Have You Suffered An
Elbow Sprain?

If you’ve been diagnosed with an elbow sprain, getting out of pain and back to activity are your first priorities. What is a sprain? How does it differ from other elbow injuries? What can you do to reduce your elbow joint pain and get back to the activities you enjoy?





Elbow Anatomy

The elbow is a hinge joint that is formed by the connection of the humerus and the ulna. The connection of these bones allows for the elbow to flex (bend) and extend (straighten). The radius also helps to form the elbow joint by connecting to the ulna thus allowing rotation of the forearm (called pronation and supination).

The elbow joint is supported by a ligament on the inside or medial aspect of the joint called the ulnar collateral ligament. The outside or lateral aspect of the joint is supported by the radial collateral ligament. A sprain is an injury to one or more of these supporting ligaments.


elbow anatomy


Typical Causes

Sprains in general usually occur from some type of trauma. A fall on an outstretched arm is the most common cause a stretch or tear of an elbow ligament.

The ulnar collateral ligament can also be injured by repeated stress on the ligament causing micro tears and instability. Baseball pictures are especially susceptible to this injury as the throwing motion creates increased stress on this medial ligament, weakening it over time.


baseball elbow stres


Ligament injuries are classified as first, second, and third degree sprains. A first degree sprain involves a slight stretch of the ligament. A second degree sprain results in a partial tear of the ligament. The most severe sprain is a third degree with the result being a complete rupture of the ligament. In cases in which both the medial and lateral elbow ligaments are torn, an elbow dislocation can occur.


Signs and Symptoms

The severity and location of the sprain will influence the type of symptoms felt. Elbow joint pain, swelling, limited motion, and weakness are all symptoms that can be related to an elbow sprain. Functional activities such as throwing, lifting, or twisting the forearm can reproduce pain. Pain on the inside of the elbow will be related to the ulnar collateral ligament and pain on the outside of the elbow will be the radial collateral.

In cases in which there is a partial or complete rupture of the ligament, joint instability may be felt. This can be either a catching feeling or a feeling of the joint being “out of place”.


Diagnosis

In cases in which a trauma occurs, diagnosis of an elbow sprain is rather easy. Ligament testing will be performed to determine how stable the elbow joint is and whether an MRI is needed. An x-ray may also be recommended to determine if an associated fracture has occurred.

Ligament sprains that occur over time can be more difficult to diagnose. Pain in the medial or lateral aspect of the elbow can also be associated with elbow tendonitis.

The region around the elbow is also a common place for symptoms associated with nerves. A pinched nerve from the neck can cause medial or lateral elbow pain, mimicking symptoms related to the ligament. Consulting an orthopedic doctor will help in differentiating the true cause of your elbow pain.


Typical Treatment

If an acute sprain has occurred secondary to trauma, use the R.I.C.E (rest, ice, compression, and elevation) method of treatment. Rest can be accomplished by both minimizing elbow use and in more severe elbow sprains, the use of a sling. Use ice therapy to minimize pain and swelling. If you have an elastic wrap, apply it around the elbow to minimize swelling. And finally for elevation, try to keep the elbow above the level of the heart to reduce joint swelling.

In significant cases of ligament tears, the use of an immobilizer brace may be necessary. Ligament sprains take between six and eight weeks to heal thus reducing stress by the use of a brace or splint may be necessary to reduce ligament stress.

Physical therapy can also be helpful in accelerating the healing process and restoring function. The use of modalities such as ultrasound and iontophoresis can be helpful in reducing inflammation. Restoring normal range of motion after immobilization can also be assisted with joint mobilization and soft tissue massage. Elbows have a tendency to becoming stiff following immobilization therefore regaining elbow extension is of primary importance.

The final portion of the rehabilitation process after an elbow sprain is strengthening and a return function. For athletes involved in throwing sports your physical therapist can also help design an appropriate program for return safely to sport activities including those that involve throwing.


Surgery

In cases in which a complete rupture of a ligament has occurred, surgery may be necessary to reattach the ligament and provide stability. This type of surgery is very uncommon as unless an associated fracture has occurred, immobilization alone is effective in allowing the ligament to heal.

For baseball players that have significant ulnar collateral ligament instability, and conservative treatment has failed, the Tommy John surgery is the treatment of choice. This surgery involves replacing the damaged ligament with a tendon from another part of the body. The good news is that with this surgery, approximately 80% return to their previous level of activity. Unfortunately, on average, recovery from this surgery back to full activity takes almost one year.

Elbow sprains generally recover well with conservative treatment. Consult with a good orthopedic doctor and physical therapist and you’ll be back in action in no time.



References

Magn Reson Imaging Clin N Am. 2009 Nov;17(4):617-38, v. Overuse and traumatic injuries of the elbow. Hayter CL, Giuffre BM.

Sports Med. 2007;37(8):717-35. A review of epidemiology of paediatric elbow injuries in sports. Magra M, Caine D, Maffulli N.

Top Magn Reson Imaging. 2006 Oct;17(5):327-36. Ligament and tendon injury to the elbow: clinical, surgical, and imaging features. Saliman JD, Beaulieu CF, McAdams TR.

Sports Med Arthrosc. 2006 Dec;14(4):221-31. Evaluation and treatment of medial ulnar collateral ligament injuries in the throwing athlete. Nassab PF, Schickendantz MS.


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