Nerve Injuries About the Elbow in the Athlete

Abstract

The athlete's elbow is a remarkable example of motion, strength, and durability. The stress placed on the elbow during sport, including the throwing motion, may lead to soft-tissue ligamentous and nerve injury. The thrower's elbow illustrates one example of possible nerve injury about the elbow in sport, related to chronic repetitive tensile and compressive stresses to the ulnar nerve associated with elbow flexion and valgus position. Besides the throwing athlete, nerve injury from high-energy direct-impact forces may also damage nerves around the elbow in contact sports. Detailed history and physical examination can often make the diagnosis of most upper extremity neuropathies. The clinician must be aware of the possibility of isolated or combined nerve injury as far proximal as the cervical nerve roots, through the brachial plexus, to the peripheral nerve terminal branches. Electrodiagnostic studies are occasionally beneficial for diagnosis with certain nerves. Nonoperative management is often successful in most elbow and upper extremity neuropathies. If conservative treatment fails, then surgical treatment should address all potentially offending structures. In the presence of medial laxity and concurrent ulnar neuritis, the medial ulnar collateral ligament warrants surgical treatment, in addition to transposition of the ulnar nerve. The morbidity of open surgical decompression of nerves in and around the elbow is potentially career threatening in the throwing athlete. This mandates an assessment of the adequacy of the nonsurgical treatment and a thorough preoperative discussion of the risks and benefits of surgery.

Performance and Return to Sport After Ulnar Nerve Decompression/Transposition Among Professional Baseball Players

“…Other pathology about the elbow can mimic ulnar nerve compression, and this RTS rate for these professional baseball players may reflect incomplete treatment of the etiology of the elbow symptoms. 8,9 When cases were compared with themselves, performance after surgery showed a decline in some performance metrics, but when cases were compared with controls, their performance did not appreciably decline. This discrepancy is likely related to the natural history of a pitcher's decline in performance with age, as pitchers who did not have ulnar nerve decompression/transposition declined in performance after the index year.…”

Return to Play After PRP and Rehabilitation of 3 Elite Ice Hockey Players With Ulnar Collateral Ligament Injuries of the Elbow

“…Given the high stresses that can occur along the medial side of the elbow, examiners should be cognizant of possible injury to the ulnar nerve at the elbow but also at the cervical spine and brachial plexus. 15…”

“…Given the high stresses that can occur along the medial side of the elbow, examiners should be cognizant of possible injury to the ulnar nerve at the elbow but also at the cervical spine and brachial plexus. 15 Imaging should begin with plain radiographs to evaluate for bony ligament avulsion injuries, valgus alignment, UCL calcification, and posteromedial osteophytes, as well as to assess for other possible pathology about the elbow. Stress radiography or fluoroscopy can be used to assess for laxity about the elbow.…”

Sportverletzungen peripherer Nerven

“…Nervenverletzungen an den Armen kommen bei allen eben genannten Sportarten relativ häufig vor und müssen v. a. auch bei verzögertem Heilungsverlauf nach Frakturen bedacht werden. Eine besondere Prädilektionsstelle ist dabei neben der Schulter der Ellbogen [21]. Dabei muss immer bedacht werden, dass der Plexus brachialis individuelle anatomische Variationen aufweisen kann [22], und es muss von der Nervenwurzel ausgehend nach distal anatomisch nach der lokalisatorischen Ursache der peripheren Schädigung gesucht werden, sofern der Läsionsort nicht aufgrund der Verletzung offensichtlich ist.…”