Sportverletz Sportschaden 2012; 26(2): 100-108
DOI: 10.1055/s-0031-1299406
Übersichtsarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Sportverletzungen und Überlastungsschäden des Ellenbogengelenks

Sport Injuries and Overuse Damage of the Elbow
L. J. Lehmann
1   Orthopädisch-Unfallchirurgisches Zentrum (Direktor: Prof. Dr. H. P. Scharf), Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg
,
S. Hünnebeck
1   Orthopädisch-Unfallchirurgisches Zentrum (Direktor: Prof. Dr. H. P. Scharf), Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim der Universität Heidelberg
,
D. Jung
2   MEO-Klinik Berlin Praxis für Schulter und Ellenbogenchirurgie (Dr. Dirk Jung), ‬Berlin‬
› Author Affiliations
Further Information

Publication History

Publication Date:
14 March 2012 (online)

Zusammenfassung

Sportverletzungen des Ellenbogens begegnen uns als Akutverletzungen und als Überlastungssyndrome. Diese betreffen in der Lebenszeitprävalenz einen Großteil der Überkopf-, Wurf- und Racketsportler. Diagnostische Algorithmen, die sich aus der Kenntnis der Bewegungsanalyse, klinischer Untersuchung und Bildgebung entwickeln, werden vorgestellt und unterstützen die Diagnosefindung der Überlastungssymptome. Grundsätzlich lassen sich viele der beschriebenen Beschwerden konservativ therapieren. Nach erfolgloser konservativer Therapie stehen arthroskopische Techniken, Bandrekonstruktionen und dekompressive Verfahren zur Verfügung. Die Prognose, zum ursprünglichen Sportniveau zurückzufinden, ist grundsätzlich gut. Resultierende Therapieempfehlungen werden auf der Basis der aktuell höchsten Evidenzgrade zusammengefasst.

Abstract

Sports injuries of the elbow joint can be acute or can arise due to chronic overuse. Such overstress syndromes are common in overhead, throwing and racket sports activities. The present article introduces diagnostic algorithms developed from knowledge gained through motion analysis, clinical examination and further imaging. The diagnosis of the overtaxing syndromes mainly depends on these findings. Basically most of the disorders in the elbow joint can be treated conservatively. If this is not the case or if the conservative treatment does not succeed, arthroscopic techniques, ligament reconstruction or nerve decompression are the major alternatives. The prognosis for regaining elbow function and returning to the previous level of performance is generally good. The resulting therapy recommendations are summarised on the basis of the current highest grades of evidence.

 
  • Literatur

  • 1 Aguinaldo AL, Chambers H. Correlation of throwing mechanics with elbow valgus load in adult baseball pitchers. Am J Sports Med 2009; 37: 2043-2048
  • 2 Ahmad CS, ElAttrache NS. Elbow valgus instability in the throwing athlete. J Am Acad Orthop Surg 2006; 14: 693-700
  • 3 Grana WA, Rashkin A. Pitcher’s elbow in adolescents. Am J Sports Med 1980; 8: 333-336
  • 4 Bayes MC, Wadsworth LT. Upper extremity injuries in golf. Phys Sportsmed 2009; 37: 92-96
  • 5 McCarroll JR. Overuse injuries of the upper extremity in golf. Clin Sports Med 2001; 20: 469-479
  • 6 Pawlak M, Kaczmarek D. Field hockey players have different values of ulnar and tibial motor nerve conduction velocity than soccer and tennis players. Arch Ital Biol 148: 365-376
  • 7 Field LD, Savoie FH. Common elbow injuries in sport. Sports Med 1998; 26: 193-205
  • 8 Byers 3rd GE, Berquist TH. Radiology of sports-related injuries. Curr Probl Diagn Radiol 1996; 25: 1-49
  • 9 De Smet AA, Winter TC, Best TM et al. Dynamic sonography with valgus stress to assess elbow ulnar collateral ligament injury in baseball pitchers. Skeletal Radiol 2002; 31: 671-676
  • 10 Miller TT, Adler RS, Friedman L. Sonography of injury of the ulnar collateral ligament of the elbow-initial experience. Skeletal Radiol 2004; 33: 386-391
  • 11 Weise K, Schwab E, Scheufele TM. Elbow injuries in childhood. Unfallchirurg 1997; 100: 255-269
  • 12 Jung D. Sportverletzugen des Ellenbogengelenkes. Krankengymnastik-Zeitschrift für Physiotherapeuten 1999; 5: 1163-78
  • 13 Kenter K, Behr CT, Warren RF et al. Acute elbow injuries in the National Football League. J Shoulder Elbow Surg 2000; 9: 1-5
  • 14 Molsa J, Kujala U, Myllynen P et al. Injuries to the upper extremity in ice hockey: analysis of a series of 760 injuries. Am J Sports Med 2003; 31: 751-757
  • 15 Deshmukh NV, Shah MS. Bilateral radial head fractures in a martial arts athlete. Br J Sports Med 2003; 37: 270-271 ; discussion 1
  • 16 Seijas R, Ares-Rodriguez O, Orellana A et al. Terrible triad of the elbow. J Orthop Surg 2009; 17: 335-339
  • 17 Hobgood ER, Khan SO, Field LD. Acute dislocations of the adult elbow. Hand Clin 2008; 24: 1-7
  • 18 Akagi M, Ito T, Ikeda N et al. Total avulsion fracture of the coronoid tubercle caused by baseball pitching. A case report. Am J Sports Med 2000; 28: 580-582
  • 19 Morrey BF. Current concepts in the treatment of fractures of the radial head, the olecranon, and the coronoid. Instructional course lectures 1995; 44: 175-185
  • 20 Morrey BF, An KN. Articular and ligamentous contributions to the stability of the elbow joint. The American journal of sports medicine 1983; 11: 315-319
  • 21 Adams JE, Hoskin TL, Morrey BF et al. Management and outcome of 103 acute fractures of the coronoid process of the ulna. The Journal of bone and joint surgery British volume 2009; 91: 632-635
  • 22 Morrey BF. Biceps tendon injury. Instructional course lectures 1999; 48: 405-410
  • 23 Morrey BF, Askew LJ, An KN et al. Rupture of the distal tendon of the biceps brachii. A biomechanical study. The Journal of bone and joint surgery American volume 1985; 67: 418-421
  • 24 Chillemi C, Marinelli M, De Cupis V. Rupture of the distal biceps brachii tendon: conservative treatment versus anatomic reinsertion – clinical and radiological evaluation after 2 years. Arch Orthop Trauma Surg 2007; 127: 705-708
  • 25 Alberta FG, Elattrache NS. Diagnosis and treatment of distal biceps and anterior elbow pain in throwing athletes. Sports Med Arthrosc 2008; 16: 118-123
  • 26 Felenda M, Steinbruck K. Rupture of the triceps tendon in the athlete. Sportverletz Sportschad 1988; 2: 120-121
  • 27 Mair SD, Isbell WM, Gill TJ et al. Triceps tendon ruptures in professional football players. Am J Sports Med 2004; 32: 431-434
  • 28 Sierra RJ, Weiss NG, Shrader MW et al. Acute triceps ruptures: case report and retrospective chart review. J Shoulder Elbow Surg 2006; 15: 130-134
  • 29 Gore RM, Rogers LF, Bowerman J et al. Osseous manifestations of elbow stress associated with sports activities. Am J Roentgenol 1980; 134: 971-977
  • 30 Baseball pitching: understanding the mechanics of throwing a baseball may help protect the shoulder and elbow. J Orthop Sports Phys Ther 2011; 41: 304
  • 31 Davis JT, Limpisvasti O, Fluhme D et al. The effect of pitching biomechanics on the upper extremity in youth and adolescent baseball pitchers. Am J Sports Med 2009; 37: 1484-1491
  • 32 Atwater AE. Biomechanics of overarm throwing movements and of throwing injuries. Exerc Sport Sci Rev 1979; 7: 43-85
  • 33 Hyman J, Breazeale NM, Altchek DW. Valgus instability of the elbow in athletes. Clin Sports Med 2001; 20: 25-45, viii
  • 34 Ahmad CS, ElAttrache NS. Valgus extension overload syndrome and stress injury of the olecranon. Clin Sports Med 2004; 23: 665-676, x
  • 35 Hume PA, Reid D, Edwards T. Epicondylar injury in sport: epidemiology, type, mechanisms, assessment, management and prevention. Sports Med 2006; 36: 151-170
  • 36 Dugas JR. Valgus extension overload: diagnosis and treatment. Clin Sports Med 2010; 29: 645-654
  • 37 Klingele KE, Kocher MS. Little league elbow: valgus overload injury in the paediatric athlete. Sports Med 2002; 32: 1005-1015
  • 38 Werner SL, Murray TA, Hawkins RJ et al. Relationship between throwing mechanics and elbow valgus in professional baseball pitchers. J Shoulder Elbow Surg 2002; 11: 151-155
  • 39 Lynch JR, Waitayawinyu T, Hanel DP et al. Medial collateral ligament injury in the overhand-throwing athlete. J Hand Surg Am 2008; 33: 430-437
  • 40 O’Driscoll SW, Lawton RL, Smith AM. The „moving valgus stress test“ for medial collateral ligament tears of the elbow. Am J Sports Med 2005; 33: 231-239
  • 41 Cain Jr EL, Andrews JR, Dugas JR et al. Outcome of ulnar collateral ligament reconstruction of the elbow in 1281 athletes: Results in 743 athletes with minimum 2-year follow-up. Am J Sports Med 2010; 38: 2426-2434
  • 42 Rettig AC, Sherrill C, Snead DS et al. Nonoperative treatment of ulnar collateral ligament injuries in throwing athletes. Am J Sports Med 2001; 29: 15-17
  • 43 Dodson CC, Thomas A, Dines JS et al. Medial ulnar collateral ligament reconstruction of the elbow in throwing athletes. Am J Sports Med 2006; 34: 1926-1932
  • 44 Purcell DB, Matava MJ, Wright RW. Ulnar collateral ligament reconstruction: a systematic review. Clin Orthop Relat Res 2007; 455: 72-77
  • 45 Kim NR, Moon SG, Ko SM et al. MR imaging of ulnar collateral ligament injury in baseball players: Value for predicting rehabilitation outcome. European journal of radiology 2011; 80: e422-e426
  • 46 Benjamin M, Toumi H, Ralphs JR et al. Where tendons and ligaments meet bone: attachment sites (‘entheses’) in relation to exercise and/or mechanical load. J Anat 2006; 208: 471-490
  • 47 Bernhang AM. The many causes of tennis elbow. N Y State J Med 1979; 79: 1363-1366
  • 48 Brosseau L, Casimiro L, Milne S et al. Deep transverse friction massage for treating tendinitis. Cochrane Database Syst Rev 2002; (4): CD003528
  • 49 Burnham R, Gregg R, Healy P et al. The effectiveness of topical diclofenac for lateral epicondylitis. Clin J Sport Med 1998; 8: 78-81
  • 50 Chung B, Wiley JP. Effectiveness of extracorporeal shock wave therapy in the treatment of previously untreated lateral epicondylitis: a randomized controlled trial. Am J Sports Med 2004; 32: 1660-1667
  • 51 Chung B, Wiley JP, Rose MS. Long-term effectiveness of extracorporeal shockwave therapy in the treatment of previously untreated lateral epicondylitis. Clin J Sport Med 2005; 15: 305-312
  • 52 Dunn JH, Kim JJ, Davis L et al. Ten- to 14-year follow-up of the Nirschl surgical technique for lateral epicondylitis. Am J Sports Med 2008; 36: 261-266
  • 53 Savoie 3rd FH, VanSice W, O’Brien MJ. Arthroscopic tennis elbow release. J Shoulder Elbow Surg 2010; 19: 31-36
  • 54 Yan H, Cui GQ, Liu YL et al. A randomized comparison of open and arthroscopic Nirschl debridement for refractory lateral epicondylitis. Zhonghua Wai Ke Za Zhi 2009; 47: 888-891
  • 55 Eygendaal D, Safran MR. Postero-medial elbow problems in the adult athlete. Br J Sports Med 2006; 40: 430-434 ; discussion 4
  • 56 Blake JJ, Block JJ, Hannah GA et al. Unusual stress fracture in an adolescent baseball pitcher affecting the trochlear groove of the olecranon. Pediatr Radiol 2008; 38: 788-790
  • 57 Cain Jr EL, Dugas JR, Wolf RS et al. Elbow injuries in throwing athletes: a current concepts review. Am J Sports Med 2003; 31: 621-635
  • 58 Rahusen FT, Brinkman JM, Eygendaal D. Arthroscopic treatment of posterior impingement of the elbow in athletes: a medium-term follow-up in sixteen cases. J Shoulder Elbow Surg 2009; 18: 279-282
  • 59 Andrews JR, Heggland EJ, Fleisig GS et al. Relationship of ulnar collateral ligament strain to amount of medial olecranon osteotomy. Am J Sports Med 2001; 29: 716-721
  • 60 Jacobson JA, Miller BS, Morag Y. Golf and racquet sports injuries. Semin Musculoskelet Radiol 2005; 9: 346-359
  • 61 Tschantz P, Meine J. Medial epicondylitis. Etiology, diagnosis, therapeutic modalities. Z Unfallchir Versicherungsmed 1993; 86: 145-148
  • 62 Chen FS, Rokito AS, Jobe FW. Medial elbow problems in the overhead-throwing athlete. J Am Acad Orthop Surg 2001; 9: 99-113
  • 63 Forster KK, Schmid K, Reichelt A. Sports-induced acute epicondylitis of the elbow and conservative therapy. Sportverletz Sportschad 1997; 11: 16-20
  • 64 Ciccotti MC, Schwartz MA, Ciccotti MG. Diagnosis and treatment of medial epicondylitis of the elbow. Clin Sports Med 2004; 23: 693-705, xi
  • 65 Hirasawa Y, Sakakida K. Sports and peripheral nerve injury. The American journal of sports medicine 1983; 11: 420-426
  • 66 Colak T, Bamac B, Ozbek A et al. Nerve conduction studies of upper extremities in tennis players. Br J Sports Med 2004; 38: 632-635
  • 67 Braddom RL, Wolfe C. Musculocutaneous nerve injury after heavy exercise. Archives of physical medicine and rehabilitation 1978; 59: 290-293
  • 68 DeFranco MJ, Schickendantz MS. Isolated musculocutaneous nerve injury in a professional fast-pitch softball player: a case report. The American journal of sports medicine 2008; 36: 1821-1823
  • 69 Hsu JC, Paletta Jr GA, Gambardella RA et al. Musculocutaneous nerve injury in major league baseball pitchers: a report of 2 cases. The American journal of sports medicine 2007; 35: 1003-1006
  • 70 Curtin P, Taylor C, Rice J. Thrower’s fracture of the humerus with radial nerve palsy: an unfamiliar softball injury. British journal of sports medicine 2005; 39: e40
  • 71 Ogawa K, Ui M. Humeral shaft fracture sustained during arm wrestling: report on 30 cases and review of the literature. The Journal of trauma 1997; 42: 243-246
  • 72 Prochaska V, Crosby LA, Murphy RP. High radial nerve palsy in a tennis player. Orthop Rev 1993; 22: 90-92
  • 73 Neal S, Fields KB. Peripheral nerve entrapment and injury in the upper extremity. Am Fam Physician 2010; 81: 147-155
  • 74 Dickerman RD, Stevens QE, Cohen AJ et al. Radial tunnel syndrome in an elite power athlete: a case of direct compressive neuropathy. J Peripher Nerv Syst 2002; 7: 229-232
  • 75 Links AC, Graunke KS, Wahl C et al. Pronation can increase the pressure on the posterior interosseous nerve under the arcade of Frohse: a possible mechanism of palsy after two-incision repair for distal biceps rupture – clinical experience and a cadaveric investigation. Journal of shoulder and elbow surgery/American Shoulder and Elbow Surgeons (et al.) 2009; 18: 64-68
  • 76 Links AC, Graunke KS, Wahl C et al. Pronation can increase the pressure on the posterior interosseous nerve under the arcade of Frohse: a possible mechanism of palsy after two-incision repair for distal biceps rupture – clinical experience and a cadaveric investigation. J Shoulder Elbow Surg 2009; 18: 64-68
  • 77 Pfandl S, Wetzel R, Hackspacher J et al. Supinator tunnel syndrome – a differential diagnosis of so-called tennis elbow. Sportverletz Sportschad 1992; 6: 71-76
  • 78 Wilhelm A. Management of epicondylitis humeri radialis through the decompression of the radial nerve. Handchirurgie 1977; 9: 185-187
  • 79 Neal S, Fields KB. Peripheral nerve entrapment and injury in the upper extremity. American family physician 2010; 81: 147-155
  • 80 Dettori NJ, Norvell DC. Non-traumatic bicycle injuries: a review of the literature. Sports medicine 2006; 36: 7-18
  • 81 Bovim G, Andersen K. Nerve compression symptoms after a long bicycle ride – the Great Test of Strength. Tidsskr Nor Laegeforen 1992; 112: 2199-2201
  • 82 Gitkind AI, Zhao P, Oh-Park MY et al. Median palmar cutaneous nerve injury in a volleyball player. American journal of physical medicine & rehabilitation/Association of Academic Physiatrists 2009; 88: 272-274
  • 83 Bassett 3rd FH, Spinner RJ, Schroeter TA. Brachial artery compression by the lacertus fibrosus. Clin Orthop Relat Res 1994; 307: 110-116
  • 84 Hariri S, McAdams TR. Nerve injuries about the elbow. Clinics in sports medicine 2010; 29: 655-675
  • 85 Aoki M, Takasaki H, Muraki T et al. Strain on the ulnar nerve at the elbow and wrist during throwing motion. J Bone Joint Surg Am 2005; 87: 2508-2514
  • 86 Glousman RE. Ulnar nerve problems in the athlete’s elbow. Clin Sports Med 1990; 9: 365-377
  • 87 Norkus SA, Meyers MC. Ulnar neuropathy of the elbow. Sports Med 1994; 17: 189-199
  • 88 Hsu WC, Chen WH, Oware A. Distal ulnar neuropathy in a golf player. Clinical journal of sport medicine: official journal of the Canadian Academy of Sport Medicine 2005; 15: 189-190
  • 89 Rettig AC, Ebben JR. Anterior subcutaneous transfer of the ulnar nerve in the athlete. Am J Sports Med 1993; 21: 836-839 ; discussion 9–40