CHAPTER 50 • ELBOW ARTICULAR LESIONS AND FRACTURES 293- Immobilization in a cast or splint for an unstable
elbow is contraindicated for more than 10 days,
because prolonged immobilization of the elbow can
lead to intractable stiffness.
•Treatment is dictated by the athlete’s symptoms and
desire to return to play.
•For MCL injuries, a trial of nonoperative treatment
with modalities to reduce swelling and medial sided
flexor-pronator strengthening as well as rotator cuff
strengthening may be sufficient.
•For LUCL injuries, physical therapy is usually inef-
fective for athletics as well as pain and dysfunction
with daily living. A hinged brace may be tried for low
demand people, but this is rarely tolerated.
TREATMENT (OPERATIVE)
•For MCL injuries, the indications for surgery are a
failure of a quality rehabilitation regimen and the ath-
lete’s desire to return to previous level of activity. The
surgical treatment consists of a tendon graft approxi-
mating the attachments of the MCL (Morrey, 1996).
Graft choices are palmaris longus or plantaris ten-
dons. The reconstruction described by Jobe (Jobe,
Stark, Lonbardo, 1986) is technically demanding,
requiring five tunnels with a tendon weave. Newer
techniques such as the docking procedure
(Rohrbough et al, 2002) or use of interference screws
are promising (Ahmad, Lee, and ElAttrache, 2003).
Results of primary repair of the MCL (without recon-
struction with a graft) have been disappointing, and
are usually reserved for patients with a bony avulsion
at the MCL origin or insertion (Williams and
Altchek, 1999).
•For LUCL injuries, the indications are pain and dys-
function, either in activities of daily living or with ath-
letics. Surgical treatment consists of either repair of
the LUCL, or surgical reconstruction of the LUCL
with a tendon graft (O’Driscoll, Bell, and Morrey,
1991).
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Ahmad CS, Lee TQ, ElAttrache NS: Biomechanical evaluation
of a new ulnar collateral ligament reconstruction technique
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Conway JE, Jobe FW, Glousman RE: Medial instability of the
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lateral ligament in athletes. J Bone Joint Surg Am68:1158–
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1999.50 ELBOW ARTICULAR LESIONS
AND FRACTURES
Edward S Ashman, MDINTRODUCTION- Elbow articular lesions and fractures are not uncom-
mon in the athlete. Seven percent of all fractures occur
in the elbow (Regan, 1994). It is important for the
sports physician to become familiar with patterns of
injury and treatment options for athletic injuries of the
elbow. - The elbow’s high degree of bony congruity, soft tissue
aspects, and high potential for stiffness make the
elbow uniquely challenging to treat after athletic
injury. A common theme of elbow injury is that early
motion is important to minimize stiffness and to nour-
ish the joint. Range of motion(ROM) required for
activities of daily living is defined as 30–130°of flex-
ion and 50°of supination and pronation (Scheling,
2002). Athletic activities may require far more motion
than this. - Pediatric and adult elbow fractures differ considerably
and will be discussed separately.