Health and Exercise Science

HLEX 3233 Injury Evaluation & Recognition – Upper Extremity

Case Study Summary Report

Case Study 2 – Elbow and Forearm
Esmeralda Reyes
Bruce is a 17y/o wrestler who competes in the 175lb weight class. The day before his next match, he is
wrestling a teammate in practice. During this practice session, he is brought down to the mat where he
lands on the tip of his left elbow.

Bruce comes over to you so that you can take a look at him. He explains how it happened and you ask
him a few questions as well. He describes his elbow as being “stiff” and has pain with extension and mild
point tenderness over the olecranon process. Within 1 hour, he begins experiencing elevated point
tenderness, 6/10 on a pain scale, and moderate edema over the olecranon process. Compression of the
radius and ulna is painful as well so you recommend that he get an x-ray to rule out any fracture.

The following day, you get word that the x-rays were negative and you also learn that while his pain is
decreasing, 3/10 on a pain scale, the localized edema surrounding the olecranon process is increasing in
size and getting warmer.

1. Describe the clinical signs and symptoms that Bruce is experiencing.

Signs (what I see): pain occurs when applying compression to the radius and ulna, moderate
edema over the olecranon process within an hour later, olecranon process is increasing in size
and getting warmer the next day, 6/10 pain within the hour after injury, pain is 3/10 the
following next day, X-ray came out negative

Symptoms (what they tell me): elbow is “stiff” after falling on it, pain with extension, mild
point tenderness over the olecranon process after landing on the tip of left elbow, elevated
point tenderness an hour later,
2. Based on Bruce’s complaints and your physical exam, what conditions would you include in your
initial assessment? Why?
Olecranon Fracture: Bruce mechanism of injury is landing on the tip of his left elbow which
occurred with applied forced. After the injury occurred, he did have pain with extension of the
elbow and started to have moderate edema over the olecranon process. Since the Xray came
out negative we know he does not have a fracture.
Dislocation: Bruce did develop swelling after the injury; however, it is common to not be able
to bend the arm when there is a dislocation at the elbow. He was not able to extend with the
pain. There was no point of time where he told us that he lost feeling in his hand and no
visible deformity.
Olecranon Bursitis: Bruce pain level decreased overtime, but he was point tender at the
olecranon bursitis. With bursitis there is swelling at the joint area and he had swelling the day
of the injury, as well as the next day.

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 Health and Exercise Science
HLEX 3233 Injury Evaluation & Recognition – Upper Extremity

3. Using the answers from question 2, determine through differential diagnosis the appropriate
medical assessment.
From the information gather and comparing it to other conditions I think Olecranon Bursitis
would be the best fit for his condition. Since, his Xray came out negative it helps to rule out
that there was no fracture. I know that wrestlers use the upper body a lot by pushing and
pulling lots of weight. Overuse of the elbow and falling onto it could have caused the joint to
irritate. He did have pain but decrease overtime which within that time he allowed the joint to
rest and heal.
4. Based on the information given and the information you’ve gathered, what would be your best
course of action? Describe in detail.
Before allowing him to leave and head to the doctors I would have stabilized the wrist, elbow,
and shoulder to assure that he would not increase the injury. Since, he did come back with a
negative Xray I would encourage him to ice it. Stabilization is still important to allow the body
to heal and clean the debris out that is hanging out at the elbow. Also, after a couple weeks I
would still want him to rest and to not overuse the elbow.

References
Starkey, C., & Brown, S. D. (2015). Examination of Orthopedic & Athletic Injuries (Fourth ed.).

Philadelphia, PA: F. A. Davis Company

INJURY EVAL & RECOGNITION - UE | Case Study Summary Report