Last weeks’ article considered the common repetitive strain injuries of the elbow and the management approach.
This week, we look at some of the acute injuries and we will focus on tendon tears and elbow joint dislocation.
The two main tendons that usually get injured are the biceps tendon, which bends the elbow, and the triceps tendon at the back which straightens the elbow.
Biceps tendon ruptures tend to occur when a large force is applied to a slightly bent elbow as when doing a biceps curl.
These injuries are also seen in when the elbow is straightening against a load for example in rugby when clearing out players from a ruck.
At the time of injury, there is a sharp pain in the elbow which may be accompanied by feeling something ‘snap’.
There’s normally immediate swelling and a bruise develops over a period of a few hours.
The athlete normally experiences loss of power when flexing the elbow but the most profound weakness is when trying to turn the forearm to get the palm pointing upwards.
A complete biceps tendon rupture/tear does not heal and in young and active sports people, surgery is frequently required.
When these injuries occur in less physically active individuals, non-surgical management may be adequate.
The surgical procedure involves re-attaching the tendon to the radius bone in the forearm.
The recovery is fairly rapid and most individuals are able to return to training within three months.
Triceps ruptures are equally infrequent and tend to occur when one falls onto outstretched hands.
The force generated in trying to prevent the elbow bending leads to a tear of the tendon.
Like with a biceps tendon tear, most people will have pain and swelling at the back of the elbow and weakness in trying to straighten the elbow against resistance.
Like with the biceps tendon, complete triceps tears don’t heal without surgical repair.
For the active and sporting person who requires strength, surgery is performed to re-attach the tendon to the bone prominence at the back of the elbow called the olecranon.
After recovery, one can typically return to sports after 3 months.
As much as these acute ruptured tendons are rare, they tend to occur more frequently in individuals who have had inflammation and tendon pain for some time preceding the injury.
For this reason it is important to heed elbow pain and to take a break from sport and complete supervised rehabilitation before re-engaging to avoid the dramatic injury.
Elbow dislocations are rare injuries which may occur in a variety of sports.
The injury typically occurs when one lands awkwardly and twists the partly bent elbow.
Dislocations cover a wide injury spectrum from simple dislocation to complex injuries with torn ligaments and bone fractures.
These injuries require urgent assessment with x-rays to define the severity.
Simple dislocations are reduced in the emergency department and after a period of rest, training is possible by six weeks.
In the more complex injuries, after the initial reduction in the emergency department, an orthopaedic review is required to plan further treatment.
Recovery from these injuries is more variable and is based on the individual case. Stiffness is commonly encountered after these injuries.
In summary, all these elbow injuries are rare but can be disruptive to the sports person.
The tendon tears tend to respond well to surgical management and a full return to sport is the norm if managed early.
As with most sports injuries prevention is the key and athletes must monitor and seek attention when challenged with persistent joint aches.