Managing elbow injuries in sport

Throwing and racquet sports cause the most common elbow injuries, says Mr Arvind Mohan

Valgus stress is the most common elbow injury associated with throwing

Elbow injuries are common in throwing and racquet sports. The most common cause of elbow injuries is the valgus stress that is generated in a throwing elbow. This results in stretching of the soft tissues on the medial side of the elbow, producing microscopic tearing and inflammation of soft tissues.  

Classification of elbow injuries can be done depending upon the sport and site of pain (see table below). A neurological examination of the various nerves is important to rule out any peripheral nerve entrapment and also to rule any cervical cause of elbow pain.  

Acute injuries  

Acute injuries of the elbow joint usually present with bruising and swelling. Mechanism of injury can indicate the underlying injury. Most patients with these signs would need an X-ray to rule out any bony injury.  

Patients should be given a sling to immobilise the elbow along with analgesics. Many of these fractures are intraarticular and would need internal fixation. Patients with tendon ruptures should be referred urgently because if operative repair is contemplated it is easy if done early.  

Chronic injuries  

Chronic injuries of the elbow are usually a result of overuse. The mainstay for treatment of these injuries includes protecting the elbow, rest, ice, compression with elastic bandage, elevation, medication (for example NSAIDs) and rehabilitation.  

Lateral epicondylitis or tennis elbow was described over 100 years ago and is 20 times more common than medial epicondylitis. The pathology is chronic tendinitis of extensor muscles primarily extensor carpi radialis brevis, and it is commonly seen in recreational tennis players in the age group of 35 to 50 years. On examination, grasping or pinching with extended wrist is painful and is known as ‘coffee cup’ test. Tenderness is 1cm to 2cm distal to the lateral epicondyle. Conservative treatment should be tried for the first week and if there is no improvement, steroid injections can be given.  

If there is still no improvement the patient should be referred. Similar treatment can be tried for medial epicondylitis.  

Instabilities of the elbow joint can be a result of previous acute ligament injuries. Mostly there is a valgus stress at the elbow joint, giving rise to the impingement of medial part of the olecranon against the olecranon fossa, producing loose bodies. This is known as olecranon impingement syndrome.  

There are also compression forces generated at the radiocapitellar joint giving rise to radiocapitellar overload syndrome. This results in osteochondral fractures, chondro- malacia and the formation of loose bodies, or finally arthritis of the elbow joint.   

Mr Mohan, is a registrar in orthopaedics, Southampton General Hospital, Southampton  

Sports and associated injuries

Type of sport Type of injury 

Medial epicondylitis of trailing arm and lateral epicondylitis of leading arm 

Racquet sportsLateral epicondylitis with back hand, especially if poor technique
Bowling Medial epicondylitis 
Baseball and volleyball Valgus stress of medial structures and compression of lateral structures 
Football Valgus stress with throwing a pass 
Weight trainingUlnar collateral ligament strain and ulnar neuritis
Canoeing and kayakingDistal bicipital tendinitis
Archery Lateral epicondylitis of bow arm 
Rock climbing Distal bicipital and brachialis tendinitis 

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