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There is a wide spectrum of pathology that affects the elbow in the athlete. This is further complicated by the complex anatomy of this articulation and the numerous normal anatomic variations that can serve as pitfalls in imaging diagnosis. A detailed knowledge of the anatomy and pathology that commonly affect this articulation can facilitate the ease and accuracy of imaging diagnosis.
We describe a new plain radiographic finding in posterior elbow dislocation: a defect in the nonarticular posterior surface of the capitellum caused by impaction of the radial head during dislocation. The defect was visible on a lateral view unobscured by overlying bony structures in the unreduced state and confirmed on both an axial view after reduction and by magnetic resonance imaging. We propose that this lesion is analogous to the Hill-Sachs/Bankart lesion complex seen in translational glenohumeral injury.
The rehabilitation of elbow trauma presents numerous challenges. Involvement of the osseous structures, compromise of the ligamentous stability, and loss of the soft tissue excursion necessary for elbow motion and function require due consideration during the treatment of elbow joint injuries. Stiffness of the elbow joint following trauma is common. This stiffness is caused by extrinsic and intrinsic factors. Contractures of the elbow joint develop as a result of contractures of the joint capsule, ligamentous structures, musculotendinous structures, intra-articular adhesions,and ectopic ossification. Early mobilization and splinting of the elbow following injury, within a safe arc of elbow motion, makes the elbow joint more compliant to the rehabilitative techniques outlined. Understanding the details of elbow anatomy, biomechanics, trauma, and surgical procedures for repairing the osseous and the ligamentous structures thus are the key factors in rehabilitating the elbow joint successfully.
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This article deals with common injuries to the elbow. Elbow anatomy is reviewed. Diagnosis and treatment of pronator syndrome,lateral epicondylitis (tennis elbow), radial tunnel syndrome, posterior interosseous nerve syndrome, medial epicondylitis (golfer's elbow), ulnar collateral ligament injury, cubital tunnel syndrome,posterolateral rotatory instability, distal biceps injuries, tricepstendon injuries, and posterior elbow impingement are discussed.
Traumatic injury of the elbow, both in the acute setting as well as in the setting of chronic repetitive microtrauma, is quite common. Specifically, the frequency of elbow dislocation is second only to that of the shoulder. Unlike the shoulder, however, the elbow is an inherently stable articulation, considered one of the most congruous joints in the body. This manuscript discussed imaging techniques for elbow evaluation in the setting of instability and reviews the osseous anatomy, as well as the anatomy of the soft tissue stabilizers of the elbow. Anatomic variants, potential pitfalls in imaging diagnosis, and the imaging findings associated with various types of elbow instability are considered.
Sideswipe injuries to the elbow cause complex fracture patterns and remain difficult management problems. The authors report a case of spontaneous bone remodeling of an extensive metaphyseal defect zone.
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Medial-tension injuries of the pitching elbow are well recognized. One contributing factor is the extreme valgus which has been noted to occur during the acceleration phase of throwing. It is hypothesized that breaking pitches generate higher medial loading because of the pronation and supination required to impart spin to the ball. The pitching motion is a complex action of all body segments to produce maximum linear and angular acceleration of the ball. The purpose of this study was to correlate elbow loading with pitching style. We measured the forearm segment for axial and tangential (varus-valgus plane) acceleration using accelerometers attached to the forearm and hand. Muscle activity was measured by EMG. Forearm rotation was assessed by stroboscopic photography. Despite different delivery styles when throwing breaking pitches, each pitcher demonstrated patterns of muscle activity and acceleration which were similar. Deceleration forces were lower than acceleration forces. Pronation and supination were documented and contribute to the direction of ball spin. Accelerometers can be used to evaluate pitching mechanics. We suggest that the main factors causing an elbow injury are the amount of throwing and the force with which the ball is thrown.
A case of anterior traumatic transportation of the ulnar nerve presenting as a nerve palsy after dislocation of the elbow is described.
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Upper extremity injuries in athletes cause pain, impairment of function, and time loss from sport participation. This article briefly discusses the epidemiology of elbow, forearm, and wrist injuries in various athletic endeavors. Included is an overview of the epidemiology of nerve dysfunction, tendon ruptures, fractures about the wrist and forearm, ligamentous injuries of the wrist, distal radioulnar joint injuries, and overuse injuries.
In summary, injuries to the elbow, wrist, and hand are common complaints in emergency department practice. A systematic, thorough examination should be carried out meticulously on each injured patient. Routine radiographs should be taken and any additional views that are needed should be ordered. Most of the commonly missed injuries are due to an inadequate physical examination and inadequate x-ray films of the injured part.