LOWER ARM INJURIES

Growth Plate Injuries of the Elbow

Growth plates are places where new bone tissue forms. They are found near the ends of the long bones in growing children. Growth plates are weaker than the surrounding bone. That makes them easier to injur.

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Lateral Epicondylitis (Tennis Elbow)

This condition, commonly called tennis elbow, is an inflammation of the tendons that connect the muscles of the forearm to the elbow. The pain is primarily felt at the lateral epicondyle, the bony bump on the outer side of the elbow.

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What Is Tennis Elbow?

Tennis elbow is a form of tendonitis that causes pain over the bony prominence called the lateral epicondyle on the outside of the elbow. It is often referred to as lateral epicondylitis.

What Causes It?

Tennis elbow is caused by repetitive stress on the muscles and tendons that are connected to the lateral epicondyle. These muscles extend along the top, or dorsal, side of the forearm to the wrist and are responsible for extending or bending back the wrist and fingers. The tendons are fibrous bands that connect the muscles to the bone, in this case the lateral epicondyle.

If too much stress is placed on these muscles and tendons, micro tears can occur at the site where the tendons attach to the lateral epicondyle (see drawing). These micro tears cause pain that is usually localized at the lateral epicondyle but the pain can occasionally radiate down the forearm. Aging appears to make these tendons more prone to breakdown. Therefore, lateral epicondylitis is more common once we get in our fourth decade of life and beyond.

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The pain increases with activities that require contraction of the affected muscles and tendons: shaking hands, turning doorknobs, picking up objects with the palm down or hitting a backhand in tennis.

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How Do I Know If I Have Tennis Elbow?

No special tests are needed to make the diagnosis. This diagnosis is made by history and physician examination of the patient. The patient may present symptoms consistent with tennis elbow and has pain when pressure is applied to the outside of the elbow. The patient frequently cannot remember an injury, but will have noticed the pain either at the beginning or end of an activity that requires wrist and elbow movement.

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X-rays are not always required when evaluating a patient with tennis elbow symptoms, but a doctor may wish to order them just to make certain that the bone structures of the elbow are normal.

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How Is Tennis Elbow Treated?

Like many overuse injuries of sport, there is no sure-fire treatment. Rest itself does not necessarily cure the problem, but it may decrease the pain and allows healing to progress. Decreased activity with the elbow and wrist is generally preferred over absolute rest and complete inactivity. The healing of tennis elbow can take weeks to months.

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Some physicians believe that the key to healing this overuse injury lies in increasing the circulation to the area while decreasing the tightness of the muscles. Therefore, stretching and strengthening exercises are frequently helpful.

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The following exercise may help: Support the forearm on a flat surface with the wrist and hand free. Hold a 1 to 2 pound weight in the hand. Keeping the palm down, slowly extend the wrist. Bring it backward, or up, and then bend it forward, or down. The muscles on the top of the forearm should contract when the wrist is moved upward and stretch when the hand is moved downward.

To balance the forearm muscles, these exercises should be repeated with the palm facing up. Each exercise should be repeated 10 times slowly.

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A loop of rubber tubing, with one end attached to a table leg or held on the floor with a foot, can be used to provide resistance instead of the weight. This will also increase circulation to the area.

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A snug, but not tight, strap worn around the top of the forearm often decreases the pull of the muscles on the lateral epicondyle and lessens pain. When symptoms are present during everyday activities, the band should be worn during all waking hours. Occasionally, an elbow sleeve with a pad specially designed to put gentle pressure over the forearm muscles can be used. This sleeve has the advantage of not only changing the pull of the muscles, but keeping them warm as well, which increases their flexibility and circulation.

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A physician may also prescribe ultrasound or electrical stimulation to increase circulation to the area.

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Nonsteroidal anti-inflammatory medications like aspirin, ibuprofen, and ketoprofen, or various prescription drugs can treat the symptoms and may decrease the pain and irritation in and around the tendon. However, it appears unlikely that these medications can actually evoke more rapid healing of the condition.

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Icing the joint after activity may also decrease the irritation and relieve the pain.

If treatment with decreased activity, exercises and medication is not effective, your physician may recommend a corticosteriod injection in the affected area. This can further decrease the pain and irritation. In some cases this is not effective and surgery can be considered for these resistant and chronic cases.

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Tips for Preventing Injury

• Warm up well before play. Muscles and tendons are like Silly Putty and stretch more when they are warm. Make sure to keep the muscles and tendons warm as you play. 

• Choose appropriate equipment and maintain it properly. A racquet handle that is too big or too small, strung too tightly or loosely, or has a too big or too small head, may increase stress to the elbow and wrist during play.

• Condition for the activity by stretching and strengthening all the muscles used in the sport. Also evaluate play techniques to make sure that they are not irritating the condition.

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Medial Apophysitis (Little Leaguer’s Elbow)

This is an injury of a growth plate on the elbow’s inner side. Growth plates are places where new bone tissue forms. They are found near the ends of the long bones of growing children. But growth plates are weaker than the surrounding bone. That makes them easier to injure.

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Osteochondritis Dissecans of the Elbow

This is a disorder that most often affects young athletes. It happens when part of a bone in the elbow loses its blood supply. It weakens, and so does the cartilage that covers it. Bone and cartilage may break off and drift around in the elbow. That can cause the joint to catch and lock up.

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Throwing Injuries of the Elbow

Throwing overhand again and again puts a lot of stress on your elbow. It can lead to injury. Young athletes, in particular, are at risk. Some play sports all year without learning how to throw properly. And, their bones are still growing. Let’s look at how the elbow can be damaged.

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Ulnar Collateral Ligament Injury

Like other joints, the elbow is held together by strong bands of tissue called “ligaments.” On the elbow’s inner side is the ulnar collateral ligament complex. We call it the “UCL.” It’s made of three bands that connect the humerus (the upper arm bone) to the lower arm’s ulna. The UCL is the elbow ligament most often injured by baseball pitchers and by other athletes who play throwing sports.

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Treatments

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Arthroscopic Debridement of the Elbow

During this outpatient procedure, the surgeon examines the inside of the elbow joint with a camera called an arthroscope. The surgeon identifies and corrects problems with the bones, ligaments and tendons of the elbow.

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Medial Ulnar Collateral Ligament Reconstruction (Tommy John Surgery)

This procedure is designed to repair a torn elbow ligament – an injury typically caused by strong, repetitive overhead throwing motions of the arm or by dislocation of the elbow. It was first performed in 1974 on baseball pitcher Tommy John.

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Common Hand & Wrist Injuries

With so many bones, ligaments, tendons, and joints keeping hands and wrists working, there is ample opportunity for injury. In fact, injuries to the hand and wrists are some of the most common ailments facing athletes. If managed properly, however, most athletes can expect their injury to heal without any significant long-term disability.

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What Are the Most Common Sports-Related Hand and Wrist Injuries?

There are a number of injuries that may occur in an athlete’s hands or wrists. They can be classified into two main categories: traumatic (acute) and overuse (chronic).

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Traumatic injuries are more likely to occur in athletes who participate in sports that require higher levels of contact (i.e., football, hockey, or wrestling), whereas overuse injuries result in athletes who participate in sports that require them to “overdo” a particular movement (i.e., baseball, tennis, or golf).

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Some common traumatic injuries in athletes include joint dislocations, sprains, muscle strains, broken bones, tendon inflammation, and ligament tears. The most common fracture injury in the athletic population occurs in the fingers.

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Overuse injuries are stress-induced and include tendon inflammation and dislocation, nerve injury, and over use stress fractures. Long-term disability is less likely to occur from overuse injuries than from traumatic injuries. However, if left untreated, an athlete’s sports performance may be significantly diminished. Surgical treatment may be required if an injury persists.

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What Should I Do If I Injure My Hand or Wrist?

Should you sustain a hand or wrist injury while participating in a game where an attending team physician is not present, seek immediate medical care if any of the following symptoms are present:

• Severe pain 

• Severe swelling 

• Numbness 

• Coldness or grayness in the finger, hand, or wrist 

• Abnormal twisting or bending of the finger or hand 

• A clicking, grating, or shifting noise while moving your finger, hand, or wrist 

• Bleeding that does not slow and persists for more than 15 minutes.

 

Contact your physician during regular practice hours if mild wrist pain, bruising, or swelling after an injury persists and does not improve after two weeks.

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For minor hand injuries, home treatment, including rest, ice, compression, and elevation to the effected limb can help relieve pain, swelling, and stiffness. An anti-inflammatory medication such as ibuprofen or naproxen may also be taken to help with the pain and inflammation.

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What Treatment Options Are Available for Hand and Wrist Injuries?

Treatment depends on the location, type, duration, and severity of the injury. While surgery is needed for some injuries, such as ligament tears, medication, “buddy-taping” (taping the injured finger to a neighboring one for support), splints, braces, casts, or physical therapy may be used as a treatment option. Your doctor will determine the best option, taking into consideration short and long-term damage; deformities, and stiffness.

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How Can I Prevent a Hand or Wrist Injury?

Wearing wrist guards, gloves, and stretching are just a few ways to help prevent a traumatic hand or wrist injury. You can prevent overuse injuries by taking breaks to rest the hands or wrists, using proper posture and technique, and utilizing protective equipment.

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Triangular Fibrocartilage Complex (TFCC) Tears

This condition is a degenerative or traumatic tear of one or more parts of the triangular fibrocartilage complex (TFCC), which stabilizes the ulna. The TFCC is composed of a group of ligaments that form connections between the radius, ulna and the carpal bones of the hand. At the center of these ligaments lies the most commonly injured structure, the triangular fibrocartilage disc, which is connected between the radius and the base of the ulnar styloid.

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More information can be found, HERE