Throwing Injuries in the Elbow

Each patient is unique and their recover will depend on the treatment method prescribed by the physician. The elbow joint consists of the joining of three bones: one from the upper arm (humerus), and two from the forearm (ulna and radius). The collateral ligaments are strong bands of tissue that hold the bones together in proper alignment. The elbow is both a ball-and-socket joint as well as a hinge joint, allowing the elbow to bend (flexion) and straighten (extension) as well as enable the hand to rotate palm-up (supination) and palm-down (pronation.) Deemed necessary for the tennis/golfer’s elbow, recovery will depend on the severity of the condition and the complexity of the procedure. The elbow will most likely be placed in a splint following surgery for a couple of weeks. Once the splint is removed, physical therapy will be recommended for a few months to stretch and restore movement in the elbow. The physician will provide instructions for when an individual can return to sports or the prior level of activity which usually takes up to six months after surgery.

Overview

When athletes throw at high speed repeatedly in sports such as baseball and football, the repetitive stress on the elbow can lead to a wide variety of overuse injuries. These injuries most often occur at the inside of the elbow as the force is typically concentrated over the inner elbow during throwing. The most common throwing injuries are:

Flexor Tendinitis – Inflammation caused by irritation to the flexor tendons at the point where they attach to the humerus on the inside of the elbow. This condition is aggravated when the individual is throwing, but severe tendinitis can cause pain to occur during rest and sleep as well.

Valgus Extension Overload (VEO) – When an individual throws, the olecranon and the humerus are twisted and pressed against each other. Over time this can result in VEO where the protective cartilage covering the olecranon is worn down and development of bone spurs occurs.

Ulnar Collateral Ligament (UCL) Injury – The most commonly injured ligament in throwers is the UCL where the injuries can range from minor inflammation to a complete tear of the ligament.

Ulnar Neuritis – In throwing individuals, the ulnar nerve is repeatedly stretched to the point of slipping out of position and causing a painful “snap,” which causes nerve irritation, also known as ulnar neuritis. This condition is often characterized by numbness and tingling in the ring and small fingers during, immediately after, or much after throwing activity.

Olecranon Stress Fracture – When muscles are fatigued and are no longer able to absorb shock, the pressure is transferred to the bone causing a small crack called a stress fracture. The olecranon is the most common site of stress fracture for individuals involved in throwing activities.

Symptoms

For the most part, these injuries result in mild to severe pain either during or immediately after throwing activities. This pain will often decrease the throwing speed and restrict their ability to throw with as much power – it can cause a breakdown in throwing mechanics. There might be associated numbness and tingling of the hand, forearm, or elbow.

Diagnosis

The physician will take many factors into consideration prior to making a diagnosis. After taking a detailed history of the symptoms, the physician will examine the arm and the elbow for strength, stability and range of motion. The physician will conduct a number of tests to recreate the stress and identify the location and severity of the associated pain. Based on the findings from the physical examination, the physician may order X-rays to look for any abnormalities, CT scans or MRI scans to identify the nature and severity of the damage to the bones as well as surrounding tendons and ligaments.

Treatment

Prevention is the best form of treatment with proper conditioning, practice, and periods of rest between throwing activities. However, when prevention fails, treatment for throwing injuries always begins with non-operative approaches.

Rest – It is advised to decrease or completely stop the activity that makes the pain worse. A great way to stay active while allowing the symptoms to subside is to switch to low-impact activities.

Medication – Over-the-counter medication such as ibuprofen and naproxen usually help reduce pain and swelling. If these are deemed insufficient by your physician, they might prescribe stronger medication to relive pain and reduce inflammation.

Physical Therapy – Physical Therapists will often prescribe specific strengthening and range of motion exercises that promote healing and help recover as much mobility in the elbow joint as possible. It is crucial that these exercises be done accurately and routinely to optimize recovery of the elbow joint.

Surgery – When non-operative treatments have been exhausted and are insufficient to control the symptoms, and the individual desires to return to his or her prior level of activity, the physician may recommend an operative approach. The exact procedure will vary based on the extent of the injury; options must be discussed extensively with the physician to determine the appropriate operative treatment and procedure.

Recovery

Each patient is unique and their recovery will depend on the treatment method prescribed by the physician. If non-operative treatment is effective, the individual may be able to return to throwing activities within six to nine weeks. If surgery is deemed necessary for the throwing injury, recovery will depend on the severity of the condition and the complexity of the procedure. In some cases, it may take upwards of nine months to return to competitive throwing activities.

Disclaimer

CALL 911 IMMEDIATELY IF YOU ARE HAVING A MEDICAL EMERGENCY!

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