Forearm & Elbow Injuries

The biceps muscle bends the arm at the elbow and rotates the forearm in order to allow the palm of the hand to face upward. It is located at the front of the arm and is attached by the biceps tendon to the shoulder blade (scapula) and the radius bone.

The biceps muscle separates near the shoulder into a long head and a short head - both of which attach to the shoulder in different places. The long head of the biceps tendon is subject to injury because it travels through the shoulder joint to its area of attachment.

A biceps tendon rupture may occur as a result of chronic tendonitis - and a long history of shoulder impingement and stability problems. While ruptures of the distal tendon near the elbow are less reported than those of the proximal tendon, they can occur with unexpected force on a bent arm in breaking a fall or shielding from a collision.

Most frequently diagnosed are ruptures of the proximal biceps tendons near the shoulder. Because of the broad range of motion the shoulder joint can attain and to which it is subjected, the proximal biceps tendon is more vulnerable to injury than the distal biceps tendon.

Proximal biceps tendons tears can be either partial or complete and are often times already a bit worn - particularly in the patient over 40 years of age.

Pain is usually sharp and sudden, often times preceded by a loud "snap." There may be a bulge in the upper arm above the elbow and an indention nearer the shoulder - possibly accompanied by bruising, pain or tenderness.

Those at Risk
Athletes subjecting their shoulder to extreme throwing force are vulnerable and likely to experience this condition during their career. Active adults who over exert in an activity, or who have a history of shoulder instability problems and degenerative tendon conditions are also at risk. In the elderly, proximal biceps tendon ruptures (in the shoulder area) are generally seen in conjunction with rotator cuff tears.

Diagnosis
Along with patient history, a physical examination involving arm movement and tightening of the biceps muscle will help determine diagnosis. For patients with a history of shoulder pain and instability, magnetic resonance imaging (MRI) or arthrogram (enhanced X-ray) may be indicated, in order to assess the condition of the rotator cuff muscles.

Treatment
Conservative nonsurgical treatment is usually successful in treating biceps tendon ruptures. This may entail cold compression in order to reduce swelling, nonsteroidal anti-inflammatory drugs (NSAIDs), and a period of rest followed by a rehabilitative strengthening and flexibility program that is specific to the patient.

When the condition is nonresponsive to conservative treatment, surgery to repair the tendon tear may be performed. This depends on the patient's history, age and work requirements.

Bursitis of the elbow, also known as olecranon Bursitis, generally results from an injury or constant pressure and stress placed on the elbow. It is the inflammation of a bursa, which consists of fluid filled cavities located at tissue sites where tendons or muscles pass over the bone near joints. It provides a slippery surface facilitating a gliding process when the elbow is extended and retracted.

When the bursa becomes inflamed, it becomes swollen and causes friction within the confined space of the elbow joint. The once slippery bursa becomes gritty and rough and can cause pain and irritation.

Those at Risk
While bursitis is often seen in patients who subject their elbows to repetitive pressure such as leaning against a hard surface and frequent bending in a sport, it is most commonly the result of trauma from either a repetitive injury or an accident or fall.

Diagnosis
A history of patient activity and description of the symptoms followed by a physical examination and X-ray can diagnose the condition.

Treatment
The treatment options for bursitis are usually nonsurgical, conservative treatment plans that may include a period of rest - possibly combined with immobilization, the use of NSAIDs (non steroidal anti inflammatory drugs) such as ibuprofen for pain relief, and a specific physical therapy program.

If the inflammation is nonresponsive to the first phase of treatment, it may be necessary to remove fluid from the bursa in conjunction with corticosteroid injections. Rarely is surgery required for this condition.

Common injuries among athletes, contusions often involve the muscles of the forearm and portion of the bony prominence of the elbow. In athletes, the forearm often absorbs the greatest portion of the impact - particularly in contact sports. This repeated force to the muscles can result in bruising and possibly bleeding, which produces stiffness during active range of motion activities. Occasionally a contusion is accompanied by a fracture, depending on the severity of the force.

Depending on the area impacted by the force, a contusion can also produce an actute hemorrhagic bursitis or a common chronic olecranon bursitis. A contusion to the ulnar nerve (an area often referred to as the "funny bone") can be very painful and send burning sensations down the ulnar side of the forearm to the ring and little fingers.

Those at Risk
Athletes involved in high impact contact sports such as football, baseball and basketball are most likely to be affected by this condition, though contusions can also result from an accident or fall.

Diagnosis
Patient history, combined with a thorough physical examination that includes range of motion tests, are used in diagnosing elbow trauma. An X-ray may be taken to identify a possible fracture, which sometimes accompanies a trauma resulting in a contusion.

Treatment
Once any accompanying fracture is addressed, a period of rest followed by a series of range of motion exercises may be all that is necessary in the treatment of contusions to the elbow or forearm.

Elbow instability is the detachment or thinning of an elbow ligament often caused by throwing activities or sports, or a trauma that resulted in a dislocation. Instability can affect either the outer (lateral) or inner (medial) portion of the elbow.

Elbow instability is classified according to five criteria, which help in identifying the severity of the condition - acute, chronic, or recurrent, as well as the area of irritation, the direction of displacement, the degree of displacement, and any associated fractures.

This condition is symptomatically similar and sometimes confused with arthritis and tendonitis.

Those at Risk
Athletes involved in throwing sports generally develop medial elbow instability. And those experiencing trauma or earlier surgery to repair a dislocated elbow most often develop lateral elbow instability.

Diagnosis
In order to accurately diagnose elbow instability, a physical examination with patient history is obtained - along with X-rays and magnetic resonance imaging (MRI) enhanced with an arthrogram. An arthrogram is the process of injecting the elbow with a small amount of dye in order to enhance the clarity of the MRI, which aids in the capturing of ligament disruption.

Treatment
The conservative treatment plan indicated for elbow instability includes anti-inflammatory medication - possibly combined with a period of immobilization.

In cases nonresponsive to conservative treatment, surgery is performed to reconstruct the biomechanics of the joint and repair the ligaments. Surgery is indicated only when the risk of long-term arthritis from prolonged friction is present.

Medial collateral ligament (MCL) injuries most often occur when the elbow is subjected to the high velocity pitches attained by amateur and professional pitchers, who may throw balls reaching speeds between 70 and 100 miles an hour. This level of throwing places a significant amount of force on the elbow joint that over time can lead to irritation, inflammation, cartilage tears, formation of bone spurs and eventually tearing of the MCL.

The MCL is part of a network of ligaments and tendons that attach and help stabilize at the elbow the bones of the lower (ulna and radius) and upper (humerus) arm.

When the MCL is torn, athletes usually maintain full range of motion and the ability to throw, but with significantly reduced force. While often times a "pop" is reported with the ligament tears, it can also be a gradual process and go undetected for a period of time.

Those at Risk
Baseball players, particularly pitchers, are most often diagnosed with this injury as a result of the frequent and irregular force exerted on their elbow joint.

Diagnosis
Patient history and physical examination are followed by a radiologic exam. Those patients experiencing extended periods of performance disruption may have an X-ray, while those experiencing a sharp "pop" - particularly during a throw - may require magnetic resonance imaging (MRI).

Treatment
A change in activity is recommended initially in order to remove the stress from the elbow. This may mean a temporary change in field position for an athlete, while the damage is assessed. A course of conservative treatment followed by rehabilitation is generally the first phase of addressing an injury or condition.

When a tear requires surgery, an exploratory arthroscopy is generally performed to confirm no other damage. And a surgery popularized by a former major league pitcher, Tommy John, called the Tommy John surgery may be indicated. The procedure - known to doctors as medial collateral ligament reconstruction - takes only an hour and returns full strength to the elbow by replacing a ligament in the medial elbow with a tendon from another area of the body (generally taken from the forearm, hamstring or foot).

The triceps tendon is likely to become inflamed and rupture when overstressed while lifting weights or pushing something that is too heavy. It can also rupture when outstretched arms are used to break a fall.

The triceps tendon is located at the back of the upper arm and inserts into the back of the elbow. The symptoms of inflammation or a rupture may include elbow pain at rest or during activity, painful swelling at the back of the elbow, and reduction in elbow function.

Those at Risk
Those frequently lifting large amounts of weight at the gym without properly strengthening opposing muscle groups are at risk of triceps tendon inflammation or rupture. Also vulnerable are skateboarders or roller bladders, who rely on outstretched arms to break a fall.

Diagnosis
Along with patient history, a physical examination involving arm movement and tightening of the triceps muscle will help determine diagnosis. For patients with a history of elbow pain, magnetic resonance imaging (MRI) or arthrogram (enhanced X-ray) may be indicated in order to assess the condition of the elbow joint and associated tendons.

Treatment
Conservative nonsurgical treatment is usually successful in treating triceps tendon inflammation or ruptures. This may entail cold compression in order to reduce swelling, nonsteroidal anti-inflammatory drugs (NSAIDs), and a period of rest followed by a rehabilitative strengthening and flexibility program that is specific to the patient.

When the condition is nonresponsive to conservative treatment, surgery to repair a tendon tear may be performed. This depends on the patient’s history, age and level of activity.

Ulnar Collateral Ligament (UCL) Tears were once devastating injuries to an athlete involved in overhead and throwing sports such as swimmers, volleyball players, pitchers and ice hockey players. But today early diagnosis and treatment keeps players in the game without skipping a beat.

The UCL of the elbow is critical for valgus stability and serves as the primary elbow stabilizer. It consists of three bands - the anterior, posterior and transverse. The anterior band contributes the greatest in valgus stability.

The acceleration phase of an overhead throw causes the greatest amount of valgus stress on the elbow - while the forearm lags behind the upper arm and creates valgus stress. This leaves the elbow primarily dependent on the anterior band of the UCL for stability. The extreme acceleration can cause the valgus force to overcome the tensile strength of the UCL and result in either chronic microscopic tears or an acute rupture.

Tearing of the ligament generally occurs after a period of localized internal soreness around the elbow. When the tear occurs, patients report feeling a "pop" followed by weakness and inability to function properly.

Those at Risk
Athletes regularly subjecting their elbow to high acceleration activities in flexion and extension are likely to incur this type of injury.

Diagnosis
Patient history and physical examination are followed by a radiologic exam. Those patients experiencing extended periods of pain may have an X-ray performed, while those experiencing deep sharp pains - particularly during a sport activity - may require magnetic resonance imaging (MRI).

Treatment
A change in activity is recommended initially in order to remove the stress from the elbow. This may mean a temporary change in position for an athlete, while the damage is assessed. A course of conservative treatment followed by rehabilitation is generally the first phase of addressing an injury or condition.

When a tear or rupture requires surgery, an exploratory arthroscopy is generally performed to confirm no other damage. And a surgery popularized by a former major league pitcher, Tommy John, called the Tommy John surgery may be necessary. The procedure - known to doctors as ulnar collateral ligament reconstruction - takes only an hour and returns full strength to the elbow and forearm by replacing the damaged ligament with a tendon from another area of the body (generally taken from the forearm, hamstring or foot).