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Institute of Advanced Orthopedics, MOSC Hospital and Medical College, Kolenchery, Kochi, Kerala

Elbow Pain

Elbow Injuries

Throwing and over head sports like bowling & badminton places extremely high stresses on the elbow. When these stresses are repeated many times, they can lead to serious overuse injury.

Unlike an acute injury that results from a fall or collision with another player, an overuse injury occurs gradually over time. In many cases, overuse injuries develop when an athletic movement is repeated often during single periods of play, and when these periods of play — games, practices — are so frequent that the body does not have enough time to rest and heal.

Anatomy

Image result for elbow joint

Your elbow joint is where three bones in your arm meet: your upper arm bone (humerus) and the two bones in your forearm (radius and ulna). It is a combination hinge and pivot joint. The hinge part of the joint lets the arm bend and straighten; the pivot part lets the lower arm twist and rotate.

At the upper end of the ulna is the olecranon, the bony point of the elbow that can easily be felt beneath the skin.

On the inner and outer sides of the elbow, thicker ligaments (collateral ligaments) hold the elbow joint together and prevent dislocation. The ligament on the inside of the elbow is the ulnar collateral ligament (UCL). It runs from the inner side of the humerus to the inner side of the ulna, and must withstand extreme stresses as it stabilizes the elbow during overhand throwing.

Several muscles, nerves, and tendons (connective tissues between muscles and bones) cross at the elbow.The flexor/pronator muscles of the forearm and wrist begin at the elbow, and are also important stabilizers of the elbow during throwing.

The ulnar nerve crosses behind the elbow. It controls the muscles of the hand and provides sensation to the small and ring fingers.

Tennis Elbow (Lateral Epicondylitis)

Tennis elbow, or lateral epicondylitis, is a painful condition of the elbow caused by overuse. Playing Tennis or other racquet sports like Badminton can cause this condition.

Tennis elbow is an inflammation of the tendons that join the forearm muscles on the outside of the elbow. The forearm muscles and tendons become damaged from overuse — repeating the same motions again and again. This leads to pain and tenderness on the outside of the elbow.

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Flexor Tendinitis

Repetitive throwing can irritate and inflame the flexor/pronator tendons where they attach to the humerus bone on the inner side of the elbow. Athletes will have pain on the inside of the elbow when throwing, and if the tendinitis is severe, pain will also occur during rest.

Ulnar Collateral Ligament (UCL) Injury

The ulnar collateral ligament (UCL) is the most commonly injured ligament in throwers. Injuries of the UCL can range from minor damage and inflammation to a complete tear of the ligament. Athletes will have pain on the inside of the elbow, and frequently notice decreased throwing velocity.

Valgus Extension Overload (VEO)

valgus extension overload elbow

During the throwing motion, the olecranon and humerus bones are twisted and forced against each other. Over time, this can lead to valgus extension overload (VEO), a condition in which the protective cartilage on the olecranon is worn away and abnormal overgrowth of bone — called bone spurs or osteophytes — develop. Athletes with VEO experience swelling and pain at the site of maximum contact between the bones.

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