Skip to main content

Common Elbow Injuries in Sport

Abstract

Athletes of all ages and skill levels are increasingly participating in sports involving overhead arm motions, making elbow injuries more common. Among these injuries is lateral epicondylitis, which occurs in over 50% of athletes using overhead arm motions. Lateral epicondylitis is characterised by pain in the area where the common extensor muscles meet the lateral humeral epicondyle. The onset of this pathological condition begins with the excessive use of the wrist extensor musculature. Repetitive microtraumatic injury can lead to mucinoid degeneration of the extensor origin and subsequent failure of the tendon. Lateral epicondylitis can almost always be treated nonoperatively with activity modification and specific exercises. If the athlete fails to respond to nonoperative treatment after 6 months to 1 year, they are candidates for surgical intervention.

Medial epicondylitis is characterised by pain and tenderness at the flexorpronator tendinous origin with pathology commonly being located at the interface between the pronator teres and flexor carpi radialis origin. Golfers and tennis players often develop this condition because of the repetitive valgus stress placed on the medial elbow soft tissues. Careful evaluation is important to differentiate medial epicondylitis from other causes of medial elbow pain. As with lateral epicondylitis, patients with medial epicondylitis not responding to an extensive nonoperative programme are candidates for surgical intervention.

A less common cause of medial elbow pain is medial ulnar collateral ligament injury. Repetitive valgus stress placed on the joint can lead to microtraumatic injury and valgus instability. When the medial ulnar collateral ligament is disrupted, abnormal stress is placed on the articular surfaces that can lead to degenerative changes with osteophyte formation. As with other elbow injuries, a strict rehabilitation regimen is first employed; ligament reconstruction is only recommended if the injury fails to improve and only in athletes requiring a high level of performance. Excessive valgus stress can also lead to posteromedial olecranon impingement on the olecranon fossa producing pain, osteophyte and loose body formation. Arthroscopic elbow debridement can often be helpful in improving motion and in reducing pain in such patients.

This is a preview of subscription content, access via your institution.

References

  1. 1.

    Koplan JP, Siscovick DS, Goldbaum GM. The risks of exercise: a public health view of injuries and hazards. Public Health Rep 1985; 100: 189–95

    PubMed  CAS  Google Scholar 

  2. 2.

    Maylack FH. Epidemiology of tennis, squash, and racquetball injuries. Clin Sports Med 1988; 7: 233–8

    PubMed  CAS  Google Scholar 

  3. 3.

    Nirschl RP. Tennis elbow. Orthop Clin North Am 1973; 4: 787

    PubMed  CAS  Google Scholar 

  4. 4.

    Nirschl RP. Muscle and tendon trauma: tennis elbow. In. Morrey BF, editor. The elbow and its disorders. 2nd ed. Philadelphia (PA): W.B. Saunders, 1993: 681–703

    Google Scholar 

  5. 5.

    Regan W, Wold LE, Coonrad R, et al. Microscopic histopathology of chronic refractory lateral epicondylitis. Am J Sports Med 1992; 20: 746–9

    PubMed  Article  CAS  Google Scholar 

  6. 6.

    Moss SH, Switzer HE. Radial tunnel syndrome: a spectrum of clinical speculations. J Hand Surg 1983; 8: 414–8

    CAS  Google Scholar 

  7. 7.

    Gellman H. Tennis elbow (lateral epicondylitis). Orthop Clin North Am 1992; 23: 75–9

    PubMed  CAS  Google Scholar 

  8. 8.

    Balasubramaniam P, Prathap K. The effect of injection of hydrocortisone into rabbit calcaneal tendons. J Bone Joint Surg 1972; 54: 729–36

    CAS  Google Scholar 

  9. 9.

    Unverferth LJ, Olix ML. The effect of local steroid injection on tendon. Am J Sports Med 1973; 1: 31–4

    Article  CAS  Google Scholar 

  10. 10.

    Froimson A. Treatment of tennis elbow with forearm support band. J Bone Joint Surg 1961; 43: 100–3

    Google Scholar 

  11. 11.

    Ilfeld FW, Field SM. Treatment of tennis elbow: use of special brace. JAMA 1966; 195: 67–71

    PubMed  Article  CAS  Google Scholar 

  12. 12.

    Groppel JL, Nirschl RP. A mechanical and electromyographic analysis of the effects of various joint counterforce braces on the tennis player. Am J Sports Med 1986; 14: 195–9

    PubMed  Article  CAS  Google Scholar 

  13. 13.

    Mackler-Snyder L, Epler M. Effect of standard and aircast tennis elbow bands on integrated electromyography or forearm extensor musculature proximal to the bands. Am J Sports Med 1989; 17: 278–83

    Article  Google Scholar 

  14. 14.

    Hennig EM, Rosenbaum D, Milani TL. Transfer of tennis racket vibrations onto the human forearm. Med Sci Sports Exerc 1992; 24: 1134–8

    PubMed  CAS  Google Scholar 

  15. 15.

    Hatze H. The effectiveness of grip bands in reducing racquet vibration transfer and slipping. Med Sci Sports Exerc 1992; 24: 226–9

    PubMed  CAS  Google Scholar 

  16. 16.

    Nirschl RP, Pettrone FA. Tennis elbow: the surgical treatment of lateral epicondylitis. J Bone Joint Surg 1979; 61: 832–40

    PubMed  CAS  Google Scholar 

  17. 17.

    Coonrad RW, Hooper WR. Tennis elbow: its course, natural history, conservative and surgical management. J Bone Joint Surg 1973; 55: 1177–82

    PubMed  CAS  Google Scholar 

  18. 18.

    Goldie I. Epicondylitis lateralis humeri (epicondylagia or tennis elbow). A pathogenetical study. Acta Chir Scand 1964; 339–41

    Google Scholar 

  19. 19.

    Verhaar J, Walenkamp G, Kester A, et al. Lateral extensor release for tennis elbow. J Bone Joint Surg 1993; 75: 1034–8

    PubMed  CAS  Google Scholar 

  20. 20.

    Baumgard SH, Schwartz DR. Percutaneous release of the epicondylar muscles for humeral epicondylitis. Am J Sports Med 1982; 10: 233–8

    PubMed  Article  CAS  Google Scholar 

  21. 21.

    Yerger B, Turner T. Percutaneous extensor tenotomy for chronic tennis elbow. An office procedure. Orthopedics 1985; 8: 1261–5

    CAS  Google Scholar 

  22. 22.

    Bosworth DM. The role of the orbicular ligament in tennis elbow. J Bone Joint Surg 1955; 37: 527–32

    PubMed  Google Scholar 

  23. 23.

    Bosworth DM. Surgical treatment of tennis elbow: a follow-up study. J Bone Joint Surg 1965; 47: 1533–7

    PubMed  CAS  Google Scholar 

  24. 24.

    Boyd HB, McLeod AC. Tennis elbow. J Bone Joint Surg 1973; 55: 1183–9

    PubMed  CAS  Google Scholar 

  25. 25.

    Conway JE, Jobe FW, Glousman RE, et al. Medial instability of the elbow in throwing athletes: surgical treatment by ulnar collateral ligament repair or reconstruction. J Bone Joint Surg 1992; 74: 67–73

    PubMed  CAS  Google Scholar 

  26. 26.

    Nirschl RP. Prevention and treatment of elbow and shoulder injuries in the tennis player. Clin Sports Med 1988; 7: 289–94

    PubMed  CAS  Google Scholar 

  27. 27.

    Bauer M, Jonsson K, Jesefsson PO, et al. Osteochondritis dissecans of the elbow: a long term follow-up study. Clin Orthop 1992; 284: 156–62

    PubMed  Google Scholar 

  28. 28.

    Bennett JB. Articular injuries in the athlete. In. Morrey BF, editor. The elbow and its disorder. 2nd ed. Philadelphia (PA): W.B. Saunders, 1993: 803–31

    Google Scholar 

  29. 29.

    Leach RE, Miller JK. Lateral and medial epicondylitis of the elbow. Clin Sports Med 1987; 6: 259–66

    PubMed  CAS  Google Scholar 

  30. 30.

    Nirschl RP. Medial tennis elbow, surgical treatment. Orthop Trans Am Acad Orthop Surg 1980; 7: 298–302

    Google Scholar 

  31. 31.

    Jobe FW, Moynes DR, Tibone JE, et al. An EMG analysis of the shoulder in pitching: a second report. Am J Sports Med 1984; 12: 218–222

    PubMed  Article  CAS  Google Scholar 

  32. 32.

    Jobe FW, Tibone JE, Perry J, et al. An EMG analysis of the shoulder in throwing and pitching: a preliminary report. Am J Sports Med 1983; 11: 3–8

    PubMed  Article  CAS  Google Scholar 

  33. 33.

    Hotchkiss RN, Weiland AJ. Valgus stability of the elbow. J Orthop Res 1987; 5: 372–9

    PubMed  Article  CAS  Google Scholar 

  34. 34.

    Morrey BF. Applied anatomy and biomechanics of the elbow joint. Instr Course Lect 1986; 35: 59–64

    PubMed  CAS  Google Scholar 

  35. 35.

    Morrey BF, An KN. Functional anatomy of the ligaments of the elbow. Clin Orthop 1985; 201: 84–90

    PubMed  Google Scholar 

  36. 36.

    Morrey BF, Tanaka S, An KN. Valgus stability of the elbow: a definition of primary and secondary constraints. Clin Orthop 1991; 265: 187–191

    PubMed  Google Scholar 

  37. 37.

    Regan WD, Korinek SL, Morrey BF, et al. Biomechanical study of ligaments around the elbow joint. Clin Orthop 1991; 271: 170–5

    PubMed  Google Scholar 

  38. 38.

    Schwab GH, Bennett JB, Woods GW, et al. Biomechanics of elbow instability: the role of the medial collateral ligament. Clin Orthop 1980; 146: 42–9

    PubMed  Google Scholar 

  39. 39.

    Sojbjerg JO, Ovesen J, Nieslen S. Experimental elbow instability after transection of the medial collateral ligament. Clin Orthop 1987; 218: 186–92

    PubMed  Google Scholar 

  40. 40.

    Glousman RE. Ulnar nerve problems in the athlete’s elbow. Clin Sports Med 1990; 9: 365–70

    PubMed  CAS  Google Scholar 

  41. 41.

    Glousman RE, Barron J, Jobe FW, et al. An electromyographic analysis of the elbow in normal and injured pitchers with medial collateral ligament insufficiency. Am J Sports Med 1992; 20: 311–7

    PubMed  Article  CAS  Google Scholar 

  42. 42.

    Field LD, Callaway GH, O’Brien SJ, et al. Arthroscopic assessment of the medial collateral ligament complex of the elbow. Am J Sports Med 1995; 23: 396–400

    PubMed  Article  CAS  Google Scholar 

  43. 43.

    Field LD, Altchek DW. Evaluation of the arthroscopic valgus instability test of the elbow. Am J Sports Med 1996; 24: 177–81

    PubMed  Article  CAS  Google Scholar 

  44. 44.

    Shaughnessy WJ, Bianco AJ. Osteochondritis dissecans. In. Morrey BF, editor. The elbow and its disorders. 2nd ed. Philadelphia (PA): W.B. Saunders, 1993: 511–33

    Google Scholar 

  45. 45.

    McManama GB, Michel LJ, Berry MV, et al. The surgical treatment of osteochondritis of the capitellum. Am J Sports Med 1985; 13: 11–7

    PubMed  Article  Google Scholar 

  46. 46.

    Woodard AH, Bianco AJ. Osteochondritis dissecans of the elbow. Clin Orthop 1975; 110: 35–41

    Article  Google Scholar 

  47. 47.

    Field LD, Altchek DW, Warren RF, et al. Arthroscopic anatomy of the lateral elbow: a comparison of three portals. Arthroscopy 1994; 10: 602–9

    PubMed  Article  CAS  Google Scholar 

  48. 48.

    Nunley PD, Savoie FH. Arthroscopic ulnohumeral arthroplasty of the elbow. American Academy of Orthopaedic Surgeons Annual Meeting; 1996 Feb 23; Atlanta (GA)

    Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Larry D. Field.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Field, L.D., Savoie, F.H. Common Elbow Injuries in Sport. Sports Med 26, 193–205 (1998). https://doi.org/10.2165/00007256-199826030-00005

Download citation

Keywords

  • Epicondylitis
  • Osteochondritis Dissecans
  • Tennis Elbow
  • Valgus Stress
  • Extensor Carpus Radialis