Elbow Pain And Swelling In A Football Player

Abstract

HISTORY: 17 y/o AA right handed football linebacker from a local high school seen in office on 9/4 with complaint of left elbow pain and swelling after falling on an outstretched elbow and wrist on 8/30. He experienced immediate pain and swelling. Seen in ER on 8/30 and placed in a splint and referred to orthopedics for suspected fracture on xray. Seen by orthopedics on 9/3 and was diagnosed with soft tissue contusion and the splint was discontinued and placed in a sling. He returned to ER on 9/3 for increased swelling/bruising in the elbow and forearm; explained to him that increased swelling/bruising due to ibuprofen taken immediately after the injury. He denied paresthesia and pain at rest. He reported pain at both medial and lateral epicondyles. PHYSICAL EXAMINATION: Inspection: diffuse swelling with bruising on medial aspect of elbow and extending down forearm Palpation: TTP to medial and lateral epicondyles and at common extensor muscle and common flexor muscle bundle ROM: normal with no pain Strength Testing: Resisted flexion, extension, supination and pronation were all 4/5 UCL laxity: painful upon valgus stress Neurological: normal Vascular: radial and capillary refill was normal DIFFERENTIAL DIAGNOSIS: 1 coronoid fracture of ulna 2 common flexor and extensor muscle bundle strain 3 UCL sprain 4 Medial and/or lateral epicondyle fracture TEST AND RESULTS: Elbow xray on 8/30 in ER showed no fracture or dislocation. No joint effusion was present. MRI was ordered after evaluation. MRI of left elbow: 9/15 - complete disruption of UCL and common flexor tendon - partial tearing of deep fibers of common extensor tendon proximally - minimal bone contusion capitellum - extensive soft tissue edema around the elbow with moderate intra-articular effusion FINAL WORKING DIAGNOSIS: Rupture of common flexor tendon and UCL TREATMENT AND OUTCOMES: A) At the initial visit: 1 Rest - he was removed from football. 2 Ice 3 Compression with ace-wrap 4 Elevation 5 Support with sling 6 Cold and electrical stimulation treatment in-office. 7 Elbow MRI ordered. B) Visit after MRI 9/16 1 Placement in extension splint to restrict elbow motion and limit retraction of common flexor tendon 2 Hand surgeon referral C) Hand Surgeon's office visit 9/23 1 Placed in elbow brace 2 Rehab by ATC at high school 3 Return to play as tolerated 4 Follow up appt on 11/4