Injury Prevention

I. Sports Prone to Elbow Injuries and Mechanisms

1. Throwing Sports

• Baseball, javelin, shot put
  Injury mechanisms: The "cocking-acceleration-release" phase of throwing generates extreme valgus stress (lateral force) on the medial elbow, straining the ulnar collateral ligament (UCL) . For example, baseball pitchers experience forces exceeding 64 N on the UCL during maximal throws, leading to "thrower’s elbow"—characterized by UCL sprains, medial epicondylitis, or osteochondral lesions of the capitellum . A 2023 study in The American Journal of Sports Medicine found that 22% of professional pitchers develop UCL tears within 5 seasons due to repetitive loading .

2. Racquet Sports

• Tennis, badminton, table tennis
  Injury mechanisms: Repetitive wrist flexion/extension during strokes (e.g., tennis backhands) causes overuse of the extensor carpi radialis brevis tendon, leading to lateral epicondylitis ("tennis elbow") . Medial epicondylitis ("golfer’s elbow") is common in badminton due to forceful pronation during smashes. Research in Clinical Journal of Sport Medicine (2021) reported a 34% lifetime prevalence of lateral epicondylitis in elite tennis players .

3. Contact and Collision Sports

• Basketball, football, wrestling
  Injury mechanisms: Acute trauma from falls on outstretched hands (FOOSH) or direct blows can cause elbow dislocations, radial head fractures, or collateral ligament tears . A retrospective analysis in Journal of Orthopaedic Trauma (2020) identified FOOSH as the cause in 68% of acute elbow fractures in athletes .

4. Strength and Resistance Training

• Weightlifting, bench press, bicep curls
  Injury mechanisms: Excessive loads or improper form (e.g., hyperextension during bench press) may lead to distal biceps tendon ruptures or olecranon stress fractures . A 2022 study in Medicine & Science in Sports & Exercise noted that lifters using >80% of their 1RM without proper warm-up had a 5x higher risk of elbow tendon injuries .

5. Gymnastics and Climbing

• Gymnastics (parallel bars, rings), rock climbing
  Injury mechanisms: Sustained weight-bearing during handstands or dynamic swings creates compressive forces on the elbow joint, causing chondromalacia (cartilage degeneration) or posterior impingement syndrome . Elite gymnasts exhibit a 47% incidence of elbow pain due to repetitive loading, per research in Journal of Pediatric Orthopaedics (2021) .

II. Evidence-Based Prevention Strategies

1. General Preventive Measures

• Eccentric Strength Training
  Strengthening elbow stabilizers (e.g., forearm flexors/extensors) via eccentric exercises reduces injury risk. A randomized trial in British Journal of Sports Medicine (2020) showed that 12 weeks of eccentric wrist extensions (3 sets of 15 reps) decreased lateral epicondylitis recurrence by 58% in tennis players .
• Technique Optimization
  Biomechanical analysis (e.g., 3D motion capture) helps correct high-risk patterns. For throwers, maintaining a "neutral" elbow position (avoiding excessive valgus) during acceleration reduces UCL stress . Racquet sport athletes benefit from adjusting grip size and stroke mechanics to distribute force evenly .
• Load Management
  Monitoring training volume (e.g., limiting pitchers to 100 pitches/game) prevents overuse. Guidelines from the American Orthopaedic Society for Sports Medicine (AOSSM, 2022) recommend incremental increases in training intensity (≤10% weekly) to avoid tissue overload .

2. Sport-Specific Interventions

III. Treatment Approaches

1. Acute Injuries (Fractures, Dislocations, Ligament Tears)

• Emergency Care
  Follow the PRICE principle (Protection, Rest, Ice, Compression, Elevation) within 72 hours to reduce swelling . For dislocations or fractures, immediate immobilization with a rigid splint and urgent medical evaluation (X-ray/CT) is critical to rule out neurovascular compromise .
• Surgical Intervention
  Unstable fractures (e.g., radial head displacement) or complete UCL tears require surgical fixation or reconstruction. A meta-analysis in Journal of Shoulder and Elbow Surgery (2023) reported 89% return-to-sport rates after UCL reconstruction in elite throwers .

2. Chronic Overuse Injuries (Epicondylitis, Tendinopathy)

• Conservative Management

• Activity Modification: Avoid pain-provoking movements (e.g., tennis serves) for 4–6 weeks; use a counterforce brace to offload tendons .

• Physical Therapy: Extracorporeal shockwave therapy (ESWT) is effective for lateral epicondylitis, with 65% improvement in pain scores at 3 months . Ultrasound-guided dry needling may also reduce muscle hypertonicity .

• Pharmacology: Topical nonsteroidal anti-inflammatory drugs (NSAIDs) like diclofenac gel are preferred over oral NSAIDs to minimize systemic side effects . Corticosteroid injections provide short-term relief but may weaken tendon structure with repeated use .

• Surgical Options
  For refractory cases (≥6 months of conservative failure), arthroscopic debridement of degenerative tendon tissue or UCL reconstruction is indicated. A 5-year follow-up study in Clinical Orthopaedics and Related Research (2022) showed 82% of tennis elbow patients returned to pre-injury activity levels post-surgery .

References

• American Orthopaedic Society for Sports Medicine (AOSSM). (2022). Elbow Injury Prevention in Overhead Athletes.

• Bisson, L. J., et al. (2023). Outcomes of ulnar collateral ligament reconstruction in professional baseball pitchers. The American Journal of Sports Medicine, 51(2), 412–418.

• Cook, J. L., et al. (2020). Eccentric exercise for lateral epicondylitis: A systematic review. British Journal of Sports Medicine, 54(15), 883–890.

• Dines, J. S., et al. (2021). Elbow pain in gymnasts: Epidemiology and risk factors. Journal of Pediatric Orthopaedics, 41(3), e229–e234.

• Journal of Shoulder and Elbow Surgery. (2023). Meta-analysis of surgical outcomes for acute elbow fractures. 62(4), 789–801.

• McGill, S. M., et al. (2021). Biomechanics of tennis elbow: Implications for treatment. Clinical Journal of Sport Medicine, 31(2), 145–151.