Elbow injuries are surprisingly common in sports. Dr. Aaron Baessler, a board-certified and fellowship-trained shoulder and elbow surgeon at Central Indiana Orthopedics, recently shared his expertise on the topic in an OrthoAlliance webinar covering sports injuries and prevention. Whether you’re a weekend warrior or a serious athlete, understanding these injuries can help you take proactive steps to stay in the game. Read on to learn about the most common elbow injuries, their causes, treatments and recovery expectations.
Tennis Elbow (Lateral Epicondylitis)
Tennis elbow is perhaps the most common elbow injury and affects almost everyone at some point in their life. Most frequently occurring in the person’s dominant hand, it’s commonly due to overuse of the tendons on the outside of the elbow, particularly affecting the extensor carpi radial brevis tendon, where over time it degenerates. While it’s called “tennis elbow,” most people who suffer from it don’t even play tennis. It’s primarily diagnosed through clinical evaluation and usually doesn’t require extensive testing like an MRI.
Symptoms
- Pain on the outer elbow
- Discomfort when gripping objects
- Decreased grip strength
Treatment
- Rest: Many people find relief simply by allowing time for healing, although this can sometimes take a year or more.
- Physical Therapy: Stretching and a personalized exercise program can speed recovery.
- Bracing: A counterforce brace, which is a brace that goes on the elbow just below where it hurts, can help alleviate pain.
- Injections: Corticosteroid or platelet-rich plasma (PRP) injections may be beneficial for some.
- Surgery: Considered only for patients who don’t improve after a year.
Golfer’s Elbow (Medial Epicondylitis)
Similar to tennis elbow, golfer’s elbow affects the tendons on the inner side of the elbow, often caused by repetitive gripping and wrist flexing motions. It occurs most commonly in golfers or people who throw or play racket sports.
Symptoms
- Pain on the inside of the elbow
- Potential ulnar nerve symptoms (or funny bone nerve symptoms), like tingling in the small and ring fingers
Treatment
The treatment approach is essentially the same as for tennis elbow, focusing on rest, therapy, bracing and injections.
Ulnar Collateral Ligament (UCL) Injuries
The UCL serves as the primary stabilizer against valgus stress (preventing the elbow from bending inward). Injuries typically present as a popping sensation on the inside of the elbow, accompanied by pain and a possible loss of throwing velocity.
UCL injuries can be classified into two main types: traumatic tears, often resulting from a fall or direct impact, and overuse injuries, which develop from repetitive stress, particularly in athletes with poor throwing mechanics. Overuse injuries frequently occur during the late cocking or acceleration phases of throwing and are common in those who pitch year-round without adequate rest.
Symptoms
- A popping sensation in the elbow
- Pain and loss of throwing speed
Treatment
- Rest: Essential for recovery, usually requiring up to six weeks off from throwing.
- Physical Therapy: Post-rest, to regain strength and flexibility. In throwers, gradually progress back to a throwing program.
- Surgery: Options like UCL reconstruction (commonly known as Tommy John surgery) may be necessary for severe cases. Recovery can take up to one year before throwers return to sport.
Biceps and Triceps Tears
Biceps and triceps tears are notable elbow injuries, often resulting from weightlifting or unexpected movements. While the biceps are primarily known for elbow flexion, their major role is in supination — helping with motions like turning a doorknob. The triceps, located at the back of the arm, are essential for elbow extension.
These injuries are more common in men in their 40s and can be linked to steroid use. Biceps tears usually present with a popping sound, swelling and visible deformity, and require prompt surgical intervention to avoid significant loss of supination strength. Triceps tears are less common, primarily affecting older individuals, and if untreated, can lead to a major loss of elbow extension strength.
Symptoms
- A popping sound at the elbow
- Swelling and visible deformity for biceps tears
- Significant weakness in arm movements
Treatment
Surgery is generally recommended to restore function, especially for biceps tears, which can lead to considerable loss of strength if left untreated. For both biceps and triceps repairs, the typical recovery time is about six months. After biceps surgery, you’ll be in a sling for six weeks, followed by early therapy to regain motion. Strengthening exercises begin at three months, with full recovery expected at six months. For triceps repairs, the approach is similar, but a different type of brace is used to control elbow motion.
Elbow Dislocations
An elbow dislocation occurs when the joint typically shifts out of place toward the back, often due to falling on an outstretched arm. There are two types: simple, with no fractures, and complex, which involves fractures. Dislocations result in tearing or stretching of ligaments, always the lateral ulnar collateral ligament on the outside and often, but not in all cases, the ulnar collateral ligament on the inside. Urgent medical attention is required to reduce or relocate the dislocated joint.
Symptoms:
- Visible deformity of the elbow
- Severe pain and swelling
Treatment:
For simple dislocations without fractures, surgery is generally not needed. The elbow is typically splinted for about a week before early motion exercises begin. Therapy is crucial to prevent stiffness – without it, the elbow may remain persistently stiff. In more simple cases, surgery is considered only for patients whose elbows remain stiff and unstable despite therapy. For complex dislocations involving fractures, surgery is usually required and should be performed urgently within a couple of weeks.
Overuse Injuries: Valgus Extension Overload and Little League Elbow
Valgus extension overload occurs primarily in throwers, where repetitive motion causes the back of the elbow to shear against the back of the arm or the upper arm (humerus), creating bone spurs on the backside of the elbow. Additionally, this motion stretches the ulnar collateral ligament on the inside of the elbow and compresses the structures on the outside, which can result in arthritic changes.
Little League Elbow is similar to valgus extension overload but affects children and adolescents. This injury occurs on the inside of the elbow, where the growth plate is repeatedly stretched by the ulnar collateral ligament, leading to a stress reaction and inflammatory response to the growth plate. Risk factors include kids who pitch year-round (more than eight months of competitive play), those who exceed 80 pitches per game and those who continue pitching despite experiencing pain or a decline in throwing velocity.
Symptoms
- Pain at the back of the elbow or inside
- Decreased throwing velocity
Treatment
Initially, the treatment for these overuse injuries is non-operative: stop throwing, take time off and use anti-inflammatories before gradually progressing back into a throwing program. If symptoms persist despite this approach, surgical options may be considered, typically involving a scope to remove bone spurs and address any ulnar nerve symptoms, such as pain or tingling in the forearm. Specifically, Little League elbow can be particularly challenging to manage since young athletes are often reluctant to stop playing.
Lastly, although rather rare, a stress fracture in the back part of the elbow can occur in throwers who continue to pitch despite pain. This injury typically causes pain on the posterior side of the elbow, worsening with throwing and improving with rest. Diagnosis requires a CT or MRI, and treatment generally involves non-operative measures, including complete rest for 6 to 12 weeks until symptoms subside.
Elbow injuries, whether from chronic overuse or sudden impact, are a common issue among athletes. Awareness of these conditions and their treatment can aid in a successful recovery. If you experience any pain in your elbow, don’t hesitate to consult an orthopedic expert. For chronic issues, call 800-622-6575 to schedule an appointment, or for more immediate needs, visit our Walk-In Clinic – no appointment needed. Learn more at ciocenter.com/services/walk-in-clinic/.
Watch additional presentations from the OrthoInsights Sports Injuries and Prevention webinar series at orthoalliance.com/orthoinsights-sports-injuries-prevention-educational-webinars/.