Acute Elbow Injuries

What are they?

As with any other area of the body, elbows can suffer injury from falls, accidents or sports participation. Acute injuries by their very nature are often sudden onset, traumatic events which lead to immediate symptoms of pain, swelling and bruising. Common fractures (lack of continuity of the bone) which can occur around the elbow region include radial head and olecranon fractures. Radial head fractures are the most common adult elbow fracture and often occur as a result of falling onto an outstretched hand. Pain and swelling is usually localised to the outside of the elbow and movements are limited, especially rotation of the forearm. Olecranon (tip of the elbow at the back) fractures can result from indirect trauma in the elderly due to a rapid pull of the muscles which insert into the back of the elbow. In younger adults this fracture usually results from a fall onto the tip of the elbow and can often lead to a comminuted (multiple displaced fragments) fracture.
 

Elbow dislocations are very common in the young, especially in those who partake in contact sports such as rugby. Dislocations are injuries which result in the joint separating from its normal position or ‘coming out of its socket’. They can occur on their own or together with fractures and in some cases can involve compromise to the nerve and vascular structures.
 

Ligaments sprains account for many acute elbow injuries. Ligaments are tough, inelastic bands which span from bone to bone across a joint to give them stability. Ligaments which run along the inside/outside of the elbow are called collateral ligaments and these can be sprained if subjected to twisting or opening up type movements to either side of the elbow joint. Sprains are characterised by localised pain and swelling and a reduction in the normal range of movement of the joint.
 

Treatment
 

Acute injuries need to be assessed quickly by a medical practitioner trained to deal with them. Fractures and dislocations need to be closely watched for problems associated with possible damage to the nerves and blood vessels. An x-ray will usually identify any fractures and appropriate management protocols should be followed. These will vary depending of the nature and site of the fracture but will usually involve some period of immobilisation in a cast.
 

Following removal of the cast the elbow will be typically stiff and a little sore. Physiotherapy rehabilitation will be required to restore full movement, strength and function and will include hands on therapy as well as home exercises.

Ligament sprains are usually treated conservatively (non-operatively).
Acute injury early management is focused on the PRICE principles:

• Protection – strapping and/or wrist splint

• Rest – from aggravating activities

• Ice – to reduce swelling and pain

• Compression – to reduce swelling and offer support

• Elevation – to aid swelling reduction

Physiotherapy management following the early stages will involve treatment techniques to reduce pain and inflammation, restore joint movement and an individually tailored exercise regime to return full strength, flexibility and function to the joint.