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Elbow Problems

Elbow Problems. Mike Putney, MD. Development. Asymptomatic pathology in high level athletes 87% prevalence of chronic UCL injuries 81% prevalence of joint injuries Increased medial laxity with stress in major league pitchers. Evaluation of the Injured Elbow.

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Elbow Problems

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  1. Elbow Problems Mike Putney, MD

  2. Development • Asymptomatic pathology in high level athletes • 87% prevalence of chronic UCL injuries • 81% prevalence of joint injuries • Increased medial laxity with stress in major league pitchers

  3. Evaluation of the Injured Elbow • Subjective complaints often precede or accompany pain • Loss of command • Loss of velocity • Subtle change in pitching mechanics

  4. Specific Injuries • Skeletally immature: acute fracture of the medial growth plate

  5. Specific Injuries • Little league elbow (apophysitis) • < 10 years old • Medial elbow pain • Decreased throwing effectiveness or distance • Medial swelling • Occasional flexion contractures

  6. Specific Injuries • Little league elbow treatment • Rest 2 - 4 weeks • NSAID’S • Stretching and strengthening especially the forearm flexors • May throw at 6 weeks if pain free

  7. Specific Injuries • Osteochondritis dissecans (OCD) • > 13 years old • Insidious onset • Dull poorly localized pain • Worse with activity • Can have locking if loose body develops

  8. Specific Injuries • Acute ulnar collateral ligament (UCL) tears • Sudden onset • One pitch • Swelling • Instability and severe pain with stability testing • Early surgery

  9. Specific injuries • Chronic UCL • Medial pain, late cocking to acceleration phase • Stress test: anterior band

  10. Specific Injuries • Chronic UCL treatment • Same as for little league elbow • May add hinged elbow brace for 6 weeks • Surgery: older athlete, valgus instability despite 6 months of nonsurgical treatment

  11. Specific Injuries • Posterior compartment • Impingement and bone spur formation • Possible loose bodies • Pain and locking especially during follow through

  12. Conclusions • Elbow injuries are more frequent than shoulder • 50 – 75% of adolescent baseball players report pain • Side-arm 3X more prone to injury • Curve-balls = shoulder pain sliders = elbow pain

  13. Conclusions • Overlap between prevention and treatment • Prevention should begin as soon as athletes begin organized sports • Avoiding year-round sports, 2 – 3 months of complete rest per year • Early recognition key to preventing damage

  14. Thank you

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