Hockey Doc

The Hockey Doc: Elbow injuries

By Dr. Rob LaPrade
http://drrobertlaprademd.com

Question: I have noticed recurrent pain in my elbow and when I touch the tip of the joint, it feels like there are chips of bone in it.  What is wrong with my elbow and what can I do to treat it?

Answer: Elbow injuries are somewhat common in ice hockey. The elbow is a hinge joint where the bones of the forearm (the radius and ulna) come together with the bone of the upper arm (humerus). The medial collateral ligament (MCL) on the inside of the elbow and the lateral collateral ligament (LCL) on the outside are the two primary ligaments that hold the joint in place.  Muscles around the joint allow for movement while bursa sacs provide lubrication and protection of the joint.

Because the elbow comes to a point, it is an area prone to frequent repeated contact. This can result in thick scarred bursal tissue, better known as bursitis. Bursa are closed, fluid-filled sacs that act as gliding surfaces to reduce friction between tissues.  Injuries to the bursa can be chronic or acute. Trauma is typically the cause of acute bursitis, which presents with pain, swelling and limited range of motion. Repeated trauma can lead to inflammation and fluid build-up within the bursa and cause chronic bursitis. The inflamed bursa can become thickened and scarred causing the feeling of bone chips in the elbow as you have described. Treatment for bursitis includes rest, ice, and anti-inflammatory medication such as Advil or Ibuprofen. A well placed foam pad over the bursa with an elastic wrap is recommended to help decrease the swelling into the bursa. Players should not return to play until the swelling has gone down because re-injury could lead to more serious elbow problems.

The best way to prevent repeated elbow trauma is to invest in a proper set of elbow pads. Pads should fit comfortably, be made of soft padding with a hard plastic outer shell, and have an opening for the elbow.

Other elbow injuries include sprains of the inner, or medial, part of the elbow, fractures, and dislocations.

Sprains are injuries to a ligament and are more commonly seen in throwing athletes. Symptoms that indicate a sprain are general and point tenderness, joint laxity, and joint swelling. Treatment should include rest and ice as well as anti-inflammatory medication, as needed. Gentle stretching and strengthening can be incorporated into treatment when the athlete no longer complains of pain. Often in ice hockey, the athlete can be fitted into an elbow brace and can be allowed to return to play based upon their comfort level.

Elbow fractures are typically the result of a fall on the joint. Symptoms of a fracture include pain, swelling, deformity of the joint and loss of motion. Just because you can move your elbow does not mean a fracture has not occurred.  If a fracture is suspected, the limb should immediately be immobilized, and you should be evaluated by a physician.

Falling with the arm outstretched is the common cause of a dislocation. Typically with a dislocation, the forearm will be shifted back, beyond the bone of the upper arm. Signs of an elbow dislocation include the obvious joint deformity, pain and swelling. As with a fracture, the arm should be immobilized in the position in which it is found, and the player should immediately see a physician. No attempt should be made to put it back in the socket.

Robert F. LaPrade, M.D., Ph.D. is a complex knee surgeon at The Steadman Clinic in Vail, Colorado.  He is very active in research for the prevention and treatment of ice hockey injuries. Dr. LaPrade is also the Chief Medical Research Officer at the Steadman Philippon Research Institute. Formerly, he was the team physician for the University of Minnesota men’s hockey team and a professor in the Department of Orthopaedic Surgery at the U of M. If you have a question for the Hockey Doc, e-mail it to This email address is being protected from spambots. You need JavaScript enabled to view it..