Elbow Injury- Pull Ups

Abstract

HISTORY: A 59-year-old right hand dominate male presented to our orthopedic clinic with complaints of pain on the medial side of his left elbow. He had no previous problems with this elbow until two weeks before his office visit. On that day he was doing a pull up on a standard pull up bar with his hands supinated when he felt a pop with immediate onset of pain in his medial, left elbow. The pain was severe enough that he had to stop working out. He continued to have medial elbow pain with any axial load to his forearm. He had no parasthesias. He was in good health with no systemic illnesses. PHYSICAL EXAMINATION: Upon physical exam he was in no acute distress. When comparing both upper extremities, there was no atrophy, deformity, ecchymosis or swelling of his upper extremity. He had some tenderness over the medial epicondyle. He was also tender 1.5cm distal to his medial epicondyle in the flexor mass, but this tenderness was proximal to the sublime tubercle of the ulna. The patient's elbow motion was 10 to 140 degrees. His medial collateral ligament was intact with no pain to valgus stress testing with the elbow in full extension, 30 degrees and 90 degrees of flexion. He was neurologically intact for all sensory and motor peripheral nerves in both upper extremities. He had full strength to resisted wrist flexion and this testing did not provoke his pain. He had a negative Tinel's at the elbow. DIFFERENTIAL DIAGNOSIS Medial Epicondylitis Tear of the Flexor Mass Ulnar Collateral Ligament Strain Fracture of the medial epicondyle Subluxation of ulnar nerve TESTS AND RESULTSPlain radiographs of the elbow including anterior-posterior and lateral view No abnormalities, medial epicondyle intact Magnetic Resonance Imaging High-grade partial tear of the common flexor attachment at the medial epicondyle with mild myotendenious strain of the pronator teres. The ulnar collateral ligament was intact. FINAL/WORKING DIAGNOSIS: Partial avulsion of the flexor-pronator mass, strain of the pronator teres TREATMENT AND OUTCOMESAllowed full range of motion of elbow but was restricted form weight lifting until follow up at six weeks. Allowed to increase weights to forearm at 6 weeks; advised to not do pull-ups Followed periodically in office until resolution of symptoms and return to sports at 6 months