Elbow Injury in Handball: Overuse Injuries

Abstract

This chapter deals primarily with overuse or misuse of the musculotendinous units in the elbow joint, which can lead to chronic problems in handball players. Handball players’ elbow joints must withstand high forces that are not often encountered in daily life. Epidemiological studies published in the literature have shown that elbow problems affect a significant number of handball players, with prevalence at least as high as observed in other throwing sports. The most common mechanism of injury is repetitive throwing motion in field players and repetitive hyperextension trauma to the extended arm in goalkeepers. Biomechanical analysis of the throwing motion in field players revealed that transition from the late cocking phase to the early acceleration is responsible for elbow lesions in these athletes. They are usually chronic in nature and are the result of repetitive overload of the dominant arm. Tyrdal and Olsen (J Shoulder Elb Surg 7:272-283, 1998) confirmed that hyperextension trauma similar to that of handball goalkeepers in cadaveric elbow specimens provokes anterior capsule rupture, transversal and longitudinal rupture of the flexor-pronator origin with elongation of the anterior part of the medial collateral ligament, occasional incomplete rupture of the lateral collateral ligament and detachment of small fragments of cartilage near the posterior edge of the olecranon. Imaging studies in elite handball players have shown typical overuse injury patterns in the dominant elbow of field players, while repetitive hyperextension stress of the elbow in handball goalkeepers provokes similar pathological changes bilaterally. On the basis of these studies, the existence of specific chronic elbow injury patterns can be confirmed in handball players-commonly known as ‘handball elbow’. We hope that the information provided will increase clinicians’ awareness of overuse syndrome in the elbow among handball players, so that these athletes can be treated appropriately and long-term elbow problems prevented.