In the previous article, Dr. Foruria explained what are the 5 most common elbow injuries and why this joint is one of the most affected in athletes. Next, he gives us information on other sports diseases of the elbow.
- Primary elbow osteoarthritis
Primary elbow osteoarthritis appears in people who subject their elbows to repeated heavy weight bearing or frequent impacts, such as in gymnastics, weightlifting, boxing, martial arts, or any discipline in which the load of their own weight has to be supported on their hands.
Fortunately, elbow osteoarthritis preserves the articular cartilage in most cases, and is characterized by the appearance of osteophytes, outbreaks of joint effusion (synovitis, arthritis), and progressive decrease in the arc of mobility of the elbow in flexion and extension (inability to stretch or bend the elbow, with associated pain at both ends of the movement).
Osteoarthritis is prevented by avoiding unnecessary and repetitive overloading during training, which should be aimed solely at giving the maximum on the day of the competition. There are athletes who enter phases in which they punish themselves too much and end up making their joints sick. A good trainer or physical trainer is the best way to achieve our sporting objectives without injury.
- The thrower’s elbow
People who play sports in which balls or other objects are thrown (water polo, handball, baseball, javelin, and tennis on serves) can develop the so-called “thrower’s elbow”. During throwing, very important forces occur that produce three types of forces that can result in different combinations of injuries:
1) Medial tension forces on the elbow (valgus), which overload the internal collateral ligament, the flexor-pronator musculature and the medial epicondyle of the elbow, and can injure these structures and render them incompetent, thus rendering the elbow unstable and producing pain with throwing.
2) Compression and impact forces between the external face of the humerus (capitellum) and the radial head, which can produce osteoarthritis, the appearance of free bodies or the dreaded osteochondritis dissecans (see below).
3) Shear friction on the surfaces of the bones of the posterior aspect of the elbow (olecranon and humerus), with the development of local osteophytes that can block the extension of the elbow and eventually rupture producing arthritic flare-ups.
Throwing technique is fundamental in preventing these injuries. It is very important to avoid unnecessary overloading due to poor throwing technique.
- Osteochondritis dissecans
This disease is one of the most feared, as it can end the career of a professional athlete and the sporting aspirations of a person who suffers from it. It occurs in individuals who subject their joint to repeated impacts, forcing the continued collision of the radial head against the articular surface of the humerus, causing a fracture of a segment of cartilage with the bone beneath it, typically in the humerus.
This broken piece causes pain in the lateral aspect of the elbow, loss of mobility and inflammation, and can become loose and remain inside the joint as a free body that causes clicking and joint locking. It is a typical injury of throwers, gymnasts, and racquet sports or fight with impact as boxing.
Again, correct sports technique, proper joint rest, and periods of non-impact training can protect against this condition. Once it appears, early diagnosis and treatment are essential to achieve a good outcome.
- Distal Biceps Ruptures
Distal biceps ruptures are injuries that usually occur in middle-aged athletes (between 40 and 60 years of age), although there are also cases in younger people. It is produced when carrying a heavy weight or performing a sudden contraction of the biceps, which is totally or partially torn from its insertion in the radius.
Depending on the intensity and degree of injury, they may be more or less evident, and partial injuries may go unnoticed even when conventional ultrasound or MRI scans are performed.
Partial ruptures cause reproducible pain when contracting the biceps, while total ruptures, after a period of initial pain, usually do not cause discomfort, but cause loss of strength and fatigue for activities requiring elbow flexion and supination of the forearm (facing the palm of the hand upwards).
Injuries to the distal biceps tendon usually occur on a tendon with previous degenerative changes that have gone unnoticed until the time of rupture. Correct training while respecting rest times and extreme caution when resuming sporting activity after a prolonged period of inactivity are the strategies to reduce the risk of suffering this injury, which often requires surgical treatment in sportingly active individuals.
- Distal triceps ruptures
Tendon ruptures of the triceps are fortunately much rarer than those of the biceps. They occur with a very abrupt or powerful contraction of the triceps when pushing or carrying weight while stretching the elbow (typical of sports such as weightlifting, or workouts such as bench presses).
The main risk factor for this injury and other tendon ruptures is the use of corticosteroids, steroids or anabolic agents to promote the development of muscle mass or for the treatment of certain diseases. Avoidance of these drugs, unless they are for the treatment of a disease, is the main preventive measure to be taken, together with proper muscle training.
- Ligament injuries
The medial and lateral collateral ligaments are two fundamental structures for keeping the bones of the elbow in contact during joint movement. While the lateral collateral ligament is injured with some frequency with severe traumatic accidents accompanying fractures and dislocations of the elbows (usually from falls on the hands), the medial collateral ligament is more frequently injured in the form of progressive wear and tear especially in pitchers (typically baseball).
Preventive measures for acute traumatic injuries include the use of hand and elbow protection in sports with a high risk of falling (such as skating), as well as instruction and training to fall and roll correctly in the event of an accident. As for medial collateral ligament injuries, again proper throwing technique and proper rest are critical to not suffering from this problem.