ELBOW INJURY-FOOTBALL

Abstract

HISTORY A 15 year old freshman high school football player presented within 24 hours of injuring his right arm in a football game. While playing as a nose tackle, he was chop blocked. He fell and supported his body with his right arm with the elbow in extension. Immediately after the injury, he experienced numbness of the fourth and fifth digits of the right hand, which resolved in a few seconds. He did not experience any popping or buckling sensation during the injury. No manipulation or reduction of the elbow was attempted prior to the office visit. No previous elbow injuries. He is right hand dominant. PHYSICAL EXAMINATION Examination revealed a moderate right elbow effusion. No ecchymosis. The medial epicondyle and origin of the flexor pronator mass were tender to palpation. There is restricted flexion and extension (30–100 degrees) secondary to pain. Pronation and supination were painful. Valgus and varus stress at 0 and 30 degrees of elbow flexion without instability. No wrist or shoulder pain with passive or active range of motion. Right upper extremity was neurovascularly intact. DIFFERENTIAL DIAGNOSIS supracondylar fracture. elbow dislocation. radial head fracture. capitellum fracture. coronoid process fracture. medial epicondyle fracture. TESTS AND RESULTS AP/lateral/capitellum x-rays: Angulated radial head fracture. Approximately 30 degrees of apex ulnar angulation. Radial capitellar joint space widened almost 1 cm on lateral side. Avulsion fracture of medial epicondyle. FINAL/WORKING DIAGNOSIS Right elbow dislocation equivalent with radial head fracture. TREATMENT AND OUTCOME Open reduction and internal fixation of radial head fracture. Physical therapy – active and active-assisted ROM right elbow and forearm. Unlocked brace. Patient initially improved without problems. Then, 4 weeks post surgery developed decreased elbow flexion/extension as well as pronation/supination range of motion. Possible intra-articular loose body. Continue physical therapy. Follow-up in two weeks. Arthroscopy if no improvement in two weeks.