Chapter 9: Elbow and Forearm

LEARNING OBJECTIVES

INJURIES AND CONDITIONS

Direct forces, excessive range of motion, and repetitive and overload stresses can result in acute and chronic injuries and conditions to the elbow and forearm. Contusions, fractures, and bursitis can be caused by a direct blow or fall. Valgus, varus, and/or rotary forces can be produced during many athletic and work activities and result in a sprain, dislocation, or fracture. Overload and repetitive contractions of the musculature can lead to strains, ruptures, and overuse injuries and conditions. Common injuries to the elbow and forearm include:

• Contusions

• Sprains

• Strains

• Ruptures

• Dislocations

• Fractures

• Bursitis

• Overuse injuries and conditions

• Abrasions

Contusions

Contusions to the elbow and forearm are caused by direct forces and commonly occur over bony prominences. The olecranon is frequently involved because of its exposure and lack of protection by soft tissue (Illustration 9–1). In collision and contact sports, direct blows can lead to contusions of the forearm. The ulnar side of the forearm, because of its location, is susceptible to injury as a result of contact with opponents and equipment. A contusion to the olecranon and/or ulnar forearm can occur, for instance, as a football tight end catches a pass, runs down field with the ball in his right arm, and is tackled, receiving a blow to the right elbow and forearm from the helmet of a defensive back.

Sprains

Sprains to the elbow are caused by acute and chronic forces. An acute valgus, varus, or rotary force or a fall on the outstretched arm causing hyperextension at the elbow can result in injury to the ulnar collateral, radial collateral, or annular ligaments (Illustration 9–2). Hyperextension of an elbow can take place, for instance, if the arms are extended to lessen the impact during a backward fall to the ground. More commonly, sprains to the ulnar collateral ligament are caused by repetitive valgus forces, which occur during the overhead throwing motion.¹⁸ For example, a baseball, softball, or tennis player with a history of medial elbow pain, indicating possible overuse, can be injured during the late cocking and early acceleration phases of the throwing motion, when valgus forces at the medial elbow are extreme. The position of the arm against the trunk protects the elbow from varus forces; injury to the radial collateral ligament is uncommon.