[jim.macp]

do any of those in the know have thoughts on how valgus instability may relate to font elbow?  and particularly how it can be pre-habilitated against?

from what i understand it is caused by a torque applied to the elbow joint which puts the inner ligaments in tension and the outer in compression.  it seems to be most commonly presented in amateur baseball leagues (hence Little League Elbow), but would seem to be a common situation for climbers too.   

for me, font elbow always manifests as a dull ache on the inside and back of the elbow.  i've never been able to pin-point a specific location beyond this, it's feels to be more within the body of the joint.  the symptoms always onset while slapping up an arete, or while moving dynamically off low side-pulls close to the centre line of the body.

i think that, in my case at least, little league elbow fits my symptoms better than the other conditions often linked to font elbow such as tendonitis of the brachioradialis, brachialis, biceps, triceps etc..  partly because i've never been able to pin-point a specific tendon in pain, and partly because i've found that when i'm suffering pain on aretes and close low side-pullls, that i can still pull hard without pain on horizontal holds in any position, or on side-pulls further above or to either side of my body. It doesn't seem to matter what position the hand is in relative to the elbow (thumb up or to the side), as much as the direction of pull in combination with a near right angled bend in the elbow.

what do you think, does this sound like a contender for the font elbow symptoms?  and if so what would the treatment and prevention regime be?

in the little league world the treatment seems to be to limit the number of pitches.  i'm hoping for something a little more proactive than 'climb less'.  this paper suggests that the wrist flexors are important in stabilising the elbow against valgus stress.  http://cat.inist.fr/?aModele=afficheN&cpsidt=16199504   presumably the other major arm muscles also play a part, so a general conditioning regime may be in order.

[GCW]

There's been a recent Font elbow thread.

Firstly, "Little League Elbow" is a growth plate type injury, consisting of a traction apophysitis of the medial epicondylar ossification centre.  Therefore, if your growth plates are fused (ie you are over 18ish) it is impossible for you to get it.

The common flexor origin is the medial epicondly.  All the muscles that bend the wrist/fingers attach here.  Therefore if you repeatedly do deep locks in flexion you aggravate the medial epicondyl and get tendinitis.  Font elbow.
Because I get the ache all round the elbow I suspect there's some aspect of capsular irritation too, but Little Leager's it ain't.

Boom.  SCIENCE, mofo! 

[jim.macp]

Cheers GCW, you are right, LLE isn't relevant, i'm mixing terms.  but what about the idea of stress on the ligaments that support joint stability (as opposed to tendonitis)?  is that what you mean by capsular irritation?

i'm not convinced by the tendonitis argument.  say for example i spend a session slapping up an arete and start to feel the familiar elbow ache.  the conventional explanation would be that i have irritated one or more of the tendons anchored around the medial epicondyle.  fair enough.  but then i move to a hard problem campusing and making long locks up a series of flat crimps and slopers.  presumably if i had tendonitis of one of the M.E. tendons then i would continue to aggravate the elbow as i would be pulling on the same drive train.  but this isn't the case (for me at least).  the problem is very specific to loads that torque the elbow, compression moves where the elbow is bent close to 90 degrees.

the ulnar collateral ligament supports more than half of the elbow's resistance to valgus stress when the elbow is bent to 90 deg.  when the elbow is more extended the elbows boney architecture and anterior capsule help out.  this explains it's specific vulnerability to moves that produce a torque around the elbow.  can tendonitis of one of the insertions at the M.E. be so specific to compression moves?

[GCW]

the ulnar collateral ligament supports more than half of the elbow's resistance to valgus stress when the elbow is bent to 90 deg.  when the elbow is more extended the elbows boney architecture and anterior capsule help out. 

Where did you hear this?  It's not correct.  In extension the elbow capsule is more lax, so the MCL has to work hard to augment capsule action.  In deeper flexion, the posterior capsule tightens.

Font elbow appears to be aggravated by locking the elbow in deep flexion, and pronation.  When I get it the elbow hurts all the time, but it's agony when releasing a deep lock.  So even campussing hurts onnrelease of the lower arm.  So to my logic, it's not the pulling that hurts it's the static parts of the elbow.  Microtears of the capsule may explain this.  I guess collateral injury may be part of it, but my pain is fairly non-specific for location.  I'd expect MCL injury to give a fairly specific medial pain, and give pain on valgus strain (which it doesn't because I've tried MCL testing on myself when I've had pain).

If someone has some spare cash, MRI during the time of pain may give us some answers.

[GCW]

Where did you hear this?  It's not correct. 

Unless you have a previous elbow injury.....

[jim.macp]

i'll try a valgus stress next time i'm suffering on an arete.  to be honest the deep lock thing doesn't seem to be as critical to me.

my source on the loading of the UCL was eMedacine:

http://www.emedicine.com/sports/topic139.htm


i'd started thinking about ligament strain/joint instability because it struck me that the 'dull joint ache' was quite similar to what i'd felt with collateral ligament strains in my fingers.  in the case of the fingers i had felt a fairly diffused ache within the joint, though i was able to pinpoint the location of the damage by prodding around with my thumb.  the UCL is obviously a lot deeper and seems to be quite a wide element so figured that it wasn't surprising that i couldn't identify it under the various tendons and nerve bundles. 

cheers for the help, great to bounce ideas off someone in the know.

[jim.macp]

but i'm forgetting the point of the thread..

if it is indeed a ligament discomfort that is the cause, what would the means of prehabilitation? 

conditioning of all of the muscle groups that act around the joint would help, but how would the conditioning be best introduced?  the stabilising muscles have to be made to react as quickly as the primary pulling muscles as you slap up an arete (if they don't you'd expect that the joint/ligaments would suffer).  so are plyometrics advisable for prehabilitating stabaliser muscles?

   

[GCW]

Where are the physios when you need them?

[Sloper]

In the pub or changing nappies.