Elbow injuries in rugby are less common than shoulder injuries.
Of course, the overuse injuries such as tendinopathy (tennis, golfer’s elbow and biceps tendinopathy) can occur and these are treated in line with other causes of the same problem. This usually involves a period of avoidance of the precipitating causes, a physiotherapy programme and modification of technique. If that fails, then a PRP injection is the next line. Surgery is required for the minority of patients.
Elbow dislocation sometimes occurs during rugby. A dislocated elbow requires emergent reduction in hospital. The integrity or fracture of bones around the elbow determines the best treatment pathway:
If there is no fracture, the dislocation is called ‘simple’. An MRI will assess the structures you’ve injured and help guide your surgeon as to your need for a general anaesthetic examination of your elbow +/- fixation of your ligaments and muscles if your elbow is still unstable. It is usually those with muscle origin avulsions as well as ligament injuries who require this approach. For those without muscle origin injury, the standard short period of splintage followed by controlled active motion is advocated.
A fracture dislocation normally requires surgery to address both the bony injuries and the ligament injuries. A CT scan helps your surgeon to plan fixation. Occasionally an external fixator is required to augment your repair for 6 weeks after your surgery, but normally controlled active motion is encouraged (sometimes in a brace) soon after your operation.
After a dislocation your ligaments need to heal. This will take a minimum of three months and then you will need to strengthen your joint. It is therefore likely that you will be off competitive play for 5-6 months. A degree of elbow stiffness (loss of end-range of motion) is common after elbow dislocation, but the recovered range is normally ‘functional’.
Recurrent instability is uncommon, but can be a challenging problem to treat. Ligament reconstruction procedures can restore stability and function. A synthetic ligament or a donor tendon can be used to create these reconstructions.
Distal Biceps rupture
Rugby players are stronger now than ever before. Heavy weight training regimes are the norm for serious players. As we enter our thirties, the ability of our tendons to adapt declines and we become prone to degenerative tendinopathies. An overwhelming force, or a sudden eccentric contraction can cause the distal biceps tendon to rupture. This causes a pop or a crack, swelling pain and bruising. In complete ruptures, your biceps muscle contour changes and you will notice weakness in both elbow flexion and forearm rotation. These injuries are best treated with early surgical repair (within 2 weeks ideally). Results of fixation are generally excellent with 95% or more of full strength returning once healed. Occasionally the tendon is only partially ruptured. In this case an MRI is useful to characterise the injury and plan whether to fix the injury or rehab without surgery.
Fractures around the elbow often require surgical fixation. Please see the elbow conditions section: ‘common elbow trauma’ for more detail. The aim is to restore enough fracture stability through fixation to allow immediate controlled rehabilitation of your elbow. In general, healing bones around the elbow will become pretty strong by three months, so you will begin to strengthen from then. Your return to competitive play will then be planned.