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Tuesday, March 11, 2014
Bone Bruise of the Elbow
Greetings. My son is entering his high school baseball season. He has been diagnosed with a bone bruise on the backside of his right elbow. He has been progressing slowly through a light throwing program. Progress seems to be slow but improving. It has been 4 months since his injury and shut down. We are deeply concerned that there maybe a deeper problem. MRIs and X-rays do not reveal ligament or tendon damage, nor does doctor examination. No bone chips or fluid build up. He has taken prescription anti inflammatory off and on as well. Could there be a deeper problem or is this a normal timeline for healing of a bone bruise?
Pain and reduced function following a bone bruise may take "weeks to months" to significantly improve. However, if your son is not more than 50% improved now, 4 months after symptoms began, and over which time he's only been performing a light throwing program and not engaging in any other potentially aggravating activities, this diagnosis may need to be reconsidered. This may require alternative or additional treatment options, either by re-evaluation by his treating physician, or perhaps getting a second opinion.
It is also important to keep in mind the following: Pain in the elbow can be "referred" there from elsewhere (such as from the shoulder or neck), and/or can result from imbalances in muscular strength/flexibility/range of motion elsewhere in the "kinetic chain" (such as in the shoulder, trunk, or hip regions), and/or can be due to poor throwing technique. As a result, in addition to physician evaluation or re-evaluation, input may usefully be obtained also from a physical therapist, athletic trainer, and/or his coach. None of these causes or contributing factors would be revealed by imaging studies of the elbow.
Brian L Bowyer, MD
Clinical Associate Professor
Physical Medicine & Rehabilitation
College of Medicine
The Ohio State University