Elbow and Forearm Injuries

Taelar Shelton, MS, ATC, AT/L

Contusions

Soft tissue or bone contustions

Usually on the medial aspect

MOI- collision, repeated blows

Acute contusions- pain, swelling, hematoma

Chornic- scars and bony callus

Treatment- RICE, protection, may need x-ray if serious

Olecranon Bursitis

Most common bursitis in the elbow

Superficial location

Acute or chronic- direct blow MOI

S&S- pain, warm, point tender, swelling

Try conservative Rx first- cold compression

Aspiration if serious

Strains

Muscles around elbow

Excessive restrictive ROM

Usually from a fall or repeated microtraumas

X-ray to r/o avulsion or epiphyseal Fx

RICE, rehabilitation exercises, theraputic ultrasound, cryotherapy (ice)

Sprains

Ligaments around the elbow

Usually from hyperextension of elbow joint

S&S- pain, shifting of elbow joint, click/pop/snap, crepitis, tender to palpation, swelling, decrease in function of elbow

Cold compress, main concern is ROM, do not massage, taping may assist in protecting injury

Lateral Epicondylitis

“Tennis Elbow” is inflammation of extension muscles at the lateral epicondyle

Repetitive extension of the wrist, throwing, microtrauma

S&S- pain during flexion/extension exercises, pain may radiate down the arm, mild swelling, point tenderness

RICE for actue tendonitis, chronic- bracing or taping and rehab

Medial Epicondylitis

“Golfer’s Elbow” is inflammation of the flexor tendons at the medial epicondyle

Repetitive flexion of the wrist, pitching, golf swing

Same Rx as tennis elbow

Osteochondritis Dissecans

OCD also occurs in the knee

Occurs in the bone and articular cartilage

Impariment of blood supply, causes loose bodies in the joint

“Locking” joint

Can require surgery

Can lead to arthritis

Ulnar Nerve Injuries

Ulnar nerve is involved

MOI- friction due to valgus force at elbow

Can be caused by impingment at the elbow

S&SS- parasthesia down ulnar side of forearm, numbness and tingling

Rx- Avoid pressure, can require surgery

Dislocation of the Elbow

FOOSH is a common MOI

Can dislocate anteriorly, posteriorlly or laterally

Olecranon deformity

Many ligmaents and tendons can be involved and may also cause a Fx

Referral imediately, reduction by MD, sling, immobilize in flexion, rehab

Fractures- Elbow

Humerus, radius or ulna

Usually a FOOSH or direct blow MOI

Higher rate of injury in children

S&S: discoloration, swelling, muscle spasm, bone displacement is possible, swelling and muscle spasm

Referral for X-ray

Volkman’s Contracture

Complication of a serious injury

Causes blood flow problems

S&S: pain, swelling, muscle spasm, pressure

Leads to permanaent muscle contracture and permanent paralysis in servere cases

Immediate referral

Wrist/Hand Injuries

Colles’ Fx

Fracture to the distal radius

FOOSH, hyperextension

Visible deformity

Ligaments are usually involved

Splint and get an xray

Carpal Tunnel Syndrome

Anterior aspect of the wrist

Transverse ligament can be too tight

Usually overuse but can be from a direct blow

Limited space for structures

S&S: complain of numbnress and tingling

de Quervain’s Tendosynovitis

Synovial lining becomes inflammed

Constant wrist movement makes this worse

S&S: aching, radiating pain in the forearm, pain with extension of the thumb, may hear a snap with movement

Rx: imobilize, ice, rest, antiinflammatory medications

Scaphoid Fx

Most common carpal bone fracture

FOOSH

Can be misdiagnosed as a sprain

Poor blood supply to this bone- can lead to necrosis

Need to get an xray and imoblize

Hamate Fx

MOI: from the handle of a golf club, tennis racquet or baseball bat

S&S: wrist pain, weakness

Usually needs to be casted

Wrist Ganglion

Herniation of the joint capsule or synovial sheath of a tendon

Can aslo be a cyst

Occurs after a wrist sprain that did not get proper Rx

Rx: Apply a pressure pad, surgical removal or draw the fluid out

Lunate Dx

Most common bone to dislocate of the carpal bones

Usually dislocates anteriorly

Deformity on the palmar aspect

Murphy’s sign

Reduction by a physician