Elbow Pain in Athletes
By Bruce Steinberg, MD
Elbow Pain in Athletes- Most Common
Injuries are a very common part of athletic injuries, and elbow pain in athletes is a common injury. There are many sports that have colloquial names for the commonly associated injuries that sport. Most people have heard of tennis elbow which refers to pain along the lateral aspect of the elbow with a backhand maneuver. The lateral side of the elbow is the point farthest away from the body with the arm held at the side (tennis elbow will be discussed in more detail later).
The Elbow Joint
The elbow is a well-fitted hinged joint which allows for a very small amount of excessive motion or toggle. The bony complex of the elbow allows for two complex motions including elbow flexion and extension as well as pronation and supination. Pronation of the right forearm is the motion used for loosening a screw with a screwdriver, whereas supination is the motion used for tightening a screw with a screwdriver.
A fully functioning elbow is extremely important to facilitate the use of the hand. The complex wide motions of the elbow allow the hand to be placed in space for grasp, pinch, and pushing activities. Injuries of the elbow involve muscles, ligaments, tendons, capsules, bones, and articular surfaces as well as nerves.
In order to diagnose elbow injuries, clinical examination is performed as well as obtaining X-rays and obtaining a magnetic resonance imaging (MRI) study. MRI has allowed for better visualization of the soft tissues about the elbow joint. Therefore, improvements are made in our ability to diagnose overuse problems such as tennis elbow (lateral epicondylitis). In addition to MRI, minimally invasive surgical procedures have shown improvements in our ability to both treat and diagnose elbow problems.
Sports Related Elbow Injuries
Baseball elbow injuries occur secondary to stresses placed across the elbow during pitching. This can cause a traction injury along the medial (the side of the elbow closest to the body when held at the side) aspect of the elbow. This injury can lead to instability of the elbow, leading to a surgical reconstruction. Many youth baseball players who do not take a break from the sport may experience baseball elbow. Many are aware of Tommy John, a former pitcher for the Los Angeles Dodgers, who underwent a medial collateral ligament reconstruction for elbow instability for this particular type of problem.
Please watch this informative video on Tennis Elbow
The most common elbow injury that will occur is lateral epicondylitis. It can also be caused by repetitive activities that occur in the workplace. Anyone who has had this problem knows that this can be a chronic debilitating problem. It can make it difficult to even perform the small activities of daily living such as lifting a coffee cup. This injury occurs most often in tennis players ages 35 and 50 who play 3-4 times per week.
Causes of Tennis Elbow
Several factors have been attributed to causing tennis elbow including:
- Heavier, stiffer, and more tightly strung racquets.
- Incorrect grip size.
- Metal racquets.
- Inexperienced players.
- Poor technique, especially backhand.
Advanced tennis players who warm up, use good technique, and are well conditioned rarely endure this problem. The treatment for tennis elbow (lateral epicondylitis) is similar to many other overuse syndromes. To do this, one must rest the elbow but still maintain cardiovascular fitness. Ice, elevation, and compression also can be helpful along with non-steroidal anti-inflammatory medications.
Rehabilitation should include stretching of the muscles that insert at the level of the elbow. In addition, several new modalities are now available to the therapists. Modalities including high voltage galvanic electrical stimulation and laser. Certainly changing one’s technique such as a poor backhand in tennis and modifying or improving one’s equipment can be very helpful for elbow pain in athletes.
If after several weeks the above treatment fails to improve the patient’s pain, consideration of an injection is an option. An injection with a steroid deep into the extensor tendons that insert at the level of the elbow can be helpful. Many also use a so-called “tennis elbow strap or brace.” Essentially, this is a band that you wear over the forearm region close to the elbow. By applying force across the muscle reduces abnormal tension of the muscle tendon unit at its origin.
Surgical Intervention for the Elbow
If the above treatments fail and an MRI demonstrates a pathological lesion, consideration of surgical intervention is then undertaken. The surgery includes a small incision with excision of the degenerative tendinous tissue at the level of the elbow. There is an increase to the blood supply to the region by placing small drill holes into the bone. Then normal muscle is rotated from nearby to replace the excised compromised tissue. The rehabilitation post-operatively from this particular procedure takes several months to return to a previous high level of play. The success rate, however, is very high. Above 85% returning to full activity without pain, 12% with lower symptoms but with some pain with vigorous activities and 3% showing no improvement.
To learn more about tennis elbow, please go to: lateral epicondylitis tennis elbow
The elbow joint is a complex anatomical structure that allows for precise placement of a hand in space. Athletics and many activities of daily living subject the elbow to great stresses that result in a wide variety of injuries. With the recent advances in diagnosis with MRI and with the procedures such as elbow arthroscopy, we have improvements in our ability to diagnose and treat elbow problems.
If you would like to learn more about throwing injuries, please watch this video.
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