Elbow and Forearm Injuries

  • Anthony Luke
  • Margaret Lee
  • Marc Safran


The elbow and forearm create a fascinating joint complex. It is a highly congruous joint that provides a wide range of motion required for functions such as sports. The adolescent athlete has the added dimensions of growth and development, which can affect forces around the joint, as well as motor function, and can be the source of multiple potential problems (1). The elbow has a complex maturation process, developing from multiple ossification centers, which can complicate the diagnosis and treatment of injuries. As a growing individual is able to perform with greater speed, strength, and endurance, the loading forces, torques, and risk of injury increase (2,3).


Radial Head Medial Epicondyle Osteochondritis Dissecans Ulnar Collateral Ligament Elbow Dislocation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Hutchinson MR, Wynn S. Biomechanics and development of the elbow in the young throwing athlete. Clin Sports Med 2004;23:531–544.CrossRefPubMedGoogle Scholar
  2. 2.
    Fleisig GS, Barrentine SW, Zheng N, Escamilla RF, Andrews JR. Kinematic and kinetic comparison of baseball pitching among various levels of development. J Biomech 1999;32:1371–1375.CrossRefPubMedGoogle Scholar
  3. 3.
    Sabick MB, Torry MR, Lawton RL, Hawkins RJ. Valgus torque in youth baseball pitchers: A biomechanical study. J Shoulder Elbow Surg 2004;13:349–355.CrossRefPubMedGoogle Scholar
  4. 4.
    Gugenheim Jr, JJ, Stanley RF, Woods GW, Tullos HS. Little League survey: the Houston study. Am J Sports Med 1976;4:189–200.CrossRefPubMedGoogle Scholar
  5. 5.
    Priest JD, Weise DJ. Elbow injury in women’s gymnastics. Am J Sports Med 1981;9:288–295.CrossRefPubMedGoogle Scholar
  6. 6.
    Snook GA. Injuries in women’s gymnastics. A 5-year study. Am J Sports Med 1979;7:242–244.CrossRefPubMedGoogle Scholar
  7. 7.
    Safran, M. Ulnar collateral ligament injury in the overhead athlete: diagnosis and treatment. Clin Sports Med 2004;23:643–663.CrossRefPubMedGoogle Scholar
  8. 8.
    Gosheger G, Liem D, Ludwig K, Greshake O, Winkelmann W. Injuries and overuse syndromes in golf. Am J Sports Med 2003;31:438–443.PubMedGoogle Scholar
  9. 9.
    Cooper C, Dennison EM, Leufkens HG, Bishop N, van Staa TP. Epidemiology of childhood fractures in Britain: a study using the general practice research database. J Bone Miner Res 2004;19:1976–1981.CrossRefPubMedGoogle Scholar
  10. 10.
    Cain EL, Jr., Dugas JR, Wolf RS, Andrews JR. Elbow injuries in throwing athletes: a current concepts review. Am J Sports Med 2003;31:621–635.PubMedGoogle Scholar
  11. 11.
    Beighton P, Solomon L, Soskolne CL. Articular mobility in an African population. Ann Rheum Dis 1973;32:413–418.CrossRefPubMedGoogle Scholar
  12. 12.
    Do T, Herrera-Soto J. Elbow injuries in children. Curr Opin Pediatr 2003;15:68–73.CrossRefPubMedGoogle Scholar
  13. 13.
    Difelice GS, Meunier MJ, Paletta Jr. GA. Elbow injury in the adolescent athlete. In: Altchek DW, Andrews JR, eds. The Athlete’s Elbow. Philadelphia: Lippincott Williams & Wilkins; 2001:231–248.Google Scholar
  14. 14.
    Morrey BF. Anatomy of the elbow joint. In: Morrey BF, ed. The Elbow and Its Disorders. Philadelphia: Saunders; 2000:13–42.Google Scholar
  15. 15.
    O’Driscoll SW, Bell DF, Morrey BF. Posterolateral rotatory instability of the elbow: clinical and radiographic features. J Bone Joint Surg 1991;73A:440–446Google Scholar
  16. 16.
    Olsen BS, Sojbjerg JO, Nielsen KK, Vaesel MT, Dalstra M, Sneppen O. Posterolateral elbow joint instability: the basic kinematics. J Shoulder Elbow Surg 1998;7:19–29.CrossRefPubMedGoogle Scholar
  17. 17.
    Safran MR, Baillargeon D. Soft-tissue stabilizers of the elbow. J Shoulder Elbow Surg 2005;14:179S–185S.CrossRefPubMedGoogle Scholar
  18. 18.
    Safran MR, McGarry MH, Shin S, Han S, Lee TQ. Effects of elbow flexion and forearm rotation on valgus laxity of the elbow. J Bone Joint Surg Am 2005;87:2065–2074.CrossRefPubMedGoogle Scholar
  19. 19.
    Cohen MS, Hastings H, 2nd. Rotatory instability of the elbow. The anatomy and role of the lateral stabilizers. J Bone Joint Surg Am 1997:79(2):225–233.CrossRefPubMedGoogle Scholar
  20. 20.
    Keefe DT, Lintner DM. Nerve injuries in the throwing elbow. Clin Sports Med 2004;23:723–742.CrossRefPubMedGoogle Scholar
  21. 21.
    Busch M. Sports medicine in children and adolescents. In: Morrissy RT, Weinstein SW, eds. Lovell and Winter’s Pediatric Orthopaedics. Philadelphia: Lippincott Williams & Wilkins; 2001:1287–1289.Google Scholar
  22. 22.
    Rudzki JR, Galetta PA, Jr. Juvenile and adolescent elbow injuries in sports. Clin Sports Med 2004;23:581–608.CrossRefPubMedGoogle Scholar
  23. 23.
    Stoane JM, Poplausku MR, Haller JO, Berdon WE. Panner’s disease: X-ray, MR imaging findings and review of the literature. Comput Med Imaging Graphics 1996;19:473–476.CrossRefGoogle Scholar
  24. 24.
    Haraldsson S. On osteochondrosis deformas juvenilis capituli humeri including investigation of intra-osseous vasculature in distal humerus. Acta Orthop Scand 1959;Suppl 38:1–232.Google Scholar
  25. 25.
    Safran MR. Elbow injuries in athletes. A review. Clin Orthop Relat Res 1995;310:257–277.PubMedGoogle Scholar
  26. 26.
    Morrey BF. Biomechanics of the elbow and forearm. In: DeLee JC, Drez Jr. D, Miller MD, eds. DeLee & Drez’s Orthopaedic Sports Medicine. Philadelphia: Elsevier Science; 2003:1213–1220.Google Scholar
  27. 27.
    Mihata T, Safran MR, McGarry MH, Abe M, Lee TQ. Effect of Humeral Rotation On Elbow Valgus Laxity: Cadaveric Study. Presented at the 5th Annual Meeting of the International Society of Ligament and Tendons, Washington, D.C., February 19, 2005Google Scholar
  28. 28.
    O’Driscoll SWLR, Smith AM: The “moving valgus stress test” for medial collateral ligament tears of the elbow. Am J Sport Med 2005;33:231–239CrossRefGoogle Scholar
  29. 29.
    Shaw JL, O’Connor FG. Elbow injuries. In: Birrer RB, Griesemer BA, Cataletto MB, eds. Pediatric Sports Medicine for Primary Care. Philadelphia: Lippincott Williams & Wilkins; 2002:350–366.Google Scholar
  30. 30.
    O’Driscoll SW. Classification and evaluation of recurrent instability of the elbow. Clin Orthop 2000;370:34–43.CrossRefPubMedGoogle Scholar
  31. 31.
    Kobayashi KBK, Rodner C, Smith B, Caputo AE. Lateral compression injuries in the pediatric elbow: Panner’s disease and osteochondritis dissecans of the capitellum. J Am Acad Orthop Surg 2004;12:246–254.PubMedGoogle Scholar
  32. 32.
    Kibler WB, Sciascia A. Kinetic chain contributions to elbow function and dysfunction in sports. Clin Sports Med 2004;23:545–552.CrossRefPubMedGoogle Scholar
  33. 33.
    Kibler WB, Chandler TJ. Range of motion in junior tennis players participating in a risk modification program. J Sci Med Sports 2003;5:51–52.CrossRefGoogle Scholar
  34. 34.
    Kissoon N, Galpin R, Gayle M, Chacon D, Brown T. Evaluation of the role of comparison radiographs in the diagnosis of traumatic elbow injuries. J Pediatr Orthop 1995;15:449–453.PubMedGoogle Scholar
  35. 35.
    Chacon D, Kissoon N, Brown T, Galpin R. Use of comparison radiographs in the diagnosis of traumatic injuries of the elbow. Ann Emerg Med 1992;21:895–899CrossRefPubMedGoogle Scholar
  36. 36.
    Skaggs DL, Mirzayan R. The posterior fat pad sign in association with occult fracture of the elbow in children. J Bone Joint Surg Am 1999;81:1429–1433.PubMedGoogle Scholar
  37. 37.
    Pudas T, Hurme T, Mattila K, Svedstrom E. Magnetic resonance imaging in pediatric elbow fractures. Acta Radiol 2005;46:636–644.CrossRefPubMedGoogle Scholar
  38. 38.
    Schwartz ML, Al-Zahrani S, Morwessel RM, et al. Ulnar collateral ligament injury in the throwing athlete: Evaluation with saline-enhanced MR arthrography. Radiology 1995;197:297–299.PubMedGoogle Scholar
  39. 39.
    Sofka CM, Potter HG. Imaging of elbow injuries in the child and adult athlete. Radiol Clin North Am 2002;40:251–265.CrossRefPubMedGoogle Scholar
  40. 40.
    Lazar RD, Waters PM, Jaramillo D. The use of ultrasonography in the diagnosis of occult fracture of the radial neck. A case report. J Bone Joint Surg Am 1998;80:1361–1364.PubMedGoogle Scholar
  41. 41.
    O’Driscoll SW, Morrey BF, Korinek S, An KN. Elbow subluxation and dislocation. A spectrum of instability. Clin Orthop 1992;280:186–197.PubMedGoogle Scholar
  42. 42.
    Price CT, Phillips JH, Devito DP. Management of fractures. In: Morrissy RT, Weinstein SL, eds. Lovell and Winter’s Pediatric Orthopaedics. Philadelphia: Lippincott Willians & Wilkins; 2001:1338–1356.Google Scholar
  43. 43.
    de las Heras J, Duran D, de la Cerda J, Romanillos O, Martinez-Miranda J, Rodriquez-Merchan EC. Supracondylar fractures of the humerus in children. Clin Orthop 2005;432:57–64.PubMedGoogle Scholar
  44. 44.
    Rasool M. Dislocations of the elbow in children. J Bone Joint Surg Br 2003;86:1050–1058.CrossRefGoogle Scholar
  45. 45.
    Josefsson PO, Nilsson BE. Incidence of elbow dislocation. Acta Orthop Scand 1986;57:537–538.PubMedGoogle Scholar
  46. 46.
    Thompson GH. Dislocations of the elbow. In: Beaty JH, Kasser JR, eds. Rockwood and Wilkins’ Fractures in Children. Philadelphia: Lippincott Williams & Wilkins; 2001:530–562.Google Scholar
  47. 47.
    Sanchez-Sotelo J, Morrey BF, O’Driscoll SW. Ligamentous repair and reconstruction for posterolateral rotatory instability of the elbow. J Bone Joint Surg Br 2005;87:54–61.PubMedGoogle Scholar
  48. 48.
    Singleton SB, Conway JE. PLRI: posterolateral rotatory instability of the elbow. Clin Sports Med 2004;23:629–642.CrossRefPubMedGoogle Scholar
  49. 49.
    Ring D, Jupiter JB, Waters PM. Monteggia Fractures in Children and Adults. J Am Acad Orthop Surg 1998;6:215–224.PubMedGoogle Scholar
  50. 50.
    Noonan KJ, Price CT. Forearm and distal radius fractures in children. J Am Acad Orthop Surg 1998;6:146–156.PubMedGoogle Scholar
  51. 51.
    Rodriguez-Merchan EC. Pediatric fractures of the forearm. Clin Orthop Relat Res 2005;432:65–72.CrossRefPubMedGoogle Scholar
  52. 52.
    Farsetti P, Potenza V, Caterini R, Ippolito E. Long-term results of treatment of fractures of the medial humeral epicondyle in children. J Bone Joint Surg Am 2001;83-A:1299–1305.PubMedGoogle Scholar
  53. 53.
    Wilkins KE. Fractures involving the medial epicondylar apophysis. In: Rockwood CA Jr., Wilkins KE, King RE, eds. Fractures in Children. 3rd ed. Philadelphia: JB Lippincott; 1991:509–828.Google Scholar
  54. 54.
    Woods GW, Tullos HS. Elbow instability and medial epicondyle fractures. Am J Sports Med 1977;5:23–30.CrossRefPubMedGoogle Scholar
  55. 55.
    Hugheds PE, Paletta GA, Jr. Little Leaguer’s Elbow, medial epicondyle injury and osteochondritis dissecans. Sports Med Arthroscopy Review 2003;11: 30–39.CrossRefGoogle Scholar
  56. 56.
    Case SL, Hennrikus WL. Surgical treatment of displaced medial epicondyle fractures in adolescent athletes. Am J Sports Med 1997;25:682–686.CrossRefPubMedGoogle Scholar
  57. 57.
    D’Hemecourt PD, Micheli LJ. In: Chan KM, Micheli LJ, eds. Sports and children. Hong Kong: Williams and Wilkins Asia; 1998:4.Google Scholar
  58. 58.
    Adams JE. Injury to the throwing arm. A study of traumatic changes in the elbow joints of boy baseball players. Calif Med 1965;102:127–132.PubMedGoogle Scholar
  59. 59.
    Baumgarten TE, Andrews JR, Satterwhite YE. The arthroscopic classification and treatment of osteochondritis dissecans of the capitellum. Am J Sports Med 1998;26:520–523.PubMedGoogle Scholar
  60. 60.
    Kandemir U, Fu FH, McMahon PJ. Elbow injuries. Current Opin Rheumatol 2002;14:160–167.CrossRefGoogle Scholar
  61. 61.
    Bowen RE, Otsuka NY, Yoon ST, Lang P. Osteochondral lesions of the capitellum in pediatric patients: role of magnetic resonance imaging. J Pediatr Orthop 2001;21:298–301.CrossRefPubMedGoogle Scholar
  62. 62.
    Stubbs MJ, Field LD, Savoie FH 3rd. Osteochondritis dissecans of the elbow. Clin Sports Med 2001;20:1–9.CrossRefPubMedGoogle Scholar
  63. 63.
    Chen FS, Diaz VA, Loebenberg M, Rosen JE. Shoulder and elbow injuries in the skeletally immature athlete. J Am Acad Orthop Surg 2005;13:172–185.PubMedGoogle Scholar
  64. 64.
    Rudzki JR, Paletta GA, Jr. Juvenile and adolescent elbow injuries in sports. Clin Sports Med 2004;23:581–608.CrossRefPubMedGoogle Scholar
  65. 65.
    Takahara M, Ogino T, Takagi M, Tsuchida H, Orui H, Nambu T. Natural progression of osteochondritis dissecans of the humeral capitellum: initial observations. Radiology 2000;216:207–212.PubMedGoogle Scholar
  66. 66.
    Takahara M, Ogino T, Tsuchida H, Takagi M, Kashiwa H, Nambu T: Sonographic assessment of osteochondritis dissecans of the humeral capitellum. AJR Am J Roentgenol 2000;174:411–415.PubMedGoogle Scholar
  67. 67.
    Takahara M, Ogino T, Fukushima S, Tsuchida H, Kaneda K. Nonoperative treatment of osteochondritis dissecans of the humeral capitellum. Am J Sports Med 1999;27:728–732.PubMedGoogle Scholar
  68. 68.
    Takahara M, Ogino T, Sasaki I, Kato H, Minami A, Kaneda K. Long term outcome of osteochondritis dissecans of the humeral capitellum. Clin Orthop Relat Res 1999;363:108–115.CrossRefPubMedGoogle Scholar
  69. 69.
    Ruch DS, Cory JW, Poehling GG. The arthroscopic management of osteochondritis dissecans of the adolescent elbow. Arthroscopy 1998;14:797–803.PubMedCrossRefGoogle Scholar
  70. 70.
    Micheli LJ, Luke AC, Mintzer CM, Waters PM. Elbow arthroscopy in the pediatric and adolescent population. Arthroscopy 2001;17:694–699.PubMedCrossRefGoogle Scholar
  71. 71.
    McManama BG, Micheli LJ, Berry MV, Sohn RS. The surgical treatment of osteochondritis of the capitellum. Am J Sports Med 1985;13:11–21.CrossRefPubMedGoogle Scholar
  72. 72.
    Yamamoto Y, Ishibashi Y, Tsuda E, Sato H, Toh S. Osteochondral Autograft Transplantation for Osteochondritis Dissecans of the Elbow in Juvenile Baseball Players: Minimum 2-Year Follow-up. Am J Sports Med 2005;34: 714–720.CrossRefPubMedGoogle Scholar
  73. 73.
    Woodward AH, Bianco AJ, Jr. Osteochondritis dissecans of the elbow. Clin Orthop Relat Res 1975;110:35–41.CrossRefPubMedGoogle Scholar
  74. 74.
    Kaeding CC, Whitehead R. Musculoskeletal injuries in adolescents. Prim Care 1998;25:211–213.PubMedGoogle Scholar
  75. 75.
    Ireland ML, Andrews JR. Shoulder and elbow injuries in the young athlete. Clin Sports Med 1988;7:473–494.PubMedGoogle Scholar
  76. 76.
    Petty DH, Andrews JR, Fleisig GS, Cain EL. Ulnar collateral ligament reconstruction in high school baseball players: Clinical results and injury risk factors. Am J Sports Med 2004;32:1158–1164.CrossRefPubMedGoogle Scholar
  77. 77.
    Conway JE, Jobe FW, Glousman RE, Pink M. Medial instability of the elbow in throwing athletes: treatment by repair or reconstruction of the ulnar collateral ligament. J Bone Joint Surg Am 1992;74:67–83.PubMedGoogle Scholar
  78. 78.
    Timmerman LA, Schwartz ML, Andrews JR. Preoperative evaluation of the ulnar collateral ligament by magnetic resonance imaging and computed tomography arthrography: evaluation in 25 baseball players with surgical confirmation. Am J Sports Med 1994;22:26–31.CrossRefPubMedGoogle Scholar
  79. 79.
    Sugimoto H, Ohsawa T. Ulnar collateral ligament in the growing elbow: MR imaging of normal development and throwing injuries. Radiology 1994;192: 417–422.PubMedGoogle Scholar
  80. 80.
    Mirowitz SA, London SL. Ulnar collateral ligament injury in baseball pitchers: MR imaging evaluation. Radiology 1992;185:573–576.PubMedGoogle Scholar
  81. 81.
    Rettig AC, Sherrill C, Snead DS, Mendier JC, Mieling P. Nonoperative treatment of ulnar collateral ligament injuries in throwing athletes. Am J Sports Med 2001;29:15–17.PubMedGoogle Scholar
  82. 82.
    Ahmad CS, ElAttrache NS. Valgus extension overload syndrome and stress injury of the olecranon. Clin Sports Med 2004;23:665–676.CrossRefPubMedGoogle Scholar
  83. 83.
    Wilson FD, Andrews JR, Blackburn TA. Valgus extension overload in the pitching elbow. Am J Sports Med 1983;11:83–88.CrossRefPubMedGoogle Scholar
  84. 84.
    Keppler P, Salem K, Schwarting B, Kinzl L. The effectiveness of physiotherapy after operative treatment of supracondylar humeral fractures in children. J Pediatr Orthop 2005;25:314–316.CrossRefPubMedGoogle Scholar
  85. 85.
    Kottke FJ, Pauley DL, Ptak RA. The rationale for prolonged stretching for correction of shortening of connective tissue. Arch Phys Med Rehabil 1966;47:345–352.PubMedGoogle Scholar
  86. 86.
    Green DP, McCoy H. Turnbuckle orthotic correction of elbow-flexion contractures after acute injuries. J Bone Joint Surg Am 1979;61:1092–1095.PubMedGoogle Scholar
  87. 87.
    Wilk KE, Reinold MM, Andrews JR. Rehabilitation of the thrower’s elbow. Clin Sports Med 2004;23:765–801.CrossRefPubMedGoogle Scholar
  88. 88.
    Kelly EW, Morrey BF, O’Driscoll SW. Complications of elbow arthroscopy. J Bone Joint Surg Am 2001;83-A;1:25–34.PubMedGoogle Scholar
  89. 89.
    Schmittenbecher, PP. What must we respect in articular fractures in childhood? Injury, 2005;36: SA35–SA43.Google Scholar
  90. 90.
    Lyman S, Fleisig GS, Andrews JR, Osinski ED. Effect of pitch type, pitch count, and pitching mechanics on risk of elbow and shoulder pain in youth baseball players. Am J Sports Med 2002;30(4)463–468.PubMedGoogle Scholar
  91. 91.
    Olsen SJ, 2nd, Fleisig GS, Dun S, Loftice J, Andrews JR. Risk factors for shoulder and elbow injuries in adolescent baseball pitchers. Am J Sports Med 2006;34:905–912.CrossRefPubMedGoogle Scholar
  92. 92.
    Pratt M. Strength, flexibility, and maturity in adolescent athletes. Am J Dis Child 1989;143:560–563.PubMedGoogle Scholar
  93. 93.
    Mulligan IJ, Biddington WB, Barnhart BD, Ellenbecker TS. Isokinetic profile of shoulder internal and external rotators of high school aged baseball pitchers. J Strength Cond Res 2004;18:861–866.CrossRefPubMedGoogle Scholar
  94. 94.
    Hinton RY. Isokinetic evaluation of shoulder rotational strength in high school baseball pitchers. Am J Sports Med 1988;16:274–279.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Anthony Luke
    • 1
  • Margaret Lee
    • 2
  • Marc Safran
    • 3
  1. 1.Primary Care Sports Medicine, Departments of Orthopedics and Family and Community MedicineUniversity of CaliforniaSan Francisco, San FranciscoUSA
  2. 2.Family Practice Resident, Department of Family and Community MedicineUniversity of CaliforniaSan FranciscoUSA
  3. 3.UCSF Sports Medicine, Departments of Orthopedics and Family and Community MedicineUniversity of CaliforniaSan Francisco, San FranciscoUSA

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