Elbow Contusion

An elbow contusion results from blunt direct trauma and produces muscle strains and ligament sprains.

Pathology

An elbow contusion results from blunt direct trauma and produces muscle strains and ligament sprains.

Symptoms

  • Pain with muscle use
  • Bruising
  • Muscle spasms
  • Loss of elbow motion, particularly elbow extension.

Causes of Loss of Elbow Extension:

  • The mobile wad and brachialis muscle crossing the elbow joint feels more comfortable when strained if the length of the muscle is shortened, making elbow flexion the preferred position for the patient.
  • The elbow joint capsule can hold a maximum of 25 ccs of fluid. This maximal capacity is allowed with the elbow in the flexed (bent) position. Consequently, if active elbow extension is avoided, an elbow contracture will develop.

Treatment

Treatment of elbow contusions is symptomatic, similar to the treatment of contusions elsewhere in the body:

  • R.I.C.E. treatment (Rest, Ice, Compression, Elevation)
  • Anti-inflammatory treatment
  • Controlled early motion
  • Therapy

The stages of R.I.C.E. are used to treat injuries such as a strain (muscle injury) and a spring (a ligament stretch injury).

The Rest stage is usually done for 24-48 hours and can include the use of slings, splints or other types of immobilizers unless otherwise advised by a physician.

The Ice stage is used for no more than 20-30 minutes, three to four times per day. Icing treatment functions by causing the arteries to narrow the size of their lumen, which in turn decreases swelling and the pain from the subsequent increased pressure. Ice treatment is best applied by using an ice slush. Ice slush is made by mixing crushed ice with water in a bag. This The ice bag should not be placed in direct contact with the skin but instead use a buffer layer between the skin and ice bag like a towel to prevent skin freezing.

The Compression stage is the wrapping of a body part to further assist in minimizing swelling and is used in conjunction with elevation. The best compressive wrapping has multiple layers providing a cushion effect. The compression wrapping should not cause constriction of the blood supply. Constriction is recognized by increasing pain to the body part wrapped. Other signs of a tight compressive dressing are:

  • A cold sensation in the wrapped limb
  • Blue discoloration of the body part
  • Any change in color from the natural skin color of the body part

The Elevation stage of treatment is best done by elevating the limb to the level of the heart. If elevation is lower than this, the effects of gravity on the veins will increase vein pressure and cause the blood to have difficulty traveling back to the heart. This can result in limb swelling.

The use of anti-inflammatory medication helps treat the pain, swelling, and inflammation occurring after injury.

Examples of anti-inflammatories include:

  • Aspirin products
  • Naprosyn
  • Mobic
  • Indocin
  • Arthrotec
  • Celebrex
  • Ibuprofen: Motrin/Advil

All of these medications have side effects and should be taken with this knowledge in mind. Prescriptions should be discussed with your pharmacist and physician.

Controlled early motion and therapy to the involved limb decreases the effects of prolonged immobilization.

Effects of Prolonged Immobilization

  • Stiffness
  • Muscle atrophy
  • Weakness
  • Longer return to pre-injury state

The type of therapy recommended will depend on the tissue type injured and the severity of the injury. Consult your surgeon for the best advice.

The home exercise program for the elbow focuses on avoiding an elbow contracture with the occasional use of splints, called static progressive splints, to assist in progressively regaining elbow motion.