The elbow is a hinge joint that connects the humerus (upper arm bone) to the radius and ulna (forearm bones). The joint allows flexion (bending the elbow) and extension (straightening the elbow) movements as well as supination and pronation (turning your palm up and down).
The elbow is made up of three bones and a multitude of soft tissue structures that are important for the stability, movement and function of the elbow.
There are many possible injuries that can result from trauma at the elbow.
One trauma that can occur at the elbow is a fracture. A fracture is where the bone has been broken due to an impact, twist or severe strain.
Common fractures found at the elbow are a fracture to the radial head, olecranon or an avulsion fracture.
A radial head fracture is a break in the radius bone (which is one of the forearm bones) just below the elbow joint. This is usually as a result of a fall onto an outstretched arm. The olecranon is the bony part located straight under the skin; this can be anything from slightly cracked to being broken into multiple pieces.
An avulsion fracture is where the part of a tendon comes away from the bone and takes some of the bone with it. This is usually associated with a dislocation.
Elbow dislocations are not a common injury but can occur during a trauma. The most common dislocation, accounting for 90% of elbow dislocations, is a posterior dislocation.
This is where the ulnar and radius move backwards out of the joint. Because it is difficult to dislocate your elbow it will require a high level of force and usually a twisting movement to fully dislocate it.
Hyperextension of the elbow can also occur from a trauma. This is where the elbow extends back further than it is designed to. From this hyperextension, ligaments and other soft tissue structures can be injured.
There are three main ligaments in the elbow joint; the medial collateral ligament, the lateral collateral ligament and the annular ligament. Ligaments are short tough bands of fibrous connective tissue. They are attached to bones or cartilage and are responsible for holding bones together and stabilising joints.
In the elbow the medial collateral ligament is found on the inside of the elbow, the lateral collateral ligament on the outer aspect of the elbow and the annular ligament encircles the head of the radius, stabilising it inside a groove known as the radial notch. Although ligaments are relatively strong and rigid by nature, it is possible to injure them.
Ligament injuries, also known as ligament sprains, are caused when the fibres become stretched or torn, or even when a ligament completely ruptures. The worse the sprain or injury the more it will affect the ligament. Ligaments sprains or injuries can be classified into three grades:
- Grade 1 - is a stretching of the ligament or very mild tear. There is little to no instability of the joint resulting from this type of sprain and whilst there may not be much pain or inflammation, a mild sprain can increase the risk of re-injury.
- Grade 2 - is a more severe but still incomplete tear of the ligament. This results in some joint laxity or loss of stability. Swelling and bruising are usually present with this grade of ligament injury and use of the joint can be difficult.
- Grade 3 - is a complete tear or rupture of the ligament. This will result in severely swelling, bruising and bleeding under the skin. As a result of a grade 3 ligament injury the joint is unstable and unable to bear weight resulting in a severe loss of function.
There are multiple tendons that can be injured in the elbow but a common one is where the biceps muscle is attached to the radial tuberosity which is located just below the elbow joint. This biceps tendon can be strained, torn or even come away from the bone. This is common place in weight lifting or other strength type sports and activities.
Another structure that is possible to injury from trauma is the nerves. There are three nerves that are found around the elbow; ulnar, radial and median nerve. The most common nerve that can be affected is the ulnar nerve. This is due to its superficial location at the elbow.
There are many different ways of causing trauma to your elbow. It could be from a fall, a direct impact to the elbow or from a twisting motion. Commonly a person has fallen onto an outstretched arm or directly onto the elbow.
It is not uncommon to experience more than one injury during one accident, for example, causing a dislocation of your elbow as well as a fracture.
Trauma can occur in everyday life, from a fall or even a road traffic accident. It can also occur during a sporting situation. The risk of having a traumatic event is increased depending on the sport you play. For example you may be more at risk playing ruby than you would be play golf due to the nature of the sport. Skiers and weight lifters are also more at risk due to the requirements of the sport.
With all traumatic elbow injuries the treatment and recovery time will be different depending on the severity of the injury. With more simple injuries they can be treated with conservative management and following the principles of RICE.
As well RICE, a course of physiotherapy to regain full range of movement and strength may be required. However, if it is a more complex injury surgery, or more complex management options, may be required.
If you have experienced an elbow fracture this can take anywhere from 6 to 12 weeks to fully heal. Usually you will be wearing a splint or a cast for at least 6 weeks to immobilise the joint. Once the cast is off, time will be needed to rehabilitate the joint to regain full range of movement and strength back. This may take weeks or months. If surgery was indicated you will be restricted from doing certain movements, such as lifting and pushing/pulling activities, for 6 weeks after the surgery.
With an elbow dislocation, a simple dislocation will be able to be realigned again in an emergency department and will be aided with painkillers. You will then usually immobilise the elbow in a sling for 1-3 weeks and then start gentle range of movement exercises. The elbow should not be immobilised for too long due to the risk of it becoming stiff. If the dislocation of more complex surgery may be indicated to realign the elbow and repair any damaged structures.
When it comes to ligament injuries, grade 1 ligament sprains usually heal within a few weeks. Maximal ligament strength will occur after six weeks when the collagen fibres have matured.
Grade 2 ligament injuries usually take somewhere between six to eight weeks to heal, at which point activity should then be progressed gradually, with a full recovery of strength and function taking anywhere up to two to three months.
Grade 3 ligament injuries usually take anywhere between three and six months to fully recover, however this obviously depends on the activities the person is looking to return to and whether or surgery is required.