Traumatic Lesions of the Elbow and Wrist

, Miguel Trigueiros4, 5, 6, Nuno Sevivas7, 8, 9, 3 and Luigi Pederzini10



(1)
Fluminense Federal University, Niterói, Rio de Janeiro, Brazil

(2)
Dom Henrique Research Centre, Porto, Portugal

(3)
Clínica do Dragão, Espregueira-Mendes Sports Centre – FIFA Medical Centre of Excellence, Estádio do Dragão, Porto, Portugal

(4)
Orthophysiatrics department HSA_CHP Porto, Pathology of the Hand/Wrist and Elbow Unit, Porto, Portugal

(5)
Hospital de Santa Maria, Porto, Portugal

(6)
Invited professor at the Sports Medicine Postgraduation, Faculdade de Medicina Universidade do Porto, Porto, Portugal

(7)
Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, 4710–057 Braga, Portugal

(8)
ICVS/3B’s – PT Government Associate Laboratory, Braga/Guimarães, Portugal

(9)
Orthopaedics department, Hospital de Braga and Hospital Privado de Braga, Braga, Portugal

(10)
Orthopaedic and Arthroscopic Department, New Sassuolo Hospital, via F. Ruini, 2, 41049 Porto, Portugal

 




Keywords
ElbowWristTraumaFootball



29.1 Introduction


Football is a sport characterized by physical contact, which explains the high rate of musculoskeletal injuries in players described in the literature. The most common injuries are lower limb injuries (69–88%) [14], but there has also been a recent increase in the rate of upper limb injuries associated with football [5, 6]. A small but significant proportion of injuries occur in the upper limb (6%), a large percentage of which affect goalkeepers (often in the thumb, 9%) [7]. Among the other players, however, there is a disturbing incidence of acute traumas due to falls. These injuries tend to affect the elbows, wrists, and hands and are sustained predominantly by players in the full-back, center-forward, and center-half positions. Outfield players are prone to acute lesions (bruises, lacerations, and sprains), whereas fractures and dislocations are less common. Despite its grass covering, the football field is hard. Players sometimes fall from a height of 2–3 m directly onto the ground and often use the upper limbs to deaden the impact.

These falls can be very traumatic. The upper limb receives all of the axial forces, causing indirect traumas with resultant injuries to the shoulder, elbow, and wrist. As mentioned above, although not common, fractures and dislocations are possible. These injuries must be diagnosed quickly as they represent a serious risk to the player.

This chapter discusses the main injuries involving the elbow and wrist encountered in football players.


29.2 Traumatic Lesions of the Elbow


The most common traumatic lesions of the elbow are sprains. Serious injuries due to contact with the ground are unlikely, and football players do not wear the elbow pads used in other sports. However, there are rare instances of capitulum humeri lesions due to abnormal falls with the hand in a defensive attitude, as well as isolated olecranon fractures.


29.2.1 Elbow Dislocation



29.2.1.1 Anatomy


The elbow may be described as a “modified hinge” joint (ginglymotrochoid) composed of three articulations: ulnohumeral (hinge), radiohumeral (rotation), and proximal radioulnar (rotation). The bone structure associated with the ligament complex, tendons, and muscles gives the joint excellent stability.


29.2.1.2 Mechanism of Injury


Posterior dislocation is the most common type of elbow injury. These injuries occur due to contact with an opponent when running or to a fall after heading the ball. There are three possible mechanisms of dislocation:


  1. 1.


    Levering force that unlocks the olecranon, combined with loading that causes complete dislocation

     

  2. 2.


    Direct injury to the elbow, although dislocation is often caused indirectly by a fall onto the palm of the hand with the arm extended and retroposed; the combination of elbow extension, arm abduction, and forearm supination results in soft tissue injury to the capsule, collateral ligaments, and musculature (posterior type dislocation)

     

  3. 3.


    Direct force at the posterior forearm, with the elbow in the flexed position (anterior type dislocation). Deformity, functional impairment, and pain require radiographic confirmation and immediate dislocation reduction

     


29.2.1.3 Diagnosis


Elbow dislocation is often evident on inspection. Deformity, pain, and functional impairment indicate dislocation, but confirmation is required by radiography (anteroposterior and lateral views). Oblique views are helpful to determine periarticular bone fragments.

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Jul 9, 2017 | Posted by in MUSCULOSKELETAL MEDICINE | Comments Off on Traumatic Lesions of the Elbow and Wrist

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