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Impinged elbow management

This condition is characterised by compression and damage to soft tissue situated at the back of, or within the elbow joint.

The joint primarily comprises the articulation of two bones, the upper arm bone and the inner forearm bone. Shock absorbing cartilage lies between these joint surfaces cushioning the impact of one bone on another.

When the elbow is straightened fully, soft tissue is compressed at the back of the joint. If these compressive forces are excessive or too repetitive and beyond what the joint can withstand, damage and inflammation of the soft tissue at the back of the elbow joint may occur. This condition is known as elbow impingement

This condition typically occurs due to activities that excessively or repetitively straighten the elbow often in combination with a sideways force. This may occur suddenly, due to a specific incident or, more commonly, due to repetitive strain associated with overuse (such as repetitive throwing).In the throwing athlete, the throwing motion (just prior to throwing) may overstretch the elbow and place significant strain on the elbow joint.

As a result, elbow impingement may occur due to overuse associated with repetitive throwing (especially in throwers who ‘open up too soon’ or throw with a low arm) and are particularly common in cricketers and javelin throwers. Elbow impingement may also occur in martial arts due to repetitive punching, forcing the elbow into excessive straightening. Occasionally, elbow impingement is seen in contact sports and may occur due to a collision to the back of the elbow (i.e. excessive force, forcing the elbow to bend in the wrong direction (such as another player falling across the back of the elbow).

Athletes with this condition typically experience pain at the back of the elbow. Pain may also increase on firmly touching the affected area. In those affected whose injury occurs from overuse, symptoms usually develop gradually and progressively over a period of time.

In minor cases of elbow impingement (whether traumatic or due to overuse), athletes may be able to continue activity only to experience an increase in pain, swelling and stiffness in the elbow after activity with rest (particularly first thing in the morning).

The writer is a physiotherapist with SportsPesa Premier League (SPL) team Mathare United.