Acute Elbow Trauma In A Collegiate Football Player

• Published in: Journal of athletic training 2001-01, Vol.36 (2), p.S-28
• Main Authors: Myers, C C, Messey, KA, Sauers, EL, Gabaldon, D L, Maddox, D M
• Format: Article
• Language: English
• ISSN: 1062-6050

Personal Data: A 19-year old male collegiate football athlete incurred a traumatic left elbow injury while returning a punt. As the athlete was being tackled, an opponent pulled on his left wrist, resulting in a traction force at the elbow. The athlete immediately felt a "pop" in his left elbow, and thought that his, "elbow was out of place". He reported no previous history of injury to his left elbow. Physical Signs and Symptoms: While approaching the injured athlete on the field the evaluating certified athletic trainer (ATC) noticed a visible deformity over the lateral aspect of the left elbow. However, once the ATC reached the athlete the visible elbow deformity was no longer present. The athlete initially reported that his "elbow had popped out", but he had quickly "put it back in". Upon further questioning of the athlete, it was discovered that following his initial injury, he had supinated his forearm and noted significant pain relief. The athlete was removed from the field and immediately evaluated by the team orthopaedic surgeon. Physical evaluation revealed decreased active range of motion (AROM) and decreased strength at the wrist and elbow, but no visible deformity. There was significant swelling of the left elbow noted several minutes after injury. Neurovascular structures were intact. Ice and compression were applied, and the athlete was put into a sling for comfort. Differential Diagnosis: 1) posterior elbow dislocation; 2) radial head subluxation; 3) radial head dislocation; 4) fracture of the proximal radius; 5) supracondylar fracture. Results of Diagnostic Imaging Tests: Radiographic evaluation revealed no abnormality of the proximal radius, proximal ulna, or distal humerus. Normal articulation of the radiohumeral, ulnohumeral, and proximal radioulnar joints was noted. Based on the mechanism of injury, history, and physical examination, the team orthopaedic surgeon diagnosed the athlete as having suffered a radial head subluxation. Clinical Course: Initial treatment of this injury involved the use of rest, ice, and compression to reduce pain and swelling. At one week post-injury pain and swelling had significantly resolved and light strengthening and AROM exercises were initiated. Proprioceptive and sport-specific exercises were added to the rehabilitation program at two weeks post-injury. Once the athlete achieved full AROM and strength of the wrist and elbow he was allowed to return to non-contact participation. At approximately four we