Elbow Injuries

Abstract

Elbow injuries in athletes are becoming more frequent, especially in those involved in racket and throwing sports. Correct diagnosis of a painful elbow requires a thoughtful understanding of the anatomy and complex kinetics of this joint. Although elbow problems may present acutely, they are more commonly seen as chronic overuse syndromes. Elbow tendinopathy is caused by tendinous microtearing followed by an incomplete reparative response. Lateral and medial epicondylitis are more common in the amateur athlete and usually respond to conservative measures. Participants in overhead sports are subjected to tremendous valgus and extension overload, generating medial tensile forces with compression on the lateral compartment and shear stresses posteriorly. This may lead to chronic injury to the elbow, the so-called valgus extension overload syndrome. This spectrum of pathology includes insufficiency of the medial collateral ligament, osteochondritis dissecans of the capitellum (in young athletes), and posterior olecranon impingement syndrome. In patients who fail to respond to conservative measures, surgical reconstruction of the medial ligament, or arthroscopic debridement of capitellar or olecranon lesions may be required. Lateral elbow pain may be due to posterolateral instability, usually found in the context of previous trauma or surgical treatment of radial head fractures or epicondylitis. Radiohumeral synovial plicae must be also considered in the differential diagnosis of pain on the lateral aspect of the elbow. Tendon ruptures, affecting the biceps and triceps, occur more often in weight lifters and should be treated surgically by re-attaching the torn tendon to bone.