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Elbow Injuries - Tennis Elbow, Sprains, Twists


Autor: dr sci.med. Milorad Jerkan    

elbow-injuries-tennis-elbow-sprains-twists

An elbow is a complex joint formed by the unity of three bones humerus, upper arm and ulna and radius of the forearm. Osseous lumps from outer and inner sides are called epicondyles. There are ligaments, tangents and bursae. Function of the flexion of the elbow is to help in folding the wrist while fingers are pressed together.

Usual Injuries

Characteristic injuries of elbow are: subluxation, luxation, olecranon fractures, fructures of the head of radius, fractures due to a hit while “passing by” (“sideswipe fractures”), fracture of ulna diaphisis combined with dislocation of the radius head (“Monteggia”), fractura radii loco typico, injuries of the soft tissue, injuries in the aeria of the head of radius, contusion of the radial nerve, ulnar neurithis, injuries of ulnar collateral ligament, hyperextensive injuries of the elbow, bursitis in the aeria of elbow and belated injuries of elbow.
Injuries usually appear due to constant repeat of  the  movements with tennis players, oarspersons, golf players. This injury is usually caused by irregularly performed  heat or because extensor muscles are insufficiently developed. This can also appear with karate players, bowlers, weightlifters and the like… A pain appears in the inner side of the elbow and causes the reduced movements.

Tennis Elbow

Tennis elbow is the inflammation of their tangeon which connects extensor muscles with outer epicondil. Those are the long muscles from the outer side of the forearm which  help to open and straighten the palm and wrist. The cause of the injury may be tennis racket which serves to reduce the force which is transmited on the hand when hitting to the minimum, if the balance in grif is disturbed it comes to  the ballast which is directed to the elbow the most. That is why when one chooses the racket, they should consult the professionals (trainers). Injury mechanism is connected with the muscles attached to latheral epicondil of humerus and those are: Extensor carpi radialis longus and brevis, m. extensor carpi ulnaris, m. extensor digitorum, m. extensor digiti minimi, m. supinator and m. anceneusus. A special imporatnce in backhand shot in tennis have the muscles of m. extensor carpi radialis longus and brevis. When hitting the ball it comes to ballast in the extensor muscles in the forearm. Every hit of this kind ends in the upper adjoinment of these muscles in the form of microtraumas and after frequent repeats microtraumatic impact brings to entensistis. Curkovic at all, marked the tennin elbow as a radial epicondilitis and can be met outside sport with house wives, buss drivers and blacksmiths.


Symptoms

Symptoms are. Sharp pain which expands to the outer side of the elbow, it can also expand down the forearm. It reduces radically movements like handshaking, holding a cup of coffee, turning the knob etc. These injuries appear with constant repeats of the movements, usually badly performed  backhand, bad technic at serving the ball and badly developed extensor muscles. It appears at tennis players, weight lifters, bowlling, skiing, home works and at direct blow.
Prevention for the appearance of tennis elbow: the essence of this injury is the choice of recket which in some of its elements causes constant microtraumas which bring with time to entensit ballast and injury which eliminate the sportist from the tennis court. In order to prevent this, it is necessary for the racket to be “spanned” (spanning the loops on the racket) according to the profile of the player, recket must be according to the player’s choice, racket weight must be optimal, grif must be adequate for the hand of the tennis player, the  movements with racket must be regular, sterothypes in game should be avoid, the way of holding the racket, the style and technic of performing the shot (straight shots, spin shots and the like) which if performed badly may cause microtraumas on extensor adjoinments of the elbow.

How to Cure Tennis Elbow

The curing is conservative in principle. We recommend inactivity up to two weeks in the first phase when we do physical therapy parallely (laser, ultrasound, magnetic impulse field and diodynamic), in case a sportsman does not accept inactivity, plaster immobilization is put up to two weeks. In case this does not help to ease the acute traumas, infiltration of hydrocortisone products is indicated with possible repeats of it two or three time the most. If all procedures do not give good results, a surgical intervention is indicated.

Luxation of the Elbow

Elbow twisting occures at fall on the arm prone in elbow. The frequency of this injury goes from   25 – 28 %  of all luxation. The mechanism of injury is in overdosed extension of the top of olecranon which points to the fosu olecrani, a joint capsule is torn, coronoid extension rises or slips from its bearing through trochlea of the upper arm bone and ends in the olecranon pitfall. Pressure still exists, it comes to pushing the forearm upwards in the line of upper arm and by easing of the force stressed flectors of the forearm contract and bring the elbow in the position of 120 degrees. This ends the luxation frontwarding. Complications due to inadequate mending process (immobilisation is not used long enough) cause the appearance of myositis ossificans. Subluxation and luxation of this joint usually appear at wrestlers, juddists, gymnasts and ball sports.

A Sharp Pain at Luxation

A clinical picture with all luxations and subluxations is similar depending on the kind of sport. It is caracterized by a sharp pain, a degree of dislocation is determined plapably, there is a great similarity with the fracture (contraction, and total functional inability of the extremity), a great deformity of the joint dominates, with large swelling, blood suffusion, and in some cases a direct compression on nerves.

How to Treat It

With luxation, the first and the main task is to perform reposition (bringing it pack to the previous position) if it is possible during the first couple of hours, especially with sportisman until spasm or twitc have not yet occurred (an immobilization is performed, then ice is put in order to prevent serosity or bloody liquid to reach the join). Immobilization usually lasts couple of weeks, and then a a patient goes for hydrotherapy (a pool or bath foams), electrostimulation, electrophoresis (a combination of analgethics and corticosteroids), diodynamic, oligothermic dose ktd, magnetotherapy,  kinesiotherapy. Start with the slight basic training when the aproval of specialist in sport medicine is received.

Open luxations, habitual and reccurent are treated obligatory by sugical means and drainage of the injured joint. Luxations originated  from the  pyogenic infection in joint, the  so – called pathological, are cured by surgical means, but only palliative effect is performed.


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