ACUTE ELBOW PAIN - BASKETBALL 1325

Abstract

HISTORY - A 28-year old, right-handed male was hit in the right triceps during a pick up game of basketball. He felt his forearm was forcibly extended beyond its usual range and felt a sudden sharp pain. He continued to play with elbow soreness. Two hours later, he experienced increased pain with decreased range of motion and joint swelling. Prior to this injury, he recalled having a long standing decreased elbow range of motion since the age of 11, when he was a little league pitcher. At age 14, he experienced lateral elbow pain, had x-rays taken and was told he had “compressed cartilage.” He received ultrasound and some physical therapy. Through his 20's he found it increasingly difficult to complete a full round of golf and experienced elbow soreness and numbness with pitching, lifting and throwing a football. PHYSICAL EXAMINATION - Examination was done one day post injury. There was diffuse joint swelling and erythema. No ecchymosis was noted. He had tenderness to palpation over the medial and lateral epicondyles, and distal triceps. Passive elbow range of motion was restricted between minus 45° of extension and 95° of flexion. No valgus or varus instability. The right shoulder lacked 30° of internal rotation and a positive lateral scapular slide in positions 2 and 3 on the right. There was crepitus with supination and pronation. Wrist flexion and extension were within normal limits. Sensation was intact DIFFERENTIAL DIAGNOSIS - Loose body Traumatic bursitis Osteochondritis dissecans Humeral/supracondylar fracture Dislocation of the humeral-ulnar joint TESTS AND RESULTS - AP and lateral radiographs of the right elbow: Large joint effusion; decreased radial humeral joint space; small osteophyte seen on the articular margin of the coranoid process of the ulna; osteopenia of the radius and ulna; no fracture; no loose body. MRI elbow: Joint effusion, a 1.2 cm loose body noted in the olecranon fossa; possible additional loose body within the ventral aspect of the joint and measures only a few mm in size. Degenerative changes are noted within the capitellum with evidence of subchondral sclerosis and cystic changes, as well as osteophytosis. No other abnormalities noted. WORKING DIAGNOSIS - Loose body TREATMENT - NSAIDS, ice and rest initiated day after injury. Resolution of swelling led to a “fixed” range of motion between minus 20° extension and 120° flexion, he underwent an arthroscopic procedure to remove the loose body. Started range of motion and strengthening exercises two weeks post surgery. Returned to sports one month after surgery.