Hyperextension of the elbow is the term used to describe the injury caused when an elbow joint is forced backwards beyond its normal range of motion, resulting in damage to the soft tissues in the joint.
Three bones articulate with each other to form the elbow: the humerus in the upper arm, and the radius and ulna in the lower arm. Together they allow the arm to move in a hinge-like manner, and also to turn the hand palm up or palm down. Between articulating surfaces are areas of cartilage, smooth, strong tissue that both cushions the ends of the bones and allows them to glide easily over each other.
Tendons are tough cords of connective tissue called collagen. They originate in muscles and attach the muscles to bones. When muscles are contracted, tendons pull on bones, causing movement. Stress placed on a tendon can damage some or all of the collagen fibers that make up the tendon, fraying or breaking them.
Ligaments are bands of strong connective tissue that join one bone to another. They support joints, keeping them in position and, in some cases, limiting excessive movement.
Elbow hyperextension often occurs during contact sports or martial arts when a strong blow forces the elbow backwards. The stress placed on the structures of the joint is more than they are designed to withstand, and the connective tissues fray or break.
- Severe pain at the moment of injury
- Pain felt at the crease of the elbow
- Increasing swelling, stiffness, and reddening with time
Although most cases of elbow hyperextension are self-limiting, in that they heal by themselves with time and rest, it is a good idea to seek medical attention in order to rule out serious damage to the ligaments, tendons, and bones of the elbow. Your doctor will take your medical history, including details of any previous elbow injury, and then ask you about the circumstances and symptoms of your current injury.
Your elbow will then be physically examined for stability, strength, range of motion, and any swelling of the joint will be noted. X-rays or other diagnostic scans might be ordered if your doctor suspects a bone fracture or seriously torn connective tissues.
Treatment of elbow hyperextension usually consists of the following conservative (non-surgical) methods:
Rest: Rest the joint completely. This is best achieved by using an elbow support such as a strap or brace.
Ice: During the acute stage of the injury, which is normally two or three days, apply ice, crushed in a bag and wrapped in a towel, to the elbow for as long as is comfortable, several times a day. This will help to reduce swelling.
Compression: Wrap the elbow in a compression bandage, or tape it firmly, but not tight enough to cause swelling in your hand or discoloration of your fingers.
Elevation: Raise your elbow above the level of your heart whenever you can. You can achieve this by resting your arm on a pile of cushions or pillows.
NSAIDs: Non-steroidal anti-inflammatory drugs such as ibuprofen (Advil), naproxen (Aleve) or aspirin will help reduce inflammation and pain.
Physical therapy: After a week or two of resting the elbow, you can begin a program of graduated exercises to restore range of motion and strength in your elbow. It would be sensible to wear an elbow support or apply tape in order to prevent hyperextension. There are several supports available and you should try different ones to find the support best suited to your arm.
If the damage to the structures in your elbow is severe enough you may need surgery. The goal of any surgical procedure would be to eliminate symptoms and restore full function to your elbow. The surgeon might need to stitch together torn ligaments or tendons, or construct a replacement structure from another part of your body to replace irreparably damaged tissue. A period of rehabilitation lasting several months, with dedicated physical therapy, would be necessary to achieve the best possible outcome. Again, wearing a protective elbow support during any future sporting activity would be recommended.
Only begin exercises with the approval of your doctor or physical therapist. Do not try to do too much too soon, and stop if you feel any pain. Ten repetitions make 1 set. Build up to 3 sets.
Sitting or standing, raise your injured arm until it is parallel with the floor, palm facing the ground. Use your other hand to gently press on your wrist. You should begin to feel a stretch in the forearm and elbow of the injured arm. Hold for 10 seconds.
Sitting or standing, raise your injured arm until it is parallel with the floor, palm facing up. Place your other hand under the wrist and use it to gently lift the injured arm, bending the elbow as far as it will go without force. To get the best stretch, relax the injured arm. Hold for 10 seconds.
Keeping your elbow at your side throughout, bend the injured arm so that the forearm is parallel to the ground and the palm is facing up. Use your other hand to press down on the palm. Resist the pressure by contracting the biceps muscle in the injured arm. Hold for 5 seconds.
Keeping your elbow at your side throughout, bend the injured arm so that the forearm is parallel to the ground and the palm is facing inwards (handshake position). Make a fist with the hand. Place your other hand under the fist. Press down with the fist, as though trying to straighten the elbow, while the other hand resists and prevents any movement in the elbow. Hold for 5 seconds.