Elbow Injury – Crossit (Olympic Lifting)

Christian Basque and David Ross, Geisinger Wyoming Valley – Sports Medicine Fellowship HISTORY: A 31 year old male presents to the clinic with right elbow pain. Patient sustained the injury while in the gym two months prior. He was Olympic weight lifting performing a power snatch when he felt a pop and pain in his elbow. He had pain and swelling in the elbow and rested for one month. After the swelling decreased he returned to activity. He presents today with continued pain most notable when performing push ups and decreased strength. PHYSICAL EXAMINATION: Upon inspection he had soft tissue swelling over the olecranon. There was tenderness over the medial epicondyle and triceps. His ROM was equal bilaterally for both elbows as was his carrying angle. Valgus and varus stress test were both negative as was resisted wrist extension. Resisted wrist flexion and pronation did produce pain. Right arm elbow extension was weak 3/5. Neurovascular assessment was intact. DIFFERENTIAL DIAGNOSIS: 1.) Medial epicondylitis 2.) Ulnar collateral ligament strain 3.) Avulsion fracture 4.) Triceps rupture TESTS AND RESULTS: X RAY of the right elbow was ordered. The findings showed normal alignment with a fractured enthesophyte at the triceps insertion on the right FINAL WORKING DIAGNOSIS: Avulsion fracture of the right olecranon MRI has been ordered to rule out a triceps tendon rupture which would necessitate repair. TREATMENT AND OUTCOME: For minimally displaced avulsion fractures splinting is recommended and immobilization for 6 weeks. Once pain has resolved range of motion exercises can be started. For avulsion fractures displaced greater than 2 mm a referral to an orthopaedic surgeon should be given. Further imaging of this patients injury will dictate treatment. If there is a triceps tendon rupture surgical intervention will be necessary. Patient has yet to be complaint with current recommendations