Boxers Elbow d2bk

1. definition. m 2. causes. m 3. clinical symptoms m 4. diagnosis m 5. management m 6. case study m 7. recent advancements m

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`algus Extension Overload Syndrome of the Elbow

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An overuse disorder caused by repetitive and uncontrolled valgus forces demonstrated during the throwing motion, especially in late acceleration and deceleration

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Also may be seen in boxers

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Osteophyte and loose body formation occurs secondary to a repetitive abutment of the olecranon against the fossa

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Anterior traction on the coronoid process and posterior compression between the olecranon, trochlea and fossa may generate synovitis, hypertrophic changes and destructive t changes and even loose bodies.; David C Reid

=oint of pain

=osterior elbow pain with lack of full extension m Catching or locking during elbow extension m Occasional Snap may be present. m

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ïistory will reveal the condition.

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=lain films: A= lateral may show a loose body or osteophyte formation at the olecranon

Conservative m Surgical: Removal of the loose body m

= overuse injuries are treated using protection, rest, ice, compression, elevation, medications, and modalities (=RICEMM).

once the pain is resolved or is improved enough so that strengthening can begin. m Flexibility and strengthening are the main goals of therapy. m Care should be taken not to proceed though this phase too quickly as the overuse syndrome can return. m The athlete may begin with simple ball squeeze and crumbling newspaper with the affected hand, causing gentle strengthening of the forearm muscles. m

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fulfilled with a home therapy program.

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the athlete can perform a preventative program with an athletic trainer or strength and conditioning coach at regular intervals.

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Coaches are very important during this phase.

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Occasional use of NSAIDs or cryotherapy may be needed.

Name: Sanampal Singh. m Age: 18yrs Sex: Male. m Occupation: Student ( boxer) m Address: Amritsar. m ïand dominance: Right. m

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r r : pain on forceful straightening of the left elbow.

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=atient was apparently well until a week back he had a bout of boxing match wherein he hit a forceful extension for a punch (JAB) and experienced a sharp pain but then continued for another 2 mins and then he stopped due to pain, the following week he was on rest for a week but pain persisted hence had to report to the ïealth Centre, O=D on 14th Aug ¶07.

= no relevant injuries. m = dull diffused type End range extension rest m

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no swelling, deformity or skin change

no temperature difference, tenderness felt at the olecranon process.

no tightness. End Extension is limited. MMT : Grade `. m

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No X-Rays taken.

To decrease pain m To improve range of motion m To prevent further insult to the t m To enhance proper bio mechanics of the t m Enhance pain free ADL·s m Return to Sport activity. m

=rotection, Rest, Ice, Compression, Elevation, Medications, Modalities (=RICEMM) Moist =acks, Ultrasound,etc. m

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r Modify Intensity, duration, and technique of forearm activity Use of proper size and type of equipment Counter-force bracing

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use of sensory level high voltage alternating current in conjunction with pre exercise heat or post exercise ice has demonstrated the most beneficial effects at the `irginia Sportsmedicine clinic;2002.

The program created by Nirschl and Sobel was designed for elbow (tendinosis), the most frequently encountered overuse injuries of the elbow in the clinical setting. m =ain Charting. m

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Stress fractures are a type of overuse injury.

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These tiny cracks in your bones develop when your muscles become overtired (fatigued) and can no longer absorb the shock of repeated impacts.

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When this happens, the muscles transfer the stress to the bones, creating a small crack or fracture.

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Stress fractures also can occur with normal usage if osteoporosis or some other disease weakens your bones and leaves them vulnerable.

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These fractures are often called "insufficiency fractures" because there isn't enough bone to withstand the normal stress of daily use

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Most stress fractures occur in the weightbearing bones of the foot and lower leg.

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Athletes who participate in high-impact sports such as track and field, basketball, gymnastics, ballet or tennis

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Adolescents whose bones have not yet fully hardened

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Women, particularly female athletes, who have abnormal or absent menstrual cycles that can result in decreasing bone mass

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Military recruits who suddenly must shift from a sedentary civilian life to a more active training regime

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A stress fracture develops from continued physical stress on the bone rather than from a single blow to the bone. It can be caused by:

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Increasing the amount or intensity of an activity too quickly (most common)

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Switching to a different playing or running surface

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Wearing improper or old shoes

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=ain that develops gradually, increases with weight-bearing activity, and diminishes with rest

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Tenderness to touch at the site of the fracture

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Swelling and warmth at the site of the injury

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Localized pain on the bone

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ïistory will give a clue about the injury.

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X-ray: although not confirmatory.

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Bone Scans:

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MRI:

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Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain.

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Rest is the most important thing you can do for a stress fracture. This includes avoiding the activity that caused the fracture and any other activities that cause pain.

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r Îou may need crutches or a walking cane to keep pressure off the leg, but most people do not.

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Maintain a healthy diet. Eat calcium-rich foods to help build bone strength.

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Use the proper equipment for your sport. Don't wear old or worn running shoes.

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Alternate activities. For example, you can alternate jogging with swimming or cycling.

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Slowly increase any new sports activity. Gradually increase time, speed and distance.

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Name: Sarabjit Kaur.

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Age: 18 yrs

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Occupation: Student; athlete (hand ball)

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Add: Amritsar.

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Chief Complaint : pain on the right leg during walking and running.

Sex: Female.

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ïO=I: =atient was apparently well until 2 weeks back she experienced slight pain but she neglected it for a whole week but did not go for her practiced sessions for the following week , but on 13th Aug he went for a bout of games and then pain increased greatly hence she reported to the ïealth Centre, O=D on 14th Aug. = No Complaint of relevance

Nature of =ain: dull , aching. m =rovocative Factors: weight bearing activities. m =alliative Factors: rest. m =ain on `AS: m

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On Observation: No Deformities. Mild localized swelling. No Skin changes.

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On =alpation: Temperature: mild warmth. Tenderness: Grade II. On Examination: No Tightness as such. Ranges of Motion within functional limits. Muscle =ower : MMT (Kendal·s) Grade 5.

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Investigations: X-Ray: slight periosteal inflammation

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to relieve pain.

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to prevent further damage.

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activity modification.

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to strengthen the ing musculature.

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correct Biomechanical cause.

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to maintan Ranges of motion

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= activity modification muscle strengthening and generalized conditioning. anti supination orthotics. achilles rehabilitation ladder Fitness training during the rehabilitation period should include cross-training so that excessive loading of the affected bone is avoided

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Treatment consists of activity restriction to minimize symptoms before engaging in a program of increasingly demanding strengthening and conditioning exercise, leading to an eventual return to play in 8-12 weeks.

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3 studies have demonstrated that use of a pneumatic leg brace allowed athletes to recover more quickly than athletes treated with activity restriction alone (Anderson, 2000; Swenson, 1997; Whitelaw, 1991). It may be that compression of the leg's soft tissues helps to unload the tibia during weight-bearing activities, thereby minimizing further microdamage and facilitating bony repair.

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Failure of nonoperative care warrants consideration of surgical intervention. Options include reamed intramedullary nailing and internal fixation with bone grafting. =ostoperative recovery time averages 6 months.