Javelin Thrower's Elbow / Medial Collateral Ligament Sprain
ByLaurence Schubert APAM
Medial Collateral (Ulnar) LigamentSprain of the Elbow
Javelinthrowers elbow is an injury to the medial collateral ligament, often caused byoveruse. This injury is common in throwing athletes who participate inbaseball, water polo, handball, tennis, cricket and javelin. You will begin toexperience this injury if the force placed on the MCL is greater than thetensile properties of the ligament. Increased load on the MCL is often causedby poor throwing technique, for example it is likely the injured athlete ispositioning their arm with 90° - 100° of abduction when ideally 120° - 130° should be achieved.
Relevant Anatomy
TheMedial Collateral Ligament (MCL) is seen in both the knee and the elbow. As thename 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 iseasily susceptible to injury. The elbow joint connects the humerus to the bonesof the forearm; radius and ulna. A separate joint within the same joint capsuleis 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 putunder valgus or varus forces, it is at risk of injury.
What are the Signs & Symptoms?
Asthis condition is predominantly an overuse injury, you will begin to experienceincreased pain and decreased power during or following throwing activities. Duringthe throw your pain can be sharp but as the condition worsens you willexperience an ache at rest, typically following a period of throwing. Uponexamination there will be marked tenderness over the site of the MCL andadjacent muscles such as your wrist flexors. You may have decreased ROM andincreased swelling around the area.
Youwill also notice pain in your elbow during everyday tasks such as carrying bagsor anything that puts the MCL under increased stress. Your practitioner willperform an MCL stress test in order to assist with the diagnosis (the test putsthe MCL under valgus stress similar to a throw, but in a more controlled environment).
Differential diagnosis
Variousother injuries can appear in the same way as MCL sprain of the elbow, theseinclude:
- Medial epicondylitis (golfer's elbow).
- Medial epicondyle avulsion fracture.
- Ulno-humeral arthritis.
- Nerve entrapment (e.g. ulnar).
Management
Acute phase:
Inthe early stages of recovery, it is essential to follow the RICE principle.Rest, Ice, Compression and Elevation. Additionally, patients may benefit fromNSAIDs in order to reduce pain, swelling andinflammation (please discuss medication with your pharmacist).
Sub-Acute phase:
Afterthe first few days of rest in complete, you will maintain a cessation ofthrowing and any aggravating tasks. This will include no throwing and any tasksthat cause pain the elbow. During this phase you will begin to complete basicisometric strengthening (exercises where you hold weight but don't move) to ensure no muscledystrophy occurs (muscle wastage). Examples of this may include stress ballsqueezes and holding a weight with your elbow bent.
Rehabilitation:
Nowit is time to start increasing the load through the elbow once again. It iscritical to be patient during the phase as you will often be experiencing verylittle pain and therefore you may think you are ready to return to throwing.Before you return to throwing you should commence strengthening of your upperlimb. This will include shoulder, elbow and wrist. Most importantly youshoulder focus on strength of biceps, triceps, elbow supination/pronation(rotation), wrist flexion and extension. During this time, you will slowlyreturn to throwing but at a reduced INTENSITY & VOLUME.
NOTE:
Theleading cause for MCL elbow strain is poor throwing technique. Therefore, it iscrucial that you address needed changes to throwing technique. If you areunable to do so, it is almost guaranteed that you will suffer this injury onceagain.
Surgery
Inrare cases, surgery is required if the injury fails to improve withconservative management. If you sustain a ruptured (fully torn) MCL, then youwill likely need surgery. The most common surgeries are a direct repair of theligament or an elbow reconstruction. You should attempt at least 3 months ofconservative treatment before considering surgery.
If you have any questions about elbow or throwing injuries then please contact us or book online for an appointment.
