Javelin Thrower's Elbow / Medial Collateral Ligament Sprain
By
Laurence Schubert APAM
Medial Collateral (Ulnar) Ligament
Sprain of the Elbow
Javelin
throwers elbow is an injury to the medial collateral ligament, often caused by
overuse. This injury is common in throwing athletes who participate in
baseball, water polo, handball, tennis, cricket and javelin. You will begin to
experience this injury if the force placed on the MCL is greater than the
tensile properties of the ligament. Increased load on the MCL is often caused
by poor throwing technique, for example it is likely the injured athlete is
positioning their arm with 90° - 100° of abduction when ideally 120° - 130° should be achieved.
Relevant Anatomy
The
Medial Collateral Ligament (MCL) is seen in both the knee and the elbow. As the
name suggests, the ligament lies on the medial (inside) aspect of the elbow,
and resists valgus forces. Much like the MCL of the knee, this ligament is
easily susceptible to injury. The elbow joint connects the humerus to the bones
of the forearm; radius and ulna. A separate joint within the same joint capsule
is the proximal radio-ulnar joint, which allow supination and pronation
(rotation) of the forearm. The elbow joint is classified as a hinge joint;
therefore, its primary movement is flexion and extension. If the joint is put
under valgus or varus forces, it is at risk of injury.
What are the Signs & Symptoms?
As
this condition is predominantly an overuse injury, you will begin to experience
increased pain and decreased power during or following throwing activities. During
the throw your pain can be sharp but as the condition worsens you will
experience an ache at rest, typically following a period of throwing. Upon
examination there will be marked tenderness over the site of the MCL and
adjacent muscles such as your wrist flexors. You may have decreased ROM and
increased swelling around the area.
You
will also notice pain in your elbow during everyday tasks such as carrying bags
or anything that puts the MCL under increased stress. Your practitioner will
perform an MCL stress test in order to assist with the diagnosis (the test puts
the MCL under valgus stress similar to a throw, but in a more controlled environment).
Differential diagnosis
Various other injuries can appear in the same way as MCL sprain of the elbow, these include:
- Medial epicondylitis (golfer's elbow).
- Medial epicondyle avulsion fracture.
- Ulno-humeral arthritis.
- Nerve entrapment (e.g. ulnar).
Management
Acute phase:
In
the early stages of recovery, it is essential to follow the RICE principle.
Rest, Ice, Compression and Elevation. Additionally, patients may benefit from
NSAIDs in order to reduce pain, swelling and
inflammation (please discuss medication with your pharmacist).
Sub-Acute phase:
After
the first few days of rest in complete, you will maintain a cessation of
throwing and any aggravating tasks. This will include no throwing and any tasks
that cause pain the elbow. During this phase you will begin to complete basic
isometric strengthening (exercises where you hold weight but don't move) to ensure no muscle
dystrophy occurs (muscle wastage). Examples of this may include stress ball
squeezes and holding a weight with your elbow bent.
Rehabilitation:
Now
it is time to start increasing the load through the elbow once again. It is
critical to be patient during the phase as you will often be experiencing very
little pain and therefore you may think you are ready to return to throwing.
Before you return to throwing you should commence strengthening of your upper
limb. This will include shoulder, elbow and wrist. Most importantly you
shoulder focus on strength of biceps, triceps, elbow supination/pronation
(rotation), wrist flexion and extension. During this time, you will slowly
return to throwing but at a reduced INTENSITY & VOLUME.
NOTE:
The
leading cause for MCL elbow strain is poor throwing technique. Therefore, it is
crucial that you address needed changes to throwing technique. If you are
unable to do so, it is almost guaranteed that you will suffer this injury once
again.
Surgery
In rare cases, surgery is required if the injury fails to improve with conservative management. If you sustain a ruptured (fully torn) MCL, then you will likely need surgery. The most common surgeries are a direct repair of the ligament or an elbow reconstruction. You should attempt at least 3 months of conservative treatment before considering surgery.
If you have any questions about elbow or throwing injuries then please contact us or book online for an appointment.
