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Don’t ignore minor elbow injuries

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By Dr. Jeff Daniels EBS Medical Columnist

Memorial Day usually signals the start of summer in Montana rather than the calendar, and summertime activities bring with them a host of interesting injuries. One that I see quite often, and have already seen this summer, is a specific fracture of the elbow from falling off a bicycle.

Elbow injuries are common, in both winter and summer. They fall into two categories: devastating fractures needing immediate surgery, and minor fractures where the elbow heals faster—and with less immobilization necessary—than most fractures elsewhere in the body.

Every year we see a couple of these minor fractures from falls off mountain bikes or other bicycles. Specifically, the end of the radius bone of the forearm gets cracked where it meets the ulna and humerus bones to make the elbow joint. Interestingly, the rider doesn’t even have to be moving to incur this type of injury.

It happens like this: You take a nice ride, and stop to take in the view. Straddling the bike in this stationary position, one foot is on the ground and the bike is tilted in that direction. Something causes you to lose your balance, and you fall sideways, extending your arm to break the fall.

Instead of putting all the force on the wrist—a much more common place to fracture than the elbow when you FOOSH (fall on an outstretched hand)—for some reason this sideways fall from a motionless bike transfers the force to the radial head in the elbow joint, causing it to fracture.

Flying over the handlebars can also result in landing in the FOOSH position, and is another common cause of radial head fractures. Depending on how fast you are going, how steep the hill is, and how you land, other injuries can also occur, especially to the shoulder and wrist. Landing on a gravel road will usually cause “road rash,” the name for superficial abrasions—often impregnated with pebbles and pine needles—that occur on the forearms, elbows and knees.

If you’re lucky enough not to hurt anything else, the most common presentation of an elbow injury is a painful, but not especially swollen elbow, getting progressively worse a day or two after the accident. Since these types of minor elbow injuries don’t hurt as much at the time of the accident, delay in getting medical care is the rule not the exception.

On examination, it’s easy to correctly diagnose before an X-ray is taken. Pronation and supination of the forearm—with the palm of the hand facing down, turning to palm up then back again—is very painful, and the injured party does not appreciate me pressing over the radial head.

With an X-ray we will either easily see a fracture, or the inside of the elbow joint presents bleeding around the shadows caused by fat, muscle and bone. We can infer from these changes that a minor fracture has occurred.

Treatment of a minor elbow fracture involves immobilizing the elbow with a long arm splint and sling. Unlike wrist and ankle fractures, which require strict immobilization for a month or more, a minor elbow fracture heals well if movement is started early, often within a week.

So be careful out there this summer, and don’t ignore an injury that is getting worse rather than improving.

Dr. Jeff Daniels has been practicing medicine in Big Sky since 1994, when he and his family moved here from New York City. A unique program he implements has attracted more than 700 medical students and young doctors to train with the Medical Clinic of Big Sky.

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