Elbow Injury – High School Football


C. Chamberlain, K. Vanic, G. Rozea \ East Stroudsburg University, PA

email: kvanic@esu.edu (Sponsor: K. N. Waninger, FACSM)

HISTORY: A 15-year-old high school linebacker was involved in a pile-up after diving for fumbled ball during a junior varsity football game. Athlete remained on the field clutching his left elbow. He described feeling a clunk and the sensation of his arm “popping out”.

PHYSICAL EXAMINATION: Initial on-field observation showed an obvious deformity at the elbow with a noticeably sulcus at distal humerus and prominent olecranon. Palpable point tenderness and observable swelling was evident. Athlete appeared neurologically and vascularly intact. The athlete was splinted and taken off the field by a stretcher. EMS pre-hospital care included pain medication prior to emergency room transport. The athlete was then transported to the hospital for further examination and diagnosis.

DIFFERENTIAL DIAGNOSIS: Compartment syndrome UE, Coronoid fracture, Terrible triad (elbow dislocation with radial head and coronoid fracture), Olecranon fracture, Posterolateral rotatory instability, Radial head fracture, Valgus Instability, Distal humerus fracture, Monteggia fracture, Medial Epicondyle fracture

TEST AND RESULTS: Initial elbow radiographs included AP, lateral and oblique views. Radiographs were revealed no apparent fracture. Stress films not considered and MRI not warranted at the time of evaluation. Prominent shift of olecranon posteriorly.

FINAL/WORKING DIAGNOSIS: Posterior elbow dislocation

TREATMENT AND OUTCOMES: After the initial hospital visit, the athlete was splinted in 90 degrees of flexion for 10 days and instructed to use a sling for comfort. Once the splint was removed, he remained in the sling for an additional three days and performed passive elbow motion as tolerated. Physical therapy commenced three times a week and included active/passive range of motion exercises. Cryotherapy and electrical stimulation modalities were administered for pain relief and muscle relaxation. At three weeks post injury, the athlete was permitted to increase exercise routine and was provided home exercise programs (which was performed with the high school’s athletic trainer). Passive extension brace was used 10 minutes/day; four times a day for subsequent 3-6 weeks post injury. Athlete did not return to full contact football activities. Five months post-injury the athlete was cleared for return to full activity. Stretching and strengthening, joint mobilization and functional activities continued through rehabilitation process. Pre-injury strength returned prior to spring sports season.

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