Elbow injury

Elbow injury is also called overload, since it develops gradually due to constant load during repeated movements. There is even such a thing as "tennis elbow" - an inflammatory process or damage to the tendons that connect the muscles of the forearm and the bony protrusion of the outer elbow zone. Such an elbow injury can develop in an athlete involved in rowing, badminton, bodybuilding, weightlifting, as well as in a person who works physically - in the construction industry, agricultural work.

Since the elbow is quite complex in structure, which on the one hand is an advantage in terms of range of motion and on the other hand is a disadvantage in terms of vulnerability, the elbow joint can be injured both by falling and by constant mechanical stress.

The elbow joint is a hinge joint that includes the radius, humerus, and ulna. They are connected by ligaments, tendons, and muscle tissue. Most often, an elbow injury occurs when falling; a person tends to reflexively "extend" the elbow as a possible cushion. A fall with an emphasis on the elbow can lead to both a dislocation and a fracture of the joint.

An elbow injury is a condition that can develop into a serious problem if not diagnosed and treated promptly.

[ 1 ], [ 2 ], [ 3 ]

Consequences of elbow injury

Complications and consequences of elbow injury can be quite serious; according to statistics, the number of complications reaches up to 40% of all diagnosed cases.

Most often, elbow trauma is accompanied by contracture - limitation of motor activity, joint mobility due to cicatricial, fibrous formations in the tendons. "Old", untreated dislocations are diagnosed much less often, and incorrect fusions after fractures of the medial zone of the condyle or olecranon are detected very rarely. Also, complications of elbow trauma include joint instability due to damaged ligaments, habitual dislocation of the head of the radius and forearm, inflammation of the distal zone of the biceps tendon.

The consequences of an elbow injury almost never lead to disability, but athletes have to say goodbye to their professional careers, and everyone else simply suffers from limited elbow mobility, which significantly worsens both their health and quality of life.

It is believed that any elbow injury is inevitably accompanied by some degree of contracture, so contractura itself can act as a symptom, rather than a separate nosology. Post-traumatic rigidity leads to damage to the collateral ligament, often without damaging the bone. Contracture is most often diagnosed as arthrogenic, since it disrupts congruence - the adequacy and consistency of the joint parts. If the elbow injury is accompanied by burns, then necrotic tissue processes and fascia join the arthrogenic complications.

The consequences of elbow injury - contractures are divided into three categories:

1. The pre-contracture stage is accompanied by painful sensations, trophic changes in tissues and cartilages, especially if the elbow is incorrectly fixed after the injury. This stage of contracture is considered curable and reversible.
2. If the first stage is not identified as complicated, the contracture continues to develop, four weeks after the injury, pathological morphological changes begin to occur in the tissues surrounding the joint. The pain increases due to the tension of the formed adhesions in the synovial membrane. This stage is characterized by the formation of young fibrous-scar tissue.
3. The stage when, due to continued rigidity, young scar tissue is transformed into a rougher, fibrous tissue. Scarring, contraction, and formation of a scar begins.

In addition to contracture, the consequences of an elbow injury can also be in the form of ossification, when specific cells, osteoblasts, are formed at the site of injury and bone growths are formed. The severity of ossification depends on the severity of the injury; most often, ossifications develop with an injury accompanied by a dislocation of the forearm.

Ossification as a consequence of elbow injury goes through the following stages in its development:

1. Latent, hidden period, which begins from the moment of injury and lasts two to three weeks. Ossificates are not visible on X-ray.
2. Ossificates begin to calcify, and X-rays show unformed, poorly visible formations.
3. Ossificates begin to structure and transform into a spongy bone state. The process lasts 3-5 months.
4. Ossifications are formed and are clearly visible on X-ray images.

Ossification is promoted by overheating during physiotherapy procedures, too zealous or premature massage, and failure to observe the period of joint immobilization.

The consequences of an elbow injury can also be expressed in degenerative changes in muscles (myodystrophy) and thromboembolism.

[ 4 ], [ 5 ]

Treatment of elbow injury

Ideally, treatment of an elbow injury should begin on the first day after the injury. The sooner the treatment process begins, the lower the risk of various complications.

How to treat a bruised elbow?

If the injury looks like a bruise, ice or a cold compress is immediately applied to the injured area. To avoid complications, you should consult a surgeon and have an X-ray to rule out a fracture. Then the joint is fixed for at least one week to ensure maximum rest. Rubbing and massage can be done only after two or three days, the first day only cold and fixation are indicated. For rubbing, the fixing bandage is removed for a while and the ointment is rubbed in with gentle circular movements. Ointments and gels containing non-steroidal anti-inflammatory drugs - diclofenac, ibuprofen, nimid - are suitable as symptomatic external agents. Starting from the third day, the elbow can be rubbed with warming ointments containing essential oils. Development of the elbow joint is permissible only after 2.5-3 weeks and is carried out in the form of gentle circular movements. Physiotherapeutic warming up and swimming are also effective. The time it takes for a full recovery depends on the severity of the injury, but usually this type of elbow injury goes away after a month.

How to treat a dislocated elbow?

If a displacement of the bone structure of the forearm is diagnosed, the ligaments are most likely damaged. This is expressed not only in pain, but also in the lack of sensitivity of the hand, limitation of its mobility. Sometimes nerve conduction is impaired so much that the pulse is not felt on the wrist. First aid is ice and fixation, then you need to immediately consult a doctor. Reduction will be performed under local anesthesia, and fixation of the elbow, forearm with a splint or orthosis. Conservative drug treatment consists of painkillers for the first three days, the appointment of chondroprotectors, improving the process of restoration of cartilage tissue. Immobilization of the joint lasts at least three weeks, then a course of massage and restorative therapeutic exercise is carried out. The set of exercises consists of flexion-extension and rotational movements that help restore the amplitude and activity of the elbow.

How to treat an elbow fracture?

As a rule, a fracture occurs inside the joint, most often such an injury is treated conservatively and only in extreme cases, when the fracture is accompanied by hemarthrosis and the formation of intra-articular cysts, surgery is indicated. A fracture can be of the following types:

• Injury to the lower epiphysis of the humerus.
• Fracture in the region of the capitate eminence.
• Fracture of the upper epiphyses of the forearm.
• Combined fracture.

In addition, the fracture can be single or with displacement. A normal fracture is subject to immobilization at a classic angle of 90 degrees. If there is a displacement, it is aligned manually, often under local anesthesia, less often surgical repositioning and fixation with pins is performed. A fixing splint is applied to the elbow for at least one month. During the process of fusion of bone and cartilage tissue, non-steroidal anti-inflammatory drugs, chondroprotectors, and vitamin therapy are indicated. When the fixation is removed, long-term restorative therapeutic exercise is indicated, helping to reduce the risk of complications in the form of contracture. Therapeutic gymnastics should be performed daily in 4-5 approaches. Massage is contraindicated for fractures, it is replaced by complex physiotherapy procedures.