Author: Ryan Riggs, MD
Co Author #1: Alec DeCastro, MD
Co Author #2: Joseph Miller, DO
Senior Editor: Jessalynn Adam, MD
Editor: Elizabeth Albright, DO

Patient Presentation:
A 24-year-old male right-hand-dominant professional hockey player presented to the clinic with left elbow pain following a fist fight on the ice during his game the previous night.

History:
He reported that he was holding his opponent with his left hand when the other player threw a punch downward onto athlete's outstretched arm. The athlete believed he had hyperextended the elbow. He was evaluated in the training room and was noted to have pain along the ulnar side of the elbow with concern for joint instability on exam. On presentation to clinic the next day, he noted continued ulnar-sided elbow pain and swelling with limitation of range of motion at the elbow joint. He denied any numbness in the elbow or hand. He denied any prior injuries or problems with the elbow.

Physical Exam:
Focused exam of the left upper extremity revealed marked swelling around the elbow with ecchymosis extending from the elbow down to the wrist. There was a superficial laceration over the ulnar side of the elbow without any drainage and it did not extend through to the dermis. The athlete had restricted range of motion of both flexion and extension. There was notable varus and valgus instability. Motor exam demonstrated intact elbow flexion and extension, wrist flexion and extension, finger and thumb flexion, extension, adduction, and abduction. He endorsed subjectively intact sensation of all digits without deficit. Radial pulses were 2+ and cap refill was less than 2 seconds.

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