Introduction
When an overhead athlete throws, their elbow experiences a great deal of tension. The bone and soft tissue of the elbow joint distribute the stresses produced during the different throwing arc stages. Repetitive stress causes attritional elbow injury in athletes, especially baseball players. The body is unable to recuperate from these frequent play periods since there is insufficient time for rest and recovery. Baseball and other overhead sports, like softball, football, tennis, and javelin, are known for this particular array of injuries.
What Are the Common Throwing Injuries of the Elbow?
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Tendinitis in the Flexor Tensor
The flexor or pronator tendons on the inner side of the elbow, where they join the humerus bone, can become irritated and inflamed with repeated throwing. Throwing causes discomfort, and if the tendinitis is severe, there is pain during rest as well.
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Injury to the Ulnar Collateral Ligament (UCL)
The ligament that throwers injure is the ulnar collateral ligament (UCL). UCL injuries can vary in severity from little inflammation and damage to a total rupture of the ligament.
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Overload With Valgus Extension
The olecranon and humerus bones are bent and compressed against one another during the throwing motion. This can eventually result in valgus extension overload (VEO), a disorder marked by aberrant bone development and the deterioration of the protecting cartilage on the olecranon. Athletes with VEO feel discomfort and edema.
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Stress Fracture of the Olecranon
Stress fractures happen when muscles get too tired to withstand further force. Stress fractures are microscopic cracks that occur when an overstressed muscle eventually transmits that overload of stress to the bone. In throwers, stress fractures most frequently occur in the olecranon.
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The Ulnar Neuritis
The ulnar nerve wraps around the bony protuberance at the inner end of the humerus when the elbow is bent. Ulnar neuritis, a disorder caused by irritation of the nerve, is the result of this straining or snapping. The ulnar nerve is frequently strained and may even become loose in throwing athletes, leading to excruciating snapping. When ulnar neuritis strikes a thrower, the agony is similar to electric shocks, beginning at the inner elbow (often referred to as the "funny bone") and continuing up the nerve until it enters the forearm. During or just after throwing, they can have numbness, tingling, or discomfort in their little and ring fingers. These sensations might also last when they are at rest.
What Are the Causes of Throwers Elbow?
Throwers typically sustain elbow injuries as a consequence of overuse and repeated exertion. The number of pitches thrown, innings pitched, and months pitched annually all have a significant impact on the injury rate of baseball pitchers. Pitchers who engage in showcases, throw at a faster velocity, or are taller and heavier are likewise more likely to sustain an injury. The largest risk of injuries occurs in pitchers who throw while fatigued or with arm discomfort. Many times, after an athlete quits throwing, the soreness goes away.
What Are the Symptoms of Throwers Elbow?
The majority of elbow injuries cause pain during throwing or after. They frequently restrict one's throwing range or slow down one's throwing speed. Pitch height may also start to become noticeable to the athletes or coaches. An athlete with ulnar neuritis will often have tingling and numbness in the elbow, forearm, or hand.
How to Diagnose Throwers Elbow?
1. Physical Examination:
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The athlete's overall health, the kind and frequency of their sports engagement, and the onset and duration of their symptoms are all discussed during the first doctor's appointment.
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The doctor will assess the elbow's strength, stability, and range of motion during the physical examination. They could assess the athlete's shoulder as well.
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In addition, the physician will measure the size and appearance of the muscles and compare the damaged elbow to the uninjured one.
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Sometimes, they will measure muscular strength and sensation.
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To determine the precise site of the pain, the physician may apply direct pressure across a variety of locations after asking the athlete to select the spot that hurts the most.
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The valgus stress test will be used by the physician to replicate the forces exerted on the elbow during throwing. A pressure band is applied to the elbow's side by the physician while the arm is held still. It is deemed a positive test if the elbow is loose or if there is discomfort throughout the exam. The outcomes of these examinations assist the physician in determining whether more elbow imaging or testing is required.
2. Imaging:
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X-Ray Imaging Tests: X-rays provide detailed pictures of dense objects, such as bone. Bone spurs, stress fractures, and other anomalies will be visible.
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CT Scans, or Computed Tomography: A three-dimensional view of the bony structures is provided by CT scans, which are highly useful in identifying bony problems such as bone spurs that may cause discomfort or impede motion.
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Magnetic Resonance Imaging (MRI): MRI scans offer a superior image of the elbow's soft tissues and can assist the physician in differentiating between ligament and tendon diseases, which frequently present with similar symptoms and physical examination results.
How to Treat Throwers Elbow?
1. Non-Surgical Care: Treatment for elbow-throwing injuries often starts with a brief period of rest.
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Physical Medicine: Strength and flexibility may be regained with certain workouts. A doctor's or physical therapist's rehabilitation regimen will involve a gradual return to throwing.
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A Change in Posture: It is possible to assess throwing mechanics to adjust body placement that overstresses the elbow.
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Medications that Reduce Inflammation: Pain and swelling can be reduced by medications like Ibuprofen and Naproxen, which are available in prescription-only dosages.
2. Surgical Intervention:
Surgical therapy may be considered if the athlete's symptoms are not alleviated by nonsurgical means.
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Arthroscopy: Arthroscopic procedures can be used to remove bone spurs on the olecranon as well as any loose bone or cartilage fragments within the elbow joint.
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Rebuilding of the UCL: Sportsmen with a strained or unstable UCL who show no improvement with conservative care may benefit from surgical ligament repair. The majority of ligament tears are not repairable with sutures. The UCL has to be surgically repaired to rebuild the elbow's strength and stability. The doctor uses a tissue transplant to repair the damaged ligament during the treatment.
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Anterior Transposition of the Ulnar Nerve: To keep the nerve from extending or breaking in ulnar neuritis patients, it can be relocated to the front of the elbow. This is referred to as an ulnar nerve anterior transposition.
Conclusion
Throwing overhead puts the elbow under extreme valgus stress, which puts athletes at risk for a particular set of ailments. Injuries have increased dramatically as a result of a rise in the popularity of overhead-throwing sports. Appropriate care still depends on an understanding of the elbow's anatomy, function, and the biomechanical link between the two. The enhanced outcomes are a consequence of advances in surgical procedures such as grafts, multiple fixation devices, and rebuilding the UCL.
