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

Cause: force on the outstretched hand 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