POSTERIOR ELBOW IMPINGEMENT

Posterior Elbow Impingement

Posterior elbow impingement is a condition where bones and soft tissues collide at the back of the elbow joint, causing pain and restricted range of motion. This condition is commonly seen in sports and occupations involving repeated extension of the elbow, such as baseball, gymnastics, and volleyball.

Mechanism of Occurrence

1. Hyperextension Stress:
   ・Caused by repeated excessive extension of the elbow during activities like pitching and gymnastics.
2. Bone Collision:
   ・The posterior parts of the humerus (olecranon fossa) and the olecranon of the ulna repeatedly contact each other, causing wear and collision.
3. Formation of Bone Spurs:
   ・Chronic stress leads to the formation of bony projections (bone spurs) at the back of the elbow, worsening the collision.
4. Entrapment of Soft Tissues:
   ・Joint capsule and synovium become entrapped and inflamed.

Main Causes

1. Sports Activities:
   ・Particularly common in baseball pitchers and gymnasts.
2. Overload Movements:
   ・Repetitive hyperextension of the elbow.
3. Trauma:
   ・Sudden external force or falls causing stress on the elbow.
4. Age-Related Changes:
   ・Degenerative changes in the joint making collisions more likely.

Symptoms

1. Pain at the Back of the Elbow:
   ・Pain is especially severe when fully extending the elbow.
2. Swelling and Tenderness:
   ・Swelling and tenderness at the back of the elbow.
3. Limited Range of Motion:
   ・Difficulty fully extending or bending the elbow.
4. Clicking or Locking Sensation:
   ・Sensation of catching due to bone spurs or entrapment of soft tissues.
5. Decreased Grip Strength:
   ・Weakness in the hand and arm due to pain.

Diagnosis

1. Medical History and Physical Examination:
   ・Confirm the location and onset of pain, evaluate the range of motion and symptoms during movement.
2. Imaging Tests:
   ・X-ray: Confirm presence of bone spurs and bone deformities.
   ・MRI: Assess inflammation and entrapment of soft tissues and synovium.
   ・CT Scan: Identify detailed bone structure and position of bone spurs.
   ・Ultrasound: Observe real-time movement of soft tissues.

Treatment

Conservative Therapy

1. Restriction of Sports Activities:
   ・Avoid stress on the elbow until symptoms improve.
2. Icing and Inflammation Management:
   ・Use ice and non-steroidal anti-inflammatory drugs (NSAIDs) to reduce pain and inflammation.
3. Use of Orthotics:
   ・Stabilize the joint with elbow supports or straps.
4. Physical Therapy:
   ・Rehabilitation to strengthen shoulder and core muscles, and enhance flexibility.
5. Joint Injections:
   ・Administer steroid injections in severe cases.

Surgical Therapy

• Arthroscopic Surgery:
  ・Remove bone spurs and entrapped soft tissues. Minimally invasive and quick recovery.
• Synovectomy:
  ・Remove the synovium in cases of severe synovitis.

Recovery Period

• Conservative Therapy: Symptoms improve in a few weeks to months.
• Post-Surgery: Generally takes 3 to 6 months to return to sports.

Prevention

1. Learning Proper Form:
   ・Guidance on movements that reduce stress on the elbow.
2. Managing Training Volume:
   ・Ensure adequate rest to avoid overuse of the elbow.
3. Improving Strength and Flexibility:
   ・Strengthen shoulder and core muscles, and enhance flexibility around the elbow joint.
4. Early Intervention:
   ・Seek appropriate treatment at the onset of pain or discomfort.

Note: Posterior elbow impingement can become chronic, making early diagnosis and treatment crucial. Ignoring symptoms, especially for athletes, can make it difficult to return to competition.

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