Elbow and Forearm Overuse Injuries
One of the most common overuse injuries seen in throwing athletes and racquet sports are elbow and forearm injuries since, it requires a repetitive elbow flexion-extension of the elbow, or a pronation- supination of the wrist. When looking to those injuries from a sports specific perspective we need to study and understand the biomechanics behind it. Repetitive elbow flexion can cause a bicep tendinosis or anterior capsule strain. On the other hand, activities involving a powerful elbow extension can cause a triceps tendinosis or posterior impingement syndrome. Besides, sports that require wrist flexion-extension or pronation-supination can lead to a radial tunnel syndrome.
At first, when evaluating an injury we need to look at the history of the athlete because by looking at their history we can relate to other injuries happened in the past. Secondly, we have to determine the onset of symptoms and find out if the symptoms disappeared with the cessation of the activity or if they persist. While evaluating we have to question the athlete and know if the pain radiates to another site of the arm, and if it is experiencing any clicking or catching with pain. I would like to list some of the specific symptoms for each individual diagnoses covered in the article. A bicep tendinosis causes an anterior elbow pain which frequently it is associated with a bicep weakening. Athletes with a triceps tendinosis complain of a posterior elbow pain which is aggravated by resisted elbow extension. Often, athletes point to the triceps insertion on the olecranon when asked to pinpoint the pain. The radial tunnel syndrome occurs after trauma to the distal humerus, and it rarely happens to athletes who repetitively pronate and supinate the forearm. Night pain can be present. When performing the physical examination to the athletes it should be systematic and complete. In the acute phase in general overuse injuries are treated using the PRICEMM treatment that stands for protection, rest, ice compression, elevation, medication, and modalities. PRICEMM is accepted for overuse syndromes of the elbow and forearm. Protection means adapting the activity and equipment to allow proper healing. Rest does not mean cessation of activity which can lead to deconditioning, but to a change in the activity that does not aggravate the injury. Ice is used to control swelling and to alleviate pain. Compression is used to prevent swelling, and elevation is used to prevent venous stasis around the injury. Medications include no steroidal anti-inflammatory drugs and the modalities frequently used include electrical stimulation, ultrasound, etc. Moreover, cryotherapy can also be used but it should be applied carefully when used over nerve entrapments. The recovery phase begins once the pain is resolved so that strengthening and flexibility can begin, which are the main goals of physical therapy. Once the strengthening and flexibility are fully recovered then the goal should be to accomplish full activity. However, a too rapid progression can cause the original symptoms to return. During the maintenance phase the coach supervision is very important since he or she must address proper biomechanics so that the injury does not reoccur causing the same overused symptoms.
Finally, the athlete returns to play once the symptoms are tolerable, and when ninety percent of the strength of the affected side has returned compared to the unaffected side. However, if the athlete dominant side was affected then they should return to play with one hundred percent strength of the non dominant side. One of the mayor complications of overused injuries is returning to the poor habits that caused the original injury; thus, corrections must occur to the biomechanics of the injury. After all, the education of athletes and coaches concerning preventing measures to help eliminate overuse injuries are of huge importance to athletic trainers. As a final point, the athlete must participate of a strengthening program to be physically prepared for the stresses of the sport and to overcome future injuries.