Database: Ovid MEDLINE(R) <1966 to January Week 3 2004>Search Strategy:--------------------------------------------------------------------------------1 exp ELBOW JOINT/ or exp ELBOW/ or exp TENNIS ELBOW/ (8700)2 exp ELBOW JOINT/in or exp ELBOW/in or exp TENNIS ELBOW/in (2397)3 overuse.tw. and 2 (36)4 limit 3 to english language (35)5 exp Tennis Elbow/ (646)6 overuse.tw. and 5 (22)7 limit 6 to english (20)8 4 or 7 (48)9 from 8 keep 1-48 (48)10 from 9 keep 1-48 (48)

***************************<1>Unique Identifier 7754894Authors Ho CP.Institution Bayside Imaging Center, Redwood City, CA 94063, USA.Title Sports and occupational injuries of the elbow: MR imaging findings.Source AJR. American Journal of Roentgenology. 164(6):1465-71, 1995 Jun.Abstract Elbow injuries may limit participation in sports and occupational endeavors, as well as activities of daily living. Conventional radiography is the appropriate initial screening technique for evaluation of possible osseous injury or arthritis/arthrosis, but often it offers little information concerning soft-tissue derangement, which is a common source of dysfunction. MR imaging can evaluate these soft tissue to assist in diagnosis, as well as in planning treatment and assessing response to treatment. This essay illustrates MR findings of both the chronic overuse and the more acute traumatic soft-tissue injuries involving ligaments, tendons, muscles, and neurovascular structures, as well as radiographically occult osteochondral injuries.

<2>Unique Identifier 7717233Authors Patten RM.Institution Department of Radiology, University of Washington School of Medicine, Seattle 98195, USA.Title Overuse syndromes and injuries involving the elbow: MR imaging findings. [Review] [8 refs]Source AJR. American Journal of Roentgenology. 164(5):1205-11, 1995 May.Abstract Most elbow injuries result not from acute trauma but from repetitive microtrauma and chronic stress overload of the joint. Such "overuse" injuries may be difficult to diagnose clinically. Occasionally, even acute traumatic injuries may be occult radiographically and difficult to detect. In patients with elbow pain of uncertain origin, MR imaging may improve diagnostic specificity and accuracy. In this essay, characteristic MR imaging findings in common traumatic and overuse syndromes of the elbow are illustrated. [References: 8]

<3>Unique Identifier 10695582Authors Chumbley EM. O'Connor FG. Nirschl RP.Institution Reid Health Services Center, Lackland Air Force Base, Texas 78236-5300, USA.Title Evaluation of overuse elbow injuries. [Review] [15 refs]Source American Family Physician. 61(3):691-700, 2000 Feb 1.Abstract The evaluation of elbow pain can be challenging because of the complexity of the joint and its central location in the upper extremity. Diagnosing the injury correctly requires an understanding of the anatomy of the elbow, which includes three articulations, two ligament complexes, four muscle groups and three major nerves. The history should be directed at pinpointing the location of symptoms and the activities that cause the patient's pain. It is important to identify the specific musculotendinous structures that are at risk for overuse or have been injured through overuse. Mechanical symptoms are indicative of intra-articular pathology, whereas neurologic symptoms are characteristic of nerve entrapment syndromes. Physical examination of the elbow and related structures should confirm the diagnosis. Only a minority of patients require diagnostic studies. Basic treatment principles are described by the acronym PRICEMM: protection, rest, ice, compression, elevation, medication and modalities (physical therapy). Surgical consultation is warranted in selected patients. [References: 15]

<4>Unique Identifier 2757133Authors Snyder-Mackler L. Epler M.Institution Department of Physical Therapy, Sargent College of Allied Health Professions, Boston University, Massachusetts 02215.Title Effect of standard and Aircast tennis elbow bands on integrated electromyography of forearm extensor musculature proximal to the bands.Source American Journal of Sports Medicine. 17(2):278-81, 1989 Mar-Apr.Abstract Classic tennis elbow, or lateral epicondylitis, has been described as an overuse or misuse injury resulting in a tendinitis. The extensor carpi radialis brevis (ECRB) and extensor digitorum communis (EDC) have been implicated as primary culprits in this pathology. Tennis elbow has been treated using a constrictive band placed several centimeters distal to the origin of these two muscles. Aircast (Aircast Inc., Summit, NJ) has developed a new style of band that employs an air-filled bladder as the counterpressure element. This study tested the effect of both standard and Aircast bands on EMG activity of the EDC and ECRB proximal to the band compared to control values. Ten normal subjects, ranging in age from 20 to 43 years, were tested. Right upper extremities were tested in all cases. The subjects' forearms were stabilized in the CYBEX II forearm stabilization V-pad. The ECRB and EDC were then impaled with monopolar EMG needle electrodes. The CYBEX data were recorded using the HUMAC system and the EMG data were recorded and analyzed using the Cadwell 7400. EMG data were recorded at 80% of maximum voluntary isometric contraction (MVIC) with no band, the standard band, and the Aircast band. An analysis of variance (ANOVA) with

repeated measures of integrated EMG (IEMG) and Duncan's multiple comparison tests revealed that the Aircast caused a significant reduction in IEMG of the ECRB and EDC when compared with control values and the standard band. The decrease in IEMG with the standard band was not statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS)

<5>Unique Identifier 1554075Authors Koh TJ. Grabiner MD. Weiker GG.Institution Department of Biomedical Engineering and Applied Therapeutics, Cleveland Clinic Foundation, Ohio 44196.Title Technique and ground reaction forces in the back handspring.Source American Journal of Sports Medicine. 20(1):61-6, 1992 Jan-Feb.Abstract The ground reaction forces at the hand that produced compression forces and varus/valgus moments at the elbow joint during the double-arm support phase of the back handspring were studied. The relationship of technique, namely elbow joint flexion, to these forces were also studied. Compression forces and forces producing valgus moments have been implicated in overuse injuries to the elbow joint. Video and force plate analysis of six young female gymnasts showed that 1) the elbow joint flexed during the double-arm support phase, and 2) the reaction forces at the hand produced large compression forces (an average of 2.37 times body weight) and sizable valgus moments at the elbow (an average of 0.03 times body weight times body height). The combination of these forces may contribute to the occurrence of lateral compression injuries of the elbow joint (e.g., osteochondritis dissecans of the capitellum). Correlations of measures of elbow angle and measures of reaction force showed that large elbow flexions may protect the elbow from large valgus moments.

<6>Unique Identifier 6148925Authors McLean ID.Title Swimmers' injuries.Source Australian Family Physician. 13(7):499-502, 1984 Jul.Abstract Swimming is an excellent sport for people of all age groups but can produce overuse injuries. Early diagnosis is essential before the resistant stage is reached: a swimmer with shoulder pain cannot 'swim it out'. Swimmers have different tolerances to high levels of activity but injuries can be reduced if attention is paid to technique, preliminary warm up and stretching exercises. Training errors and faulty technique cause problems but psychological stress in the teenage group should not be overlooked.

<7>Unique Identifier 1419555Authors Ernst E.Institution

Department of Physical Medicine and Rehabilitation, Medical School, University of Vienna.Title Conservative therapy for tennis elbow. [Review] [34 refs]Source British Journal of Clinical Practice. 46(1):55-7, 1992 Spring.Abstract Tennis elbow is a common overuse syndrome. It is accompanied by degenerative changes in the enthesis of the extensor carpi radialis brevis muscle. It may be best diagnosed clinically by eliminating other possible causes of lateral elbow pain. Physical methods should always be selected as initial treatment. Immobilisation is the initial advice that most doctors give: ultrasound has been shown to be effective in a placebo-controlled, double-blind trial, and low energy laser has been found to reduce objective but not subjective symptoms. Other forms of physical treatment like electrotherapy, thermotherapy and massages can be tried, even though proof of their efficacy needs to be established more firmly. When physical treatments have failed, steroid injections can help. If symptoms still persist, then surgery is called for. There are still many open questions surrounding the syndrome of tennis elbow. Research into this common soft tissue disease should be intensified. [References: 34]

<8>Unique Identifier 3779335Authors Nimmo MA. McLean D. Mutrie N. McKenzie S.Title An holistic approach to recovery from an overuse injury in a games player.Source British Journal of Sports Medicine. 20(3):103-6, 1986 Sep.Abstract The management of a chronic injury to an international squash player is described. By good physiotherapeutic management and the involvement of an interdisciplinary team it was possible to make gains in the non-playing period. The rehabilitation period included physiological assessment on the basis of which a training programme was devised with target goals set throughout the period. Mental rehearsal of skills was included at all stages. As a result, the player's confidence was maintained and fitness levels improved. The long term prognosis has been good. The model could be applied to any sports injury.

<9>Unique Identifier 8792052Authors Holtzhausen LM. Noakes TD.Institution Department of Anatomy and Cell Biology, University of Cape Town Medical School, Observatory, South Africa.Title Elbow, forearm, wrist, and hand injuries among sport rock climbers. [Review] [25 refs]Source Clinical Journal of Sport Medicine. 6(3):196-203, 1996 Jul.Abstract OBJECTIVES: Sport rock climbing with its repetitive high-torque movements in gaining the ascent of a rock face or wall, often in steep overhanging positions, is associated with a unique distribution and form of upper limb injuries. In this article, we review the biomechanical aspects of sport rock climbing and the

types of injuries commonly encountered in the forearm, wrist, and hand regions of elite sport rock climbers. Because elbow, forearm, wrist, and hand injuries predominate, representing 62% of the total injuries encountered, these anatomical areas have been selected for review. DATA SOURCES: The predominant source of data are the published work of Bollen et al. The remaining sources were obtained through electronic search of the Medline and Current Contents Databases (last searched May 1995). German and French articles were included in the search criteria. STUDY SELECTION: Only studies dealing with acute soft tissue and overuse injuries amongst sport rock climbers were selected. DATA EXTRACTION: Data were extracted directly from the sourced articles. DATA SYNTHESIS: The following injuries have been described in detail with regard to their presentation, diagnosis, treatment, and prevention amongst sport rock climbers: medial epicondylitis, brachialis tendonitis, biceps brachii tendonitis, ulnar collateral ligament sprain of the elbow, carpal tunnel syndrome, digital flexor tendon pulley sheath tears, interphalangeal joint effusions, fixed flexion deformities of the interphalangeal joints, and collateral ligament tears of the interphalangeal joints. CONCLUSION: Many of the injuries are specific to the handhold types used by the rock climber. Accurate diagnosis and effective treatment of these unique injuries will be facilitated by a wider understanding of the biomechanical aspects of rock climbing and an awareness of the patterns and incidence of injuries in this sport. [References: 25]

<10>Unique Identifier 7641448Authors Safran MR.Institution University of Pittsburgh, Center for Sports Medicine and Rehabilitation, PA, USA.Title Elbow injuries in athletes. A review. [Review] [112 refs]Source Clinical Orthopaedics & Related Research. (310):257-77, 1995 Jan.Abstract Elbow injuries are becoming more common as increasing numbers of people participate in throwing and racquet sports. The understanding and treatment of elbow injuries is becoming more sophisticated in conjunction with better noninvasive and invasive diagnostic techniques. The majority of injuries to the elbow in the athlete are chronic, overuse injuries. These injuries are the result of repetitive intrinsic or extrinsic overload, or both, resulting in microrupture of soft tissue such as ligament or tendon. In children, apophyses, being the weakest link in the immature musculoskeletal system, are susceptible to stress injuries. Elbow injuries are most commonly caused by valgus stress, from throwing or axial compression, resulting in increased force absorbed by the medial elbow. With repetitive valgus stress, patients may develop chondromalacia, loose bodies in the posterior or lateral compartments, injury to the ulnar collateral ligament, myotendinous injury to the flexor-pronator muscle group, osteochondritis dissecans, or ulnar neuritis. The purpose of this paper is to (1) define the significance of elbow injuries in athletics, (2) review the anatomy and biomechanics of the elbow, and (3) discuss the prevention and treatment of elbow injuries. [References: 112]

<11>Unique Identifier 7712560Authors Ellenbecker TS.

Institution HealthSouth Sports Medicine, Scottsdale, Arizona, USA.Title Rehabilitation of shoulder and elbow injuries in tennis players. [Review] [87 refs]Source Clinics in Sports Medicine. 14(1):87-110, 1995 Jan.Abstract Optimization of treatment of the tennis player with an upper extremity overuse injury requires a thorough understanding and analysis of the biomechanical and physiologic stresses inherent in the game of tennis. Anatomic adaptations found in the upper extremity of elite tennis players provide the framework for evaluation and treatment of overuse injury through both an anatomically based total-arm strength program and efforts to normalize joint arthrokinematics. Integration of these key factors allows the clinician to rehabilitate the patient and design preventive conditioning programs in a scientifically based, sport-specific manner. [References: 87]

<12>Unique Identifier 7600591Authors Rettig AC. Patel DV.Institution Department of Research and Education, Methodist Sports Medicine Center, Indianapolis, Indiana, USA.Title Epidemiology of elbow, forearm, and wrist injuries in the athlete. [Review] [50 refs]Source Clinics in Sports Medicine. 14(2):289-97, 1995 Apr.Abstract 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. [References: 50]

<13>Unique Identifier 7712557Authors Roetert EP. Brody H. Dillman CJ. Groppel JL. Schultheis JM.Institution United States Tennis Association, Key Biscayne, Florida, USA.Title The biomechanics of tennis elbow. An integrated approach. [Review] [23 refs]Source Clinics in Sports Medicine. 14(1):47-57, 1995 Jan.Abstract Tennis elbow afflicts 40% to 50% of the average, recreational tennis players; most of these players more than 30 years of age. Tennis elbow is thought to be the result of microtrauma, the overuse and inflammation at the origin of the ECRB as a result of repeated large impact forces created when the ball hits the racket in the backhand stroke. Several authors have found that EMG activity in the ECRB, the muscle and tendon complex afflicted in tennis elbow, is high during the acceleration and early follow-through phases of the groundstrokes and

during the cocking phase of the serve. Unfortunately, none of the authors gave evidence to support the claim that muscle activity in the ECRB at ball contact is high. In the one-handed backhand, the torques at impact (17-24 nm) will be absorbed by the tendons of the elbow. Giangarra and his colleagues observed that the two-handed backhand "allows the forces at ball impact to be transmitted through the elbow rather than absorbed by the tissues at the elbow." Other authors have reported that players using a two-handed backhand will rarely develop lateral epicondylitis, because the helping arm appears to absorb more energy and changes the mechanics of the swing. As seen by Morris and colleagues, Giangarra and associates, and Leach and colleagues, players who utilize the two-handed backhand have a very low incidence of tennis elbow. These three studies conclude that the two-handed backhand stroke is probably the most effective backhand stroke to prevent lateral tennis elbow. Studies show that wrist extensors are highly involved in all strokes (serve, forehand, and both one- and two-handed backhand strokes). This relatively high involvement (40%-70% MVC) throughout play may result in overload of this muscular group. Thus, tennis elbow may be caused simply by continued use of this muscular system in all strokes, and not just because of the high forces absorbed at impact. Another theory concerning impact states that if the extensor group is already at near maximum contraction, vibrations and twisting movements are transferred directly through the muscle (muscle stiffness at this point would be great) to the tendinous insertion, causing repeated microtrauma. If the muscle is the stiffest element in the system, the force will be transferred to the tendon. It is evident that a need exists for specific study of muscular response during impact. More microanalysis of the impact phase needs to be conducted specifically for the one-handed backhand groundstroke. [References: 23]

<14>Unique Identifier 7600597Authors Thomas DR. Plancher KD. Hawkins RJ.Institution Caremark Sports Center at Vail, Colorado, USA.Title Prevention and rehabilitation of overuse injuries of the elbow.Source Clinics in Sports Medicine. 14(2):459-77, 1995 Apr.Abstract Rehabilitation from injury and prevention of injury are terms that describe differing aspects of the same challenge. The clinician must be continually aware of the principles of rehabilitation and their order of priority (prevent further damage, restore motion, restore strength, reestablish coordination) while supervising patients' progress toward their goals. If patients are made aware of these principles at an early stage, and taught to take as much responsibility as possible for their own rehabilitative course, they will be more likely to reach their own ideal compromise of safety and speed of progress. In addition to helping with rehabilitation from injury, knowledge and self-awareness that patients obtain during this process may help in the prevention of future injuries.

<15>Unique Identifier 8726320Authors Plancher KD. Peterson RK. Steichen JB.Institution Albert Einstein College of Medicine, Bronx, New York, USA.Title

Compressive neuropathies and tendinopathies in the athletic elbow and wrist. [Review] [142 refs]Source Clinics in Sports Medicine. 15(2):331-71, 1996 Apr.Abstract Overuse syndromes of the upper extremity in the athletic population are a common and often difficult problem for physician and patient alike. Optimal function of the upper extremity is tied intimately to success in many sporting activities. Correct diagnosis and proper care require a thorough knowledge of the pertinent anatomy, pathophysiology, and pathomechanics involved in each disorder. Conservative care with rest, activity modification, and medication is adequate for most athletic injuries. Surgical intervention may be indicated for continuing pain, decreased performance, or to prevent chronic changes. Surgery must be followed by thoughtfully prepared training and rehabilitation programs to optimize the chances of a successful outcome. [References: 142]

<16>Unique Identifier 8726322Authors Gill TJ 4th. Micheli LJ.Institution Harvard University, Combined Residency Program in Orthopaedic Surgery, Boston, Massachusetts, USA.Title The immature athlete. Common injuries and overuse syndromes of the elbow and wrist. [Review] [49 refs]Source Clinics in Sports Medicine. 15(2):401-23, 1996 Apr.Abstract Specific elbow and wrist injuries are predictable in the skeletally immature athlete based on the biomechanics of the sport and the age of the patient. The physician must be aware of the potential for overuse injuries. Modification in training regimens is essential for recovery. A greater emphasis must be placed on the prevention of these injuries. As a general rule, the young athlete should not progress more than 10% per week in the amount and frequency of training. Correction of muscle-tendon imbalances is accomplished by maintaining strength and flexibility of susceptible tissues. In throwers, a triceps-strengthening program of progressive resisted extension exercises and a forearm flexor/extensor-strengthening program using the French curl technique are helpful. Careful attention to throwing technique and proper coaching are essential. The goal for the young athlete is early recognition of the injury and thereby prevention of a long-term disability. [References: 49]

<17>Unique Identifier 9330808Authors Behr CT. Altchek DW.Institution Sports Medicine and Shoulder Service, Hospital for Special Surgery, New York, New York, USA.Title The elbow. [Review] [74 refs]Source Clinics in Sports Medicine. 16(4):681-704, 1997 Oct.Abstract Elbow disorders in the athletic population comprise a wide range of injuries from acute trauma to those caused by chronic overuse of the joint. Certain

injuries are orthopedic emergencies that must be recognized immediately by the team physician to avoid potential complications. Other overuse injuries need to be accurately diagnosed and treated so further injury can be prevented and the athlete can return to competition as expediently as possible. Finally, the decision to refer an athlete for surgical treatment often rests with the team physician; only with an adequate understanding of the elbow disorders in the athlete can these decisions be made. [References: 74]

<18>Unique Identifier 14560549Authors Nirschl RP. Ashman ES.Institution Georgetown University Medical Center, 4000 Reservoir Road, Washington, DC 20057, USA. nirschl@erols.comTitle Elbow tendinopathy: tennis elbow. [Review] [24 refs]Source Clinics in Sports Medicine. 22(4):813-36, 2003 Oct.Abstract The pathoanatomy of overuse tendinopathy is noninflammatory angiofibroblastic tendinosis. The areas of elbow abnormality are specific, including the ECRB-EDC complex laterally, the pronator teres, flexor carpi radialis medially, and triceps posteriorly. The goals of nonoperative treatment are to revitalize the unhealthy pain-producing tendinosis tissue. The key to nonoperative treatment is rehabilitative resistance exercise with progression of the exercise program. If rehabilitation fails, the surgical interventions as described are highly successful. [References: 24]

<19>Unique Identifier 11494834Authors Rizio L. Uribe JW.Institution Department of Orthopaedic Surgery, University of Miami, Miami, Florida, USA.Title Overuse injuries of the upper extremity in baseball. [Review] [56 refs]Source Clinics in Sports Medicine. 20(3):453-68, 2001 Jul.Abstract The shoulder and elbow are prone to many overuse injuries in baseball. Injury to the muscles or ligaments leads to pain and loss of effectiveness in competition. Although many of these disorders respond to conservative management, surgery is sometimes necessary to provide pain relief and restore function. Unfortunately, overuse injuries that require surgery still are career-threatening injuries. Correct diagnosis and treatment increase the probability of a throwing athlete returning to competition. [References: 56]

<20>Unique Identifier 11227698Authors Stubbs MJ. Field LD. Savoie FH 3rd.Institution Mississippi Sports Medicine and Orthopaedic Center, Jackson, Mississippi, USA.Title

Osteochondritis dissecans of the elbow. [Review] [28 refs]Source Clinics in Sports Medicine. 20(1):1-9, 2001 Jan.Abstract Osteochondritis dissecans of the elbow remains a difficult problem to manage in the young athlete. Though the etiology is unclear, a definite association between overuse with repetitive microtraumatic insult and OCD has been established. Early detection and appropriate treatment can provide the best chance for preventing an unfavorable outcome. In many cases, conservative treatment regimens will provide complete resolution of symptoms, return of function, and full recovery, including return to sports participation. Surgical indications should be recognized, however, and surgical management carried out when warranted. Most authors treat unstable lesions primarily by excision of the fragment, accompanied by drilling or burring of the base of the lesion. Symptoms usually improve significantly, but approximately half of all patients will continue to experience chronic pain or limitation of elbow motion, highlighting the significance and severity of OCD of the elbow. [References: 28]

<21>Unique Identifier 11845021Authors Kandemir U. Fu FH. McMahon PJ.Institution Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania 15203, USA.Title Elbow injuries. [Review] [82 refs]Source Current Opinion in Rheumatology. 14(2):160-7, 2002 Mar.Abstract The elbow is a commonly injured joint, yet physicians may be less comfortable treating injuries to the elbow compared with knee and shoulder injuries. Common injuries involving the elbow are tendinosis, instability, tendon ruptures, osteochondritis dissecans, and fractures. Tendinosis is a common overuse injury and may occur on the lateral, medial, or infrequently, the posterior side of the elbow. Injury to the medial or lateral ulnar collateral ligaments may result in instability. Repetitive trauma from overuse is the most common etiologic factor in athletes. Distal biceps and triceps tendon injuries may result in elbow disability in active individuals. Partial tears are more difficult to diagnose than complete ruptures. Osteochondritis dissecans of capitellum affects adolescents involved in overhead throwing athletics. Fractures about the elbow most commonly involve the radial head in adults, and the distal humerus in children. Athletes are prone to elbow injuries resulting from both overuse and acute trauma. Our purpose is to describe the diagnosis and treatment of these common elbow injuries in athletes of all ages. [References: 82]

<22>Unique Identifier 8850152Authors Byers GE 3rd. Berquist TH.Institution Mayo Clinic Jacksonville, Jacksonville, Florida, USA.Title Radiology of sports-related injuries. [Review] [148 refs]Source Current Problems in Diagnostic Radiology. 25(1):1-49, 1996 Jan-Feb.Abstract

Participation in organized sports and fitness activity continues to increase in the United States. As a result, more acute bone and soft-tissue injuries are occurring in this patient population. Chronic overuse syndromes are also more common today. It is important for radiologists to understand the mechanism of injury so that they can properly approach the imaging of these patients. Although magnetic resonance imaging (MRI) is frequently the technique of choice, other imaging methods are also important and may, in certain cases, be preferred to MRI. In this review, we discuss extremity injuries by anatomic region. The spine is not included. A tailored imaging approach to each anatomic region and type of injury is discussed. [References: 148]

<23>Unique Identifier 12959710Authors Salyapongse A. Hatch JD.Institution Department of Orthopedic Surgery, The Permanente Medical Group, 280 West MacArthur Boulevard, Oakland, CA 94611, USA.Title Advances in the management of medial elbow pain in baseball pitchers. [Review] [19 refs]Source Current Sports Medicine Reports. 2(5):276-80, 2003 Oct.Abstract Overhead-throwing athletes, particularly baseball pitchers, subject their elbows to tremendous amounts of valgus stress during the throwing motion. As a result of this stress, baseball pitchers are at considerable risk for injury. The proper functioning and stability of the elbow depends upon the bony articulations and soft tissue structures. The stresses placed across the elbow joint with repetitive throwing can lead to injury. Although the majority of injuries encountered are overuse injuries, acute injuries can also occur. Proper and timely diagnosis and treatment of these throwers is critical, to allow for the athlete's successful return to competition. [References: 19]

<24>Unique Identifier 7635130Authors Ranney D. Wells R. Moore A.Institution Department of Kinesiology, University of Waterloo, Ontario, Canada.Title Upper limb musculoskeletal disorders in highly repetitive industries: precise anatomical physical findings.Source Ergonomics. 38(7):1408-23, 1995 Jul.Abstract Physical assessment of 146 female workers in highly repetitive jobs found 54% to have evidence of musculoskeletal disorders in the upper limb that are potentially work-related. Many workers had multiple problems, and many were affected bilaterally (33% of workers). Muscle pain and tenderness was the largest problem, both in the neck/shoulder area (31%) as expected and in the forearm/hand musculature (23%), a previously unreported site. Most forearm muscle problems were found on the extensor side. Carpal tunnel syndrome was the most common form of neuritis with 16 people affected (7 people affected bilaterally). De Quervain's tenosynovitis and wrist flexor tendinitis were the most commonly found tendon disorders in the distal forearm (12 people affected for each diagnosis). The results suggest that exposure should be measured

bilaterally. They also suggest that muscle tissue is highly vulnerable to overuse. Stressors that affect muscle tissue, such as static loading, should be studied in the forearm as well as in the shoulder.

<25>Unique Identifier 10098064Authors Ciccotti MG. Jobe FW.Institution Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.Title Medial collateral ligament instability and ulnar neuritis in the athlete's elbow. [Review] [36 refs]Source Instructional Course Lectures. 48:383-91, 1999.Abstract Athletes who participate in overhand sports may sustain a host of injuries to the medial elbow. The chronic repetitive stress caused by the high velocity nature of the overhand throwing mechanism predisposes these athletes to overuse injuries. Medial collateral ligament instability and ulnar neuritis are common disorders seen in this patient population. A thorough understanding of the anatomy of the medial elbow as well as the pathophysiology of these disorders and their nonsurgical and surgical treatments are essential to providing these athletes with optimal care and hastening their return to sports. [References: 36]

<26>Unique Identifier 11513070Authors Dryson EW. Walls CB.Institution New Zealand Institute of Occupational and Environmental Medicine, Auckland, New Zealand.Title The distribution of occupations in two populations with upper limb pain.Source International Journal of Occupational & Environmental Health. 7(3):201-5, 2001 Jul-Sep.Abstract Occupations of two geographically distinct populations of patients with upper limb pain were examined. Relative risks for being in an occupation were calculated for subjects with epicondylitis, carpal tunnel syndrome, and pain syndromes in one population and nonspecific occupational overuse syndrome (OOS) in the other. Population A subjects (806 female, 154 male Auckland clinic referrals) with epicondylitis and carpal tunnel syndrome had higher rates of manual occupations compared with the Auckland employed population, consistent with previous research. Both Population A and Population B subjects (1,188 female, 499 male national notifications to the Department of Labour) with pain syndrome or nonspecific OOS had increased rates of clerical occupations. Relative risks ranged from 2.24 (95% CI 1.69,2.97) to 3.92 (3.50 ,4.40). Word processor operators, data-entry operators, and mail sorters were overrepresented in both populations. An unexplained association between nonspecific upper arm pain and being in some clerical occupations requires further research.

<27>

Unique Identifier 11258643Authors Popovic N. Ferrara MA. Daenen B. Georis P. Lemaire R.Institution Department of Orthopedic Surgery, University Hospital Sart Tilman, Liege, Belgium. Nebojsa.Popovic@chu.ulg.ac.beTitle Imaging overuse injury of the elbow in professional team handball players: a bilateral comparison using plain films, stress radiography, ultrasound, and magnetic resonance imaging.Source International Journal of Sports Medicine. 22(1):60-7, 2001 Jan.Abstract The purpose of this study was to compare the manifestations of elbow stress due to repetitive valgus forces between the dominant and the non-dominant elbow in 40 uninjured elite team handball players using plain films, stress radiographs, ultrasound, and MRI examination. On comparative plain films generalized bony hypertrophy manifested by increased humeral diameter, and cortical hypertrophy of the humeral shaft of the dominant extremity was observed in all players. A significantly greater difference in medial joint space opening between stressed and unstressed elbows was measured in the dominant elbow compared with the non-dominant elbow (0.41 +/- 0.59 mm). The ultrasonographic findings showed statistically significant bilateral differences in the thickness of the flexor-pronator tendon (0.90 +/- 0.56 mm), extensor tendon (0.96 +/- 0.50 mm), triceps tendon (0.69 +/- 0.27 mm), and medial collateral ligament (0.47 +/- 0.24 mm): the values were systematically higher on the dominant side. US examination showed intra-articular effusions in 67% and small loose bodies in 33.3% of the players, exclusively in dominant elbows. MRI showed joint effusion in the same subjects as US, but loose bodies were only detected in half of the cases found by ultrasound. This study demonstrates that repetitive stress on the dominant extremities of handball players is responsible for physiologic and pathologic changes in the dominant elbow.

<28>Unique Identifier 12480012Authors Rich BC. McKay MP.Institution Department of Emergency Medicine, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA.Title The Cubital Tunnel syndrome: a case report and discussion.Source Journal of Emergency Medicine. 23(4):347-50, 2002 Nov.Abstract Cubital Tunnel Syndrome is the second most common peripheral neuropathy of the upper extremity. It presents as elbow, forearm, or hand pain in the ulnar nerve sensory distribution and it is the result of overuse, trauma, or entrapment of the ulnar nerve at the elbow. Proper physical diagnosis can localize the site of ulnar nerve entrapment to the elbow or wrist. Both conservative and operative modalities exist to treat the Cubital Tunnel Syndrome; optimal management is still unclear.

<29>Unique Identifier 9836172Authors

Barrentine SW. Fleisig GS. Whiteside JA. Escamilla RF. Andrews JR.Institution American Sports Medicine Institute, Birmingham, AL 35205, USA.Title Biomechanics of windmill softball pitching with implications about injury mechanisms at the shoulder and elbow.Source Journal of Orthopaedic & Sports Physical Therapy. 28(6):405-15, 1998 Dec.Abstract Underhand pitching has received minimal attention in the sports medicine literature. This may be due to the perception that, compared with overhead pitching, the underhand motion creates less stress on the arm, which results in fewer injuries. The purpose of this study was to calculate kinematic and kinetic parameters for the pitching motion used in fast pitch softball. Eight female fast pitch softball pitchers were recorded with a four-camera system (200 Hz). The results indicated that high forces and torques were experienced at the shoulder and elbow during the delivery phase. Peak compressive forces at the elbow and shoulder equal to 70-98% of body weight were produced. Shoulder extension and abduction torques equal to 9-10% of body weight x height were calculated. Elbow flexion torque was exerted to control elbow extension and initiate elbow flexion. The demand on the biceps labrum complex to simultaneously resist glenohumeral distraction and produce elbow flexion makes this structure susceptible to overuse injury.

<30>Unique Identifier 8156067Authors Almekinders LC. Almekinders SV.Institution Division of Orthopaedic Surgery, University of North Carolina at Chapel Hill 27599-7055.Title Outcome in the treatment of chronic overuse sports injuries: a retrospective study.Source Journal of Orthopaedic & Sports Physical Therapy. 19(3):157-61, 1994 Mar.Abstract Overuse injuries due to repetitive motion are common in recreational and elite athletes. Some overuse injuries resolve quickly after activity modification, but others can persist, which often prompts the patient to seek medical attention. This study retrospectively reviewed outcome and compliance in the treatment of chronic overuse sports injuries. One hundred and two patients were contacted by telephone an average of 27 months following their initial visit for chronic overuse injury. A questionnaire regarding the treatment and outcome was completed. Of this group, 38 (37%) claimed to be completely better, 28 (28%) were improved, but 36 (35%) were not better or worse. Anterior knee pain had a significantly worse outcome than any other injury (p < 0.05). Excluding anterior knee pain, 71% were improved or completely better. Neither activity modification nor combination treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) and physical therapy through stretching and strengthening exercises was associated with a better result. Noncompliance rates were 9% for NSAID therapy and 13% for exercise treatment. These results indicate that chronic overuse injuries are not always self-limiting but can result in prolonged symptoms.

<31>Unique Identifier 7600167Authors

Lowery WD Jr. Kurzweil PR. Forman SK. Morrison DS.Institution Southern California Center for Sports Medicine, Long Beach 90806, USA.Title Persistence of the olecranon physis: a cause of "little league elbow".Source Journal of Shoulder & Elbow Surgery. 4(2):143-7, 1995 Mar-Apr.Abstract The elbow is one of the most common sites of overuse injuries in adolescent baseball players. The term "little league elbow" has been used to describe a number of entities. This article reports three cases of painful persistence of the olecranon epiphyseal plate in adolescent pitchers. Symptoms associated with this entity may improve with rest and avoidance of the aggravating activity. However, if symptoms persist and the contralateral growth plate has closed, internal fixation may be necessary and is effective in relieving the symptoms.

<32>Unique Identifier 11575037Authors Stockard AR.Institution Department of Family Medicine and Division Chief of Primary Care Sports Medicine, University of North Texas Health Science Center at Fort Worth, Texas, USA. astockar@hsc.unt.eduTitle Elbow injuries in golf.[see comment]. [Review] [15 refs]Comments Comment in: J Am Osteopath Assoc. 2002 Jan;102(1):11; PMID: 11837335Source Journal of the American Osteopathic Association. 101(9):509-16, 2001 Sep.Abstract Golf is not a sport known for its high injury level; however, injuries do occur. Such mishaps usually involve overuse-type injuries that are more common among amateur golfers than among professional golfers. This article attempts to provide an overview of golf injuries to the elbow, with a concentration on incidence, proper diagnosis, adequate treatment (including rehabilitation), and prevention strategies. After reading this article, primary care physicians should be able to manage most golfing injuries to the elbow. [References: 15]

<33>Unique Identifier 8398718Authors Herzog RJ.Institution Bayside Imaging Center, Redwood City, California.Title Magnetic resonance imaging of the elbow. [Review] [54 refs]Source Magnetic Resonance Quarterly. 9(3):188-210, 1993 Sep.Abstract With the current popularity of racket and throwing sports, the number of individuals seeking medical care for elbow pain and dysfunction has increased rapidly. Before the development and implementation of magnetic resonance imaging (MRI), radiologic imaging examinations provided the treating physician limited information to determine the precise etiology of elbow disorders, because they usually involve soft-tissue structures. With MRI, it is now possible to accurately assess the integrity of the ligaments, tendons, and muscles

surrounding the elbow, and to detect pathologic changes in these tissues secondary to acute macrotrauma or chronic microtrauma, e.g., overuse injuries. By defining the nature and extent of these abnormalities, the choice of the appropriate therapeutic regimen is facilitated. With MRI, it is also now possible to noninvasively evaluate the natural history of these soft-tissue disorders and to determine the effects of different therapeutic interventions. [References: 54]

<34>Unique Identifier 2936937Authors Polisson RP.Title Sports medicine for the internist. [Review] [53 refs]Source Medical Clinics of North America. 70(2):469-89, 1986 Mar.Abstract Because of increasing participation in leisure sports and exercise rehabilitation programs, many patients are developing nonsurgical, soft tissue overuse syndromes. Many of these musculoskeletal problems arise because of underlying biomechanical difficulties, training errors, or improper use of equipment. Epidemiologic observations reveal that these individuals frequently visit a general medical practitioner before seeking the advice of an orthopedic specialist. Prompt diagnosis simply requires an appreciation of anatomy and an analytic understanding of sports biomechanics. Although compulsive about their level of physical activity, many of those affected with overuse syndromes are highly motivated individuals who will predictably improve with the judicious use of NSAIDs, elimination of training errors, and the use of appropriate sports equipment and footwear. Simple orthotics may be needed for correction of biomechanical problems. For many of these localized musculoskeletal disorders, strict adherence to gradual physical rehabilitation activities is advisable. [References: 53]

<35>Unique Identifier 6029782Authors Corrigan AB.Title The overuse syndrome in athletes.Source Medical Journal of Australia. 2(4):148-53, 1967 Jul 22.

<36>Unique Identifier 6843972Authors Micheli LJ.Title Overuse injuries in children's sports: the growth factor.Source Orthopedic Clinics of North America. 14(2):337-60, 1983 Apr.

<37>Unique Identifier 2678071

Authors Chop WM Jr.Institution Department of Family Practice, University of Oklahoma College of Medicine-Tulsa.Title Tennis elbow.[see comment]. [Review] [8 refs]Comments Comment in: Postgrad Med. 1990 Feb 15;87(3):32, 34; PMID: 2304890Source Postgraduate Medicine. 86(5):301-4, 307-8, 1989 Oct.Abstract Tennis elbow, or lateral epicondylitis, is a common condition of the elbow resulting from overuse during athletic or occupational activity. Functionally, it is a tendinitis of the origin of the forearm extensor muscle mass. Diagnosis is mainly based on symptoms and signs, including lateral elbow pain during twisting and gripping and tenderness at the lateral forearm exacerbated by stress testing of the forearm extensors. Comprehensive treatment should include rest, use of ice, antiinflammatory drug therapy, use of sleep-cycle modifiers, and sometimes surgery in otherwise unresponsive cases. [References: 8]

<38>Unique Identifier 1609006Authors Nicola TL.Institution Harvard Medical School, Boston, Massachusetts.Title Elbow injuries in athletes. [Review] [18 refs]Source Primary Care; Clinics in Office Practice. 19(2):283-302, 1992 Jun.Abstract Most elbow injuries carry an excellent prognosis for return to a given sport. Early identification of overuse injuries and joint contractures can deter bone deformities in later life. Early evaluation can deter severe complications such as that of neurovascular injury. Rehabilitation should not be considered complete until there has been maximal restoration and correction of technique and accuracy in addition to the issue of soft-tissue healing. [References: 18]

<39>Unique Identifier 10336196Authors Stevens MA. El-Khoury GY. Kathol MH. Brandser EA. Chow S.Institution Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City 52242, USA.Title Imaging features of avulsion injuries.Source Radiographics. 19(3):655-72, 1999 May-Jun.Abstract Avulsion injuries are common among participants in organized sports, especially among adolescent participants. Imaging features of both acute and chronic avulsion injuries of the pelvis, knee, ankle and foot, shoulder, and elbow were evaluated to help distinguish these injuries from more serious disease processes such as neoplasm and infection. At radiography, acute injuries (ie, those resulting from extreme, unbalanced, often eccentric muscular

contractions) may be associated with avulsed bone fragments, whereas subacute injuries have an aggressive appearance that may include areas of mixed lysis and sclerosis. Chronic injuries (ie, those resulting from repetitive microtrauma or overuse) or old inactive injuries may be associated with a protuberant mass of bone and may bear a striking resemblance to a neoplastic or infectious process. Although not usually required, computed tomography is helpful in the diagnosis if radiographic findings are equivocal or if the injury is not in the acute phase. MR imaging is best suited for the evaluation of injuries to muscles, tendons, and ligaments. Recognition of characteristic imaging features and familiarity with musculotendinous anatomy will aid in accurate diagnosis of avulsion injuries.

<40>Unique Identifier 9167671Authors el-Khoury GY. Daniel WW. Kathol MH.Institution Department of Radiology, University of Iowa College of Medicine, Iowa City, USA.Title Acute and chronic avulsive injuries. [Review] [42 refs]Source Radiologic Clinics of North America. 35(3):747-66, 1997 May.Abstract Avulsive injuries are common traumatic lesions, especially in young athletes. They can be acute, resulting from excessive tensile forces, or chronic, due to overuse. Avulsion injuries can resemble osteomyelitis or neoplasm and, therefore, familiarity with the radiographic patterns as well as the different muscle attachments is helpful for the clinician to arrive at the correct diagnosis. This article discusses acute and chronic avulsive injuries in the pelvis, knee, elbow, shoulder, and foot. [References: 42]

<41>Unique Identifier 8844911Authors Barry NN. McGuire JL.Institution Division of Immunology and Rheumatology, Stanford University Medical Center, California, USA.Title Overuse syndromes in adult athletes. [Review] [34 refs]Source Rheumatic Diseases Clinics of North America. 22(3):515-30, 1996 Aug.Abstract Approximately 50% of all sports participants will be injured at some point, and at least half of these injuries will be attributed to overuse. This article provides an in-depth review of the presentation, diagnosis, and treatment of the most common overuse injuries encountered in the adult population: epicondylitis, shoulder impingement/rotator cuff tears, patello-femoral dysfunction, and Achilles tendinitis. Stress fractures, the "ultimate" overuse injuries, are also discussed. [References: 34]

<42>Unique Identifier 11476423Authors

Kjaer M.Title The treatment of overuse injuries in sports.Source Scandinavian Journal of Medicine & Science in Sports. 11(4):195-6, 2001 Aug.

<43>Unique Identifier 10946740Authors Groah SL. Lanig IS.Institution Physical Medicine and Rehabilitation, Santa Clara Valley Medical Center, San Jose, California 95128, USA.Title Neuromusculoskeletal syndromes in wheelchair athletes. [Review] [63 refs]Source Seminars in Neurology. 20(2):201-8, 2000.Abstract With the growth of wheelchair athletics at both grassroots and national levels, there has been an increased incidence of sports-related and overuse syndromes in the wheelchair-user population. This article provides an overview of the available literature on the incidence, prevalence, evaluation, prevention, and rehabilitative management of these types of clinical syndromes. [References: 63]

<44>Unique Identifier 9467189Authors Patel M.Institution Department of Radiology, Sinai Hospital, Baltimore, MD 21215, USA.Title Upper extremity radionuclide bone imaging: shoulder, arm, elbow, and forearm. [Review] [39 refs]Source Seminars in Nuclear Medicine. 28(1):3-13, 1998 Jan.Abstract Along with resurgence of physical activity during these fitness conscious times, there is increasing participation by people of all ages in sporting activities. Enrollment in organized and recreational sports among young adults and children has increased with as many as 30% of adolescents participating in competitive high school athletics. Despite improvements in equipment, the number of sports-related injuries presenting for medical attention has increased. Injuries to the upper extremities account for more than 25% of all sports-related injuries, but receive disproportionately less attention compared to lower extremity injuries. If neglected, upper extremity injuries can end the career of a professional athlete and cause sufficient damage to hinder daily activities in a recreational participant. Overuse syndromes, brought on by repetitive microtrauma are sports-specific, and often challenging to diagnose. Accurate diagnosis requires a thorough understanding about mechanism of injury, site of pain, and knowledge of the sport. After a thorough physical exam, a variety of radiographic testing is often necessary to promptly diagnose and manage the injury so athletes can return to competition as soon as possible. [References: 39]

<45>

Unique Identifier 9885097Authors Brukner P.Institution Olympic Park Sports Medicine Centre, Melbourne, Victoria, Australia. opsmc@opsmc.com.auTitle Stress fractures of the upper limb. [Review] [57 refs]Source Sports Medicine. 26(6):415-24, 1998 Dec.Abstract Stress fractures are commonly found in the lower limb, but also occur in the upper limb, and are particularly associated with upper limb-dominated sports such as tennis and swimming and those involving throwing activities. Stress fractures of the clavicle and scapula are rare but have been reported, whereas those of the humerus are more frequent and have been described mainly in adolescent baseball pitchers. Olecranon stress fractures occur in throwers and gymnasts. Stress fractures of the ulna and radius have also been reported in a number of different upper limb-dominated sports. In all cases, these fractures heal with conservative management. The physician should consider stress fracture as a possible diagnosis in cases of upper limb pain of bony origin where the pain is associated with overuse. [References: 57]

<46>Unique Identifier 9777684Authors Bylak J. Hutchinson MR.Institution University of Illinois at Chicago, Department of Orthopaedic Surgery, USA.Title Common sports injuries in young tennis players. [Review] [28 refs]Source Sports Medicine. 26(2):119-32, 1998 Aug.Abstract Tennis is a popular racquet sport played by boys, girls, men and women. Tennis players frequently begin playing in childhood and may continue playing into late adulthood. Preadolescent and adolescent players have open growth plates and a reduced muscle power, lower level of coordination and smaller stature compared with adult players. The physical characteristics of the young tennis player mean that unique demands are placed on the developing athlete which can, in turn, be associated with different types and patterns of injury. The most common types of injury in tennis players of all ages are muscle sprains and ligament sprains secondary to overuse. These are a particular problem in the adolescent age group because, in general, this group begin playing with a lower level of physical conditioning. Fortunately, injuries in younger players are usually not longstanding and the overuse (chronic) problems seen in older players, such as patellar tendinosis and tennis elbow, are less common in younger players. Anatomically, lower extremity injuries are twice as common as those to the upper extremity or spine, with ankle injury being the most common. Prevention of injury in young tennis players, or at least a reduction in the incidence, is possible. Some traumatic injuries, including contusions, abrasions, lacerations and fractures, may be unavoidable as a result of aggressive play, but others may be prevented by monitoring equipment and the court surface to ensure a safe field of play. The prime target of prevention in young tennis players should be overuse injuries. The principles of 'overload' and staged involvement are of particular importance in this age group. A gradual, progressive increase in the intensity of tennis practice, the slow introduction of new court surfaces and a

staged progression in the teaching of tennis skills can help to reduce the incidence of injury in young tennis players. [References: 28]

<47>Unique Identifier 9739540Authors Theriault G. Lachance P.Institution Physical Education Department, Laval University, Ste-Foy, Quebec, Canada.Title Golf injuries. An overview. [Review] [41 refs]Source Sports Medicine. 26(1):43-57, 1998 Jul.Abstract Over the years, golf has become an increasingly popular sport, attracting new players of almost all ages and socioeconomic groups. Golf is practised by up to 10 to 20% of the overall adult population in many countries. Beyond the enjoyment of the sport itself, the health-related benefits of the exercise involved in walking up to 10 km and of relaxing in a pleasant natural environment are often reported to be the main motives for adhering to this activity by recreational golfers. Golf is considered to be a moderate risk activity for sports injury; however, excessive time spent golfing and technical deficiencies lead to overuse injuries. These are the 2 main causes of injuries among golfers, and each has specific differences in the pattern in which they occur in professional and amateur golfers. Golf injuries originate either from overuse or from a traumatic origin and primarily affect the elbow, wrist, shoulder and the dorsolumbar sites. Professional and weekend golfers, although showing a similar overall anatomical distribution of injuries by body segment, tend to present differences in the ranking of injury occurrence by anatomical site; these differences can be explained by their playing habits and the biomechanical characteristics of their golf swing. Many of these injuries can be prevented by a preseason, and year-round, sport-specific conditioning programme including: (i) muscular strengthening, flexibility and aerobic exercise components; (ii) a short, practical, pre-game warm-up routine; and (iii) the adjustment of an individual's golf swing to meet their physical capacities and limitations through properly supervised golf lessons. Finally, the correct selection of golf equipment and an awareness of the environmental conditions and etiquette of golf can also contribute to making golf a safe and enjoyable lifetime activity. [References: 41]

<48>Unique Identifier 9519400Authors Rettig AC.Institution Methodist Sports Medicine Center, Department of Research and Education, Indianapolis, Indiana, USA.Title Elbow, forearm and wrist injuries in the athlete. [Review] [76 refs]Source Sports Medicine. 25(2):115-30, 1998 Feb.Abstract Competitive and recreational athletes sustain a wide variety of soft tissue, bone, ligament, tendon and nerve damage to their upper extremities. Most such injuries are related to direct trauma or repetitive stress, and account for a significant amount of 'down time' for athletes participating in a wide range of sports, particularly those in which the arm is utilised for throwing, catching

or swinging. Overuse injuries to the elbow include musculotendinous injuries, ulnar nerve injuries and ligamentous injuries. Osteochondrol lesions of the capitellum and posterior impingement injuries in the joint are frequently seen in athletes as well. Acute traumatic injuries to the elbow include tendon ruptures, elbow dislocations and intra-articular fractures. Forearm overuse injuries in athletes include fracture of the carpal scaphold, fracture of the hook of the hamate, Kienbock's syndrome and pisoquetral syndromes. ligamentous injuries include scapholunate, lunotriquetral and midcarpal instability injuries. Injuries to the distal radio-ulnar joint and triangular fibrocartilage are also quite common in athletes, and require careful evaluation and treatment. [References: 76]