injury of the elbow and a primary cause of elbow pain
Cause: repeated forearm flexion and extension

movements; small micro-tears at muscle attachments
Lateral Epicondylitis
• The pain felt with lateral epicondylitis normally occurs at the lateral
epicondyle or slightly outside the elbow. Gripping items may
become difficult because of weakness and increased pain within
the forearm.
Imaging
• Regardless of whether the tendonosis is located medially or laterally,
MR imaging demonstrates the same epicondylitis features on either
side.
• Ultrasonography can find calcifications in the lateral epicondyle region
and may be useful in diagnosing tendonosis.
• In cases of chronic lateral epicondylitis, the capsule below the extensor
carpi radial brevis (ECRB) tendon should be examined for tears.
• Currently, the best modality for diagnosing capsular tears is arthroscopic
techniques. Although MR falls short of accurately imaging capsular tears
of the ECRB tendon, CT arthrography has shown excellent success at
displaying capsular tears.
Goals
• Decreased pain.
• reduce Joint swelling, inflammation, or
restriction.
• ROM improved.
• Muscle performance increased.
• Ability to perform activities is improved.
interventions
• Ice therapy
• Ultrasound therapy.
• ROM exercises
• Stretching
• Active assistive and resistive exercises
stretches
• Wrist Flexion
• Wrist Extension
Strengthening
Medial Epicondylitis
• As golfer’s elbow
• medial epicondylitis is common in individuals who overuse
their wrist flexors and forearm pronator .
• less frequently than lateral epicondylitis.
• Medial epicondylitis : affects the insertion point of the flexor
carpi radialis.
Medial Epicondylitis
• The patient presents with pain at the medial aspect of the
elbow.
• As with lateral epicondylitis, radiographic evidence of medial
epicondylitis can be difficult to find, but small calcifications or
spurs next to the medial epicondyle are common. MR imaging
most often is used for diagnosis.
• Elbow dislocation
Cause: fall on outstretched arm

with elbow in hyperextension,
twist with elbow in flexion
S&S:  pain
Care: call emergency, referral for
reduction, sling, ice
Phase I: Weeks 1-4
• Goals:
• Control edema and pain
• Protect injured tissues
• Intervention:
• Continue to assess for neurovascular compromise
• Elevation and ice
• Gentle PROM - working to get full extension
• Splinting as needed
• Strengthen through ROM.
• Soft tissue mobilization if indicated – especially assess
the brachialis myofascia
Phase II: Weeks 5-8
• Goals: Control any residual symptoms of edema and
pain
• Full ROM
• Minimize deconditioning
• Intervention:
• • Continue to assess for neurovascular compromise
• • Elevation and ice
• • Gentle PROM - working to get full extension
• • Splinting as needed
• • Strengthen through ROM
• • Soft tissue mobilization if indicated – especially
assess the brachialis myofascia
Phase III: Weeks 9-16
• Goals: Full range of motion and normal strength
• Return to preinjury functional activities
• Intervention:
• Strengthening exs
• Return to ADLS
• • Progress sport specific or job specific training
Nerve Entrapment Problems
Where nerve passes through awkward place
between tendons
over bone
under ligaments
Can be pinched or rubbed

Knowing anatomy
of
nerve courses
can help understand
patient’s complaints
• Complaints – nerve injury

– Pain
– Impaired sensation – numbness
– Impaired motor - weakness
The
Ulnar Nerve
• Ulnar Nerve
– Entrapment sites
Ulnar nerve
Exposed to trauma
bumping, pressing on table or arm rest
Stretched by anatomy and position

holding telephone receiver, sleeping
with elbow flexed
• Numbness
Common Elbow Conditions
• Ligament & Tendon Injuries
– UCL (Ulnar Collateral Ligament)
– Medial & Lateral Epicondylitis
• Bone & Growth Plate Injuries
– Occur in Growing children
– Medial Apophysate
• “Little Leaguer’s Elbow”
Diagnosing Elbow Overuse
• Pain is NOT a sign of a strength deficit.
• Common Symptoms
– Loss of form, accuracy, or velocity
– Takes longer to loosen up
– Early Fatigue
– Pain
– Stiffness
– Swelling
-USA Baseball Medical and Safety Advisory Committee

Treating Elbow Overuse
• Prevention is the best
treatment!
• Initial Treatment
– Rest, Ice, Gentle stretching
• Involve your coach early
• When to see a doctor…
– Pain that lasts more than a few
days
– Swelling or stiffness in the joint
Preventing Elbow Injuries
• Watch pitch counts and rest days!
• Always warm up & cool down
• Learn proper mechanics
• Don’t forget strength &
conditioning
• Avoid multiple teams
• Don’t pitch through pain or fatigue

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Sports Trauma and Overuse

STOP Elbow Injuries

• Why are we so concerned about elbow injuries?

Lateral epicondylitis is the most common sports-related

Cause: repeated forearm flexion and extension

Cause: fall on outstretched arm

Can be pinched or rubbed

• Complaints – nerve injury

Stretched by anatomy and position

-USA Baseball Medical and Safety Advisory Committee

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