Lesson

History

The following are key questions to consider when taking a history from a football player presenting with elbow pain.

Mechanism of injury
Most elbow injuries seen in football (or in most sports) occur as a direct result of trauma. The most common injury mechanism is a fall onto an outstretched hand or elbow. This can cause various fracture patterns, dislocation, or a combination of both (fracture-dislocation). A more gradual onset of symptoms is more characteristic of tendinopathy.
Location of pain
The location of pain is also important as symptoms are frequently localised to the site of the pathology. Good examples of this are common extensor (lateral) and common flexor (medial) tendinopathies.
Bruising
The presence of bruising suggests a more significant injury. Bruising in the cubital fossa is highly suggestive of a distal biceps tendon injury.
‘Pop’ or ‘snap’
A popping or snapping sensation can indicate a tendon rupture, some fractures, or a medial ligament injury.
Neurovascular symptoms
Neurovascular symptoms can be complications of acute fractures or may be the result of peripheral nerve pathology. They may also imply that the pain is referred from a more proximal site (like the cervical spine).
Defining the mechanism of injury is a key consideration at the elbow. There are a number of conditions which are related primarily to ‘overuse’, like tendinopathy. Athletes will often describe a ‘trivial’ trauma which they may think has caused the injury.

André Pedrinelli

Orthopaedic – Prosthetics / Sports Medicine