HYPEREXTENSION OF THE ELBOW JOINT - PATHOANATOMY AND KINEMATICS OF LIGAMENT INJURIES

According to an epidemiologic study (Scand J Med Sci 1996;6:297-302) t he mechanism of ''handball goalie's elbow'' may be forced hyperextensi on. The pathomechanics of hyperextension were studied in nine macrosco pically normal male cadaver elbow joints. The mean age of the donors w as 43.2 years (range 25 to 61 years). Kinematic tests were performed w ith an experimental three-dimensional kinematic loading apparatus. Hyp erextension loads induced joint laxity during flexion of less than 50 degrees. The kinematic changes were significant in joint flexion durin g forced valgus and external and infernal axial rotation, but were not significant in flexion during forced varus. No instability was found with flexion beyond 90 degrees. The hyperextension loads produced four lesions: (1) anterior capsule rupture; (2) L-shaped rupture of the pr onator/flexor origin with elongation of the anterior part of the media l collateral ligament; (3) occasional incomplete rupture of the latera l collateral ligament and (4) small fragments of cartilage near the po sterior edge of the ulna in one of the specimens. One or more of these lesions may be responsible for the symptoms in ''handball goalie's el bow.''