Rehabilitation of the Elbow in the Throwing Athlete (original) (raw)
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Rehabilitation of the Elbow Following Sports Injury
Clinics in Sports Medicine, 2010
Injuries to the elbow occur frequently in the overhead athlete due to the repetitive loads and forceful muscular activations inherent in throwing, hitting, serving, and spiking. 1,2 The most common injuries in the athlete include humeral epicondylitis, valgus extension overload, and ulnar collateral ligament injury. 3,4 The initial upper extremity evaluation including radiographs is the critical first step in early recognition and diagnosis of elbow injury, and allows for the referral to physical therapy whereby a comprehensive rehabilitation program can be initiated. The purpose of this article is to review the common elbow injuries in the overhead athlete and clinical tests used to confirm them, in addition to providing key concepts in the rehabilitation programs used to treat individuals with elbow injury and return them to high-level overhead activity. COMMON INJURIES IN THE ATHLETE'S ELBOW One of the most common overuse injuries of the elbow is humeral epicondylitis. 5,6 The repetitive overuse reported as one of the primary causative factors is particularly evident in the history of many athletic patients with elbow dysfunction. Epidemiologic research on adult tennis players reports incidences of humeral epicondylitis ranging from 35% to 50%. 7-11 This incidence is actually far greater than that reported in elite junior players (11%-12%) (United States Tennis Association, unpublished data, 1992). 12 Reported in the literature as early as 1873 by Runge, 13 humeral epicondylitis or ''tennis elbow'' as it is more popularly known, has been extensively studied by many investigators. Cyriax, 14 in 1936, listed 26 causes of tennis elbow, and an extensive study of this overuse disorder by Goldie 15 in 1964 reported hypervascularization
Rehabilitation of the thrower's elbow
Clinics in Sports Medicine, 2004
Injuries to the elbow occur often in the overhead athlete. The repetitive overhead motion involved in throwing is responsible for unique and sportspecific patterns of elbow injuries. These are caused by chronic stress overload or repetitive microtraumatic stress observed during the overhead pitching motion as the elbow extends at over 23008/s, producing a medial shear force of 300 N and compressive force of 900 N [1,2]. In addition, the valgus stress applied to the elbow during the acceleration phase of throwing is 64 Nm [1,2], which exceeds the ultimate tensile strength of the ulnar collateral ligament (UCL) [3]. Thus, the medial aspect of the elbow undergoes tremendous tension (distraction) forces, and the lateral aspect is forcefully compressed during the throw.
Reconstruction of the elbow: Surgeons' perspective
Journal of Hand Therapy, 1999
Understanding and treating elbow dislocation and the resultant instability can be demanding. Ligaments about the elbow provide roughly 50% of joint stability.' This review will begin with acute and recurrent medial and posterolateral instability, discussing the most significant contributions of the last decade in anatomy, ligament reconstruction, and rehabilitation. Medial Instability An acute tear of the medial collateral ligament is the most frequently isolated ligamentous injury of the elbow. Originally described in javelin throwers, this injury is seen almost exclusively in throwing athletes because of the enormous valgus stresses on the elbow during the late cocking and acceleration phases of throwing." Repetitive microtrauma can also cause inflammation and microscopic tears in the ligament.' The medial collateral ligament complex is composed of three parts: an anterior oblique ligament, a fan-shaped posterior oblique ligament, and a This paper is followed, on p. 73, by a paper presenting a hand therapist's commentary on the same subject.
Management of complex elbow instability
MUSCULOSKELETAL SURGERY, 2010
Complex elbow instability is a challenging injury even for expert elbow surgeons. The preoperative radiographs should be carefully evaluated to recognize all lesions that may occur in complex elbow instabilities. Recognizing all the possible lesions is critical to achieve an optimal outcome. The most common types of injuries are as follows: (1) radial head fractures associated with lateral and medial collateral ligaments lesions (with or without elbow dislocation); (2) Coronoid fractures and lateral collateral ligament lesion (with or without elbow dislocation);
Reconstruction of Posttraumatic Elbow Instability
Clinical Orthopaedics and Related Research, 2000
Successful reconstruction of posttraumatic elbow instability depends on restoration of the anatomic contributors to stability. The osseous and articular structures are paramount. The radial head and coronoid should be repaired or reconstructed and the olecranon (proximal ulna) should be repaired in anatomic alignment so that the contour and dimensions of the trochelar notch are restored and the radiocapitellar joint is aligned appropriately. The lateral collateral ligament complex is commonly disrupted and usually can be reattached to its origin from the lateral epicondyle. Patients with longstanding subluxation or dislocation may require temporary hinged external fixation or reconstruction of the collateral ligaments with tendon grafts. Posttraumatic instability of the elbow is a complex condition about which little has been written and few data have been pubsubtle instability that contributes to the gradual development of ulnohumeral arthrosis, as symptomatic instability limiting the ability to use the upper extremity for forceful tasks, as lished.
Management and Treatment of Elbow and Forearm Injuries
Emergency Medicine Clinics of North America, 2010
Orthopedic injuries to the upper extremity are frequently seen in the emergency department (ED). The emergency medicine practitioner must be proficient in recognizing these injuries and their associated complications, and be able to provide appropriate orthopedic management. This article highlights the most frequent forearm and elbow injuries seen in the ED.
Open Elbow Arthrolysis for Post-traumatic Elbow Contracture
Upsala Journal of Medical Sciences, 2008
Background: Post-traumatic contracture is a common complication after elbow trauma. If conservative therapy fails to restore adequate elbow motion, arthrolysis is indicated. The purposes of this study were to evaluate the clinical outcome of open arthrolysis for post-traumatic elbow contracture and to determine factors influencing the outcome. Methods: Twenty-seven patients with post-traumatic elbow contracture were followed-up after open arthrolysis for at least 12 months. Before surgery, the mean limitation in extension was 30° and the mean maximum flexion was 83°. A posterior surgical approach was used in 18 patients, and a lateral approach was employed in nine patients. Using the posterior approach, the fibrotic posterior capsule was excised and the ulnar collateral ligament was split. Both the anterior and posterior capsules were released with a lateral approach. Results: The mean flexion increased from 83° to 121°, but the mean extension improved little from-30° to-26°. The mean flexion-extension arc increased from 53° to 95°. According to the elbow evaluation score by the Japanese Orthopaedic Association, both pain and function scales improved significantly. By Hertel's subjective evaluation, the results were good in 13 patients, fair in ten patients, and poor in four patients. Twenty-three patients (85 percent) were satisfied with the results, but four were not satisfied because of residual contracture. These poor results were related to severe soft tissue trauma, residual displacement of intra-articular fragments, and recurrence of heterotopic bone formation. Conclusions: Tendon lengthening of stiff triceps, accurate reduction of intra-articular fragmens, and sharp epiperiosteal resection around the heterotopic bones are essential procedures of open arthrolysis to restore adequate motion in post-traumatic elbow contracture.
Journal of Shoulder and Elbow Surgery, 2013
Background: Restriction of elbow mobility is a very frequent complaint after trauma or surgery. The objective of this study was to assess and compare the effectiveness of dynamic, static, or staticprogressive bracing in patients with elbow stiffness of traumatic or postoperative origin and without evidence of ossification. For the purpose of this study, effectiveness was measured as the increase in total range of motion, as well as extension and flexion. Materials and methods: We performed a systematic search of the keywords ''elbow AND (stiffness OR stiff) AND (brace OR splint OR conservative)'' in the online databases PubMed, EMBASE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and the Cochrane Library. We included all clinical studies using dynamic or static bracing in patients with elbow stiffness. Eligible outcomes were changes in total range of motion, flexion, and extension; sustainability of results; and complications. Results: We included 13 eligible studies, providing data on 14 treated groups in 247 patients. The mean age of these patients was 34.5 AE 10.4 years, and female patients comprised 46% AE 12%. The mean duration from the incident to the start of brace treatment was 6.9 AE 5.1 months. The mean improvement in range of motion during the course of treatment was 38.4 AE 8.9 (95% confidence interval, 39.5 -41.8 ).