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Elbow Annular Ligament Tear & Strain Physiotherapy
An injury or sprain in the annular ligament of your elbow can lead to complications in the joint function. This particular painful elbow condition is typically characterized by:
- Skin discoloration or
- A feeling of weakness in the lateral side of the elbow
Unfortunately, it is the younger adults and children who are generally more prone to annular ligament damage. Although rare, the condition can also occur in adults, especially seniors who have suffered some form of an elbow injury before.
Other names given to this type of injury include:
- Annular ligament displacement
- Pulled elbow
- Radial head subluxation
- Nursemaid’s elbow (for children only)
Here, we provide a detailed overview of what adult annular ligament is, how it can be damaged, and the treatment options available to patients affected by it.
The article also discusses other painful elbow conditions that can be confused with annular ligament tears and how physiotherapy can help you recover from the sprain.
What Is Annular Ligament and What Does It Do?
As is the case with
virtually all painful hand and elbow conditions, recovering from an annular
ligament injury requires you to first understand the basic function and
position of the damaged part.
Ligaments, as you might
already know, are bands of tough elastic tissue that surround a joint. They serve to connect two bones together, support movement, and protect your joints from
forces and impact.
Our elbow joint is
primarily stabilized by three ligaments:
- the annular ligament
- the lateral collateral
ligament and the
- the medial collateral ligament
The annular ligament wraps
around the radial head within the radial notch and attaches it to the ulna. This
allows for the rotation of the two bones during the supination and pronation of
Simply put, the annular
ligament supports the rotation motion of your hand. For instance, every time
you turn a key, use a screwdriver, or drink tea in a cup, you do so with the
help of this tissue.
Given the way it’s naturally
sandwiched between the two main bones of your arm, the annular ligament is
highly susceptible to damage. It can be easily injured by elbow overuse or
direct trauma to the joint.
type of soft tissue injury is extremely common in children because in the early
stages of bone formation, bones can easily slip out of place or the ligament can be easily injured, especially common is where someone pulls a
child by the arm, the child might get an annular ligament sprain - even my best friend's kid had this happened to her, and she was just 1+ years old.
They found out only when their kid
stopped moving the painful elbow and kept saying pain and crying, before
realizing what had happened and bringing the kid to see an orthopedic
doctor. Fortunately these kinds of conditions are very mild with almost
no residual issues, and it usually resolves entirely.
first of all, What Causes Annular Ligament Pain?
In most cases, it can be
hard to identify the exact cause of adult annular ligament sprains. This is
especially true when the onset of pain is the result of gradual damage over
However, generally speaking,
there are several factors that physicians identify as the major cause of this
ligament sprain. This includes:
- Repetitive Strain
Injuries (RSI) that overload your annular ligament
conditions like osteoarthritis that create instability in the elbow joint
- Any former injury
that resulted in the dislocation of the elbow
injuries like avulsion fractures
that loosens the ligament at the bone
participation in activities that involve heavy use of the elbow and forearm
- Falling on an
Symptoms of Annular Ligament Sprain
The main symptoms of elbow annular ligament sprain or injury include the following:
- Sharp, shooting
pain when you rotate your elbow or flex your arm
- Persistent pain
along the outer side of the elbow
- Throbbing pain
near the elbow joint
- Difficulty in
- A tingling
sensation that spreads down the forearm to the hand
- Loss of strength
in the arm and elbow joint
Note that the symptoms of
annular ligament sprain differ from person to person, depending on the extent
of tissue damage.
A direct trauma to the
ligament is likely to cause more damage than that caused by daily muscle
Generally, an annular ligament injury can be classified into three
1 – Is when the ligament is only slightly overstretched or very mildly
torn. Typically, there is no effect on the joint function. While there may be
little to virtually no pain, a mild sprain can increase the risk of a more
2 – Is when there is significant damage or a relatively large tear in the
ligament. This can partially hinder arm movement and result in swelling and
bruising. Continuing using grade 2 sprained ligaments can develop into bigger
problems down the lane.
3 – Refers to the complete rupture of the ligament. Intense pain,
bruising, and heavy swelling are typically present in such injuries. Grade 3
ligament sprains require immediate medical attention. Failing to do so can have
prolonged effects, including permanent immobilization of the joint.
Other Conditions Similar to Annular Ligament Sprain
Pain due to annular ligament
sprain is most commonly confused with the pain stemming from tennis elbow.
Tennis elbow is a condition
of the lateral epicondylar region of the elbow that causes pain around the
outside of the joint. It usually occurs due to strenuous overuse of the muscle
and tendons in the forearm. While the symptoms of tennis elbow tend to overlap
with those of annular ligament sprain, the two conditions are, in fact, very
different from each other. As such, they require different treatments as well.
Symptoms of adult annular
ligament sprain can also be confused with Golfer’s Elbow.
elbow, also known as medial epicondylitis, is a condition that causes pain,
inflammation, and tenderness in the tendons that connect the forearm to the
elbow. The most common cause of this injury is an overload of the connecting
Who Is most At Risk of Experiencing Annular Ligament Pain?
- People who have
previously suffered from elbow dislocation, avulsion fractures, or any similar
kind of joint or muscle damage are at high risk of this injury.
- Baseball players,
especially pitchers, are likely to suffer from annular ligament pain.
- People who
frequently participate in sports activities that involve repetitive overhead
motion, such as throwing, are prone to damaging their annular ligament.
- Athletes like
tennis players and volleyball players have a high chance of experiencing
annular ligament pain.
hammering, or gardening for extensive hours can lead to annular pain due to
excessive strain on the ligaments.
- Elderly men and
women with a history of muscle or joint problems, such as arthritis or bursitis,
are more susceptible to this type of soft tissue injury.
what are the Treatments for Annular Ligament Sprain?
Treatment for annular
ligament sprain begins with an acute diagnosis of the injury.
This is vital for
identifying the extent of damage to the annular ligament and helps rule out
other possibilities as well.
Your doctor and our principal physiotherapists will ask for your full medical history and perform a thorough
examination to come to a sound conclusion. Typically, patients are asked to
perform different types of elbow movements, along with other resistivity tests.
This often includes what is
known as valgus and varus stress tests. The doctor might put gentle pressure on
specific trigger points to check the severity of the sprain.
At times, patients might be
referred to get an x-ray or an MRI scan done to confirm the diagnosis. However,
the need to obtain radiographs of the affected area arises only in rare cases
where the symptoms are too severe to be considered a probable fracture. The results
of the scan allow your physician to see precisely where the ligaments have been
stretched or torn.
anti-inflammatory drugs (NSAIDs) are often used for the relief of pain and
inflammation. If the pain is too intense, patients might be prescribed a mild
narcotic or corticosteroid injection as well.
How our principal Physiotherapists Help People with Annular Ligament
If the injury is not too
serious to require surgical treatment, conservative pain management techniques
and physiotherapy are usually sufficient to help patients recover.
In fact, even when patients
undergo a surgical procedure, physiotherapy is generally required as a follow
up plan to restore the normal function of the tissues.
Our elbow and hand
physiotherapists have vast experience helping people with different kinds of pain
problems successfully get on the road to recovery.
To control pain and ensure the
healthy function of the elbow joint, following an annular ligament injury, we
generally start with a customized treatment plan.
This includes specific
exercises that promote natural healing of the torn ligaments by enhancing blood
flow and improving the flexibility of the joint. For example, elbow mobility
exercises are effective in increasing the range of motion, whereas strength and
resistance exercise will provide greater stability in the joint.
Stretching and loading
exercise is of prime importance in treating damaged ligaments as there is an
increased risk of atrophying otherwise.
Our expert physiotherapists
for elbow and hand conditions will carefully examine the degree of damage to
determine which exercises will work best for you. We focus on exercises that not only help
repair torn or damaged tissues, but also reduce the chances of re-injury at the
To ensure faster and
complete recovery, we might also use ice therapy, hot compresses, deep tissue massage,
tapes or braces in conjunction with the physical therapy.
In the end, remember that
although painful, annular ligament sprain can be easily treated in as little as
a few weeks. The key is to visit our principal physiotherapists and seek medical help as soon as
you possibly can.
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At the first session, our specialist physiotherapists will carry out a thorough
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Follow up sessions are inline to provide
expert treatment for your pain as well as prescribing specific
exercises to reduce your risk of re-injury and giving you a long term
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