Your Comprehensive Guide To The Sporting Elbow

5 min read. Posted in Elbow
Written by Elsie Hibbert info

As physios, we know the elbow can be far from the “funny bone” when it comes to sporting injuries! Elbow injuries can be complex to both assess and treat, particularly when it comes to athletes. While they might not be the most common cases you see, it’s essential to stay sharp on elbow anatomy and function to accurately assess, diagnose, and treat patients and get them back to their sport with full function. Elbow rehabilitation requires a thorough, evidence-based approach. Luckily, I had expert physio Ian Gatt’s Masterclass to provide me a much needed deep dive into the management of elbows in the sporting population—I’ve outlined a few key tips below.

For a comprehensive overview of assessment and management of the sporting elbow, watch Ian’s full Masterclass HERE.

 

Diagnosis

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Diagnosing elbow injuries in athletes can be particularly challenging due to the complex anatomy and overlapping symptoms of various conditions. This makes it essential to conduct a thorough assessment of movement patterns, load history, and functional deficits to pinpoint the source of pain and ultimately get the patient better. To do this effectively, it’s key to understand your elbow anatomy, and brush up on the common injuries affecting each area of the elbow. So that’s where we’ll start – below I’ve listed some of the common injuries Ian outlines in each area of the elbow:

Anterior elbow

Acute onset:

  • Distal biceps tear
  • Capsular injuries
  • Loose bodies

Gradual onset:

  • Distal biceps tendinopathy
  • Pronator teres syndrome
  • Radial tunnel syndrome
  • Radiculopathy (C6)
  • Osteochondritis Dissecans (OCD)

Posterior elbow

Acute onset:

  • Triceps tear
  • Loose bodies
  • Fractures (olecranon process or radial head/neck)
  • Olecranon bursitis

Gradual onset:

  • Triceps tendinopathy
  • OCD
  • Posterior impingement

Lateral elbow

Acute onset:

  • Posterolateral instability
  • Radial head subluxation/dislocation
  • Fracture of radial head/neck

Gradual onset:

  • Lateral epicondylalgia
  • Irritation of the radio-capitellum synovium or bursa
  • Radial tunnel syndrome
  • Radiculopathy
  • OCD

Medial elbow

Acute onset:

  • Ulnar collateral ligament sprain
  • Common flexor origin injury
  • Loose bodies

Gradual onset:

  • Medial epicondylalgia
  • Medial impingement
  • Ulnar nerve neuropathy

It’s also important to note that there are going to be differences between youth and adult athletes when it comes to elbow injuries. Adults are more likely to experience tendinopathy, while in younger athletes, you’re more likely to encounter epicondyle fractures, OCD or conditions like Little League Elbow (medial epicondyle apophysitis).

As we’ve covered, diagnosing elbow injuries is complex, with many potential sources of pain in a small area. A strong understanding of elbow anatomy is essential—not just for diagnosis, but for assessing and treating functional limitations. Check out the video from Ian’s Masterclass below where he describes the importance of applying this anatomical knowledge in a clinical setting:

 

Treatment

Effective treatment for elbow injuries relies heavily on an accurate diagnosis and understanding the patient’s current functional level. As Ian puts it, “prognosis = diagnosis + function”. It’s also important to recognise the differences between youth and adult athletes. For instance, research shows that children have reduced elbow joint position sense compared to adults (1), which may increase their risk of injury during the transition from youth to adult sports.

Ian highlights the clinical utility of understanding joint stability at the elbow, and incorporating proprioceptive exercises in the patient’s rehabilitation. Watch the below video from his Masterclass, in which he demonstrates some useful exercises:

There may be some value in passive treatments as adjuncts, but only if they are meaningful to the patient. It’s essential the patient understands the short-term benefits of these treatments, alongside the exercises and strategies required for long-term recovery and a successful return to sport. Watch Ian explain a common self-management strategy he gives to his patients in this video taken from his Masterclass:

Post-op and trauma

Managing traumatic and/or post-op elbows can be tricky – we want to make the best decision for the patient’s outcome, and it often requires balancing the need for protective healing to ensure stability with the goal of preventing Post-Traumatic Elbow Stiffness (PTES). According to Ian, most adult elbow dislocations are simple and don’t require surgery, though in high-impact sports like boxing, seeking a surgical opinion is worthwhile. While it may be tempting to use a brace, there’s some controversy surrounding their effectiveness. In many instances, Ian recommends using something less restrictive, such as a sleeve, to promote mobility while still offering support. Overhead rehabilitation is often a great starting point, as it enhances joint congruity and can lead to better outcomes. Ian also suggests that closed kinetic chain exercises may be more effective early on for improving pain and range of motion.

 

Wrapping up

And there you have it! I hope this blog has given you a glimpse into managing sporting elbow injuries, but it really only scratches the surface of Ian’s excellent Masterclass. He goes much deeper into the functional anatomy, assessment, and treatment of various elbow injuries in athletes. Elbow injuries may not be the most common cases we see as physios, but that’s exactly why it’s essential to sharpen our anatomy and assessment skills—so we’re fully prepared when the next elbow injury comes our way!

If you want to learn from the elbow expert himself, watch Ian Gatt’s full Masterclass HERE.

Want to level up your elbow game?

Dr Ian Gatt has done a Masterclass lecture series for us!

“The Sporting Elbow”

You can try Masterclass for FREE now with our 7-day trial!

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References

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