Professor Joideep Phadnis – Treatment and Management of Elbow Injuries – Injury Rehab Network

The first Injury Rehab Network with BASRaT in December featured a presentation from Professor Joideep Phadnis, Consultant Elbow and Shoulder Surgeon, Fortius Clinic. The online event took place on Wednesday 3rd December, attended by 300 sports rehabilitation practitioners.

Joideep shared insights into the treatment and management of soft tissue elbow injuries. The recording is available to watch here.

Professor Joideep Phadnis – Consultant Elbow and Shoulder Surgeon, Fortius Clinic

Professor Phadnis is an experienced Elbow and Shoulder Surgeon with a tertiary NHS practice at University Hospitals Sussex in Brighton, where he is Honorary Professor at Brighton & Sussex Medical School. He is widely recognised for high-quality outcomes, with referrals from GPs, physiotherapists, and consultants across the Southeast and beyond.

His work covers the full range of elbow and shoulder surgery, including sports injuries, arthritis, trauma, minimally invasive techniques, and computer-planned interventions. He has published around one hundred peer-reviewed papers on areas such as joint replacement, tendon conditions, arthroscopy, trauma, and patient safety.

Alongside clinical practice, he teaches nationally and internationally, is honorary clinical reader at Brighton and Sussex Medical School, directs the Sussex Shoulder and Elbow Fellowship, and contributes to committees within BESS, ESSKA, and ISAKOS.

In 2023 he received a National Clinical Excellence award for his contributions, with particular reference to elbow surgery.

Treatment and management of soft tissue elbow injuries in sport

His practice is around 80% focused on elbow surgery, covering sports injuries, trauma, arthroplasty, and revision.

The presentation covered:

• Anatomy and biomechanics
• Diagnosis
• Soft tissue injuries
• Sports

Anatomy and biomechanics

The elbow was described as a stable joint supported by dynamic stabilisers. The medial and lateral ligaments act as primary stabilisers. The LCL functions like a hammock supporting the radial head and provides varus and external rotation stability. The MCL provides valgus and internal rotation stability, with the anterior band the key element.

Forces during throwing can lead to valgus extension overload, causing medial tension, lateral compression, posterior medial impingement, and shear. Most elbow dislocations involve a valgus force with an MCL tear.

The anatomic tipping point for stability lies at the LCL and CEO (Common Extensor Origin). Diagnosis aims to rule out injury in these structures. LCL integrity is assessed using the Posterolateral Rotatory Drawer Test. The joint may remain stable with MCL and CFO injury, but stabilisation surgery can be required if the LCL and CEO are also affected. Supine exercises were highlighted as effective for rehabilitation as they maximise stability and use gravitational and compressive forces.

MCL Injuries in Athletes

MCL injuries present differently in athletes compared to the general population because sporting demands exceed routine daily requirements. They are common in goalkeepers, throwers, weightlifters, American Football, gymnastics, tennis, athletics, and MMA.

Non-surgical management may suit partial injuries and full-thickness tears in lower-risk sports.

This approach includes flexor pronator training, technique changes, and adjusting activity frequency. Surgical planning focuses on identifying which tears need treatment, the choice between repair and reconstruction, and priorities for returning to sport.

Historically, reconstruction followed the ‘Tommy John Surgery’ technique. Modern approaches favour primary repair with internal bracing, which offers a quicker return to activity than grafting.

Valgus Extension Overload

These injuries appear in sports involving valgus and extension forces and may lead to:

• Posteromedial impingement
• Posteromedial osteophyte
• Chronic attenuated MCL
• Associated lateral lesions

Lateral Compression Injuries

This section covered OCD Capitellum, Plicae, and Radio-capitellar arthrosis.

Osteochondritis Dissecans (OCD) is common in adolescent athletes, particularly those involved in throwing actions, gymnastics, and tennis. Symptoms include locking, pain, and loose bodies. Diagnosis is often delayed, and the condition is linked with adult arthritis, so practitioners were advised to treat as OC until proven otherwise.

Stable lesions are usually managed non-operatively. Unstable lesions require surgery such as debridement, minced cartilage grafting, or OATS (Osteochondral Autologous Transplantation Surgery).

Distal Biceps and Triceps Tears

Acute and chronic tears, diagnosis, management, and special situations were discussed.

Distal biceps anatomy includes short and long heads, with variation in around 20% of individuals. Presentation often follows eccentric flexion force or injury during extension and may involve sudden severe pain, a pop, and inability to continue activity.

Examination findings may include:

• ‘Reverse Popeye’ deformity
• Asymmetry
• Skin puckering
• Anteromedial forearm bruising
• Loss of normal rise and fall
• Weakness resisted flexion
• Weakness resisted supination

The hook test assesses the absence of a hookable tendon. Imaging is only needed when diagnosis is unclear. Non-operative management can leave individuals with a supination and flexion deficit, so surgery may be chosen to address weakness, fatigue, appearance, cramping, and nerve pain. The open repair uses a transosseous cortical button to reattach the tendon.

Chronic or retracted tears may lead to cramping, snapping, nerve pain, fatigue, and appearance-related concerns. Surgery can involve allograft reconstruction.

Triceps tendon tears are uncommon but frequently missed. Power may be partly preserved even when the tear is complete.

Risk factors include:

• Weightlifting
• Combat sports
• Collision sports
• Anabolic steroids
• Corticosteroid injections
• Endocrine disorders

Mechanisms often involve forceful eccentric contraction, bench pressing, direct trauma, or a fall onto an outstretched hand.

Diagnosis considers:

• History of a single acute event
• Extensive bruising
• Full ROM in elbow
• Possible preserved active extension
• Preserved lateral expansion
• Extension lag
• Weakness with gravity elimination
• Squeeze test

Early surgery is recommended as full-thickness tears retract. The technique described was a knotless double row low-profile repair.

Summary points on biceps and triceps tears:

• Early recognition and treatment important
• Outcomes with surgery are excellent
• Awareness of complications
• Chronic reconstruction produces good results

Tennis Elbow – Lateral Epicondylitis

The aetiology was outlined as focal pain at the ECRB tendon origin:

• Degenerative
• Mechanical
• Neurogenic
• Not inflammatory

Research volume is large but inconsistent in quality.

A 2019 symposium advised using the term Lateral Elbow Tendinopathy. The condition resolves without intervention, and practitioners were encouraged to follow BESS Guidelines.

Headline recommendations include:

• Corticosteroid should not be used
• Shockwave therapy should not be used
• Physio should be offered to all
• PRP may have no benefit over a placebo
• Surgery may have no benefit over a placebo

Where symptoms persist without concurrent pathology, management may include:

• Education and counselling
• Reassurance that symptoms are not harmful
• Physio
• Non-interventional management
• Consider PRP with counselling of a placebo
• Consider surgery with counselling of a placebo

Persistent symptoms with concurrent pathology may require:

• Arthroscopic surgery – synovitis, chondral damage, ligament plication
• Open surgery – acute tears, ligament repair or reconstruction

Summary

Key points from the presentation:

• Understand anatomy and biomechanics
• Early diagnosis and treatment help
• Surgical interventions are available
• Acute and chronic

Further information and follow Professor Joideep Phadnis

• Fortius Clinic
• University Hospitals Sussex
• X: @lbowfixr

Q&A

Questions from practitioners were answered during the session. Insights can be found in the recording (click here).

The Global Elbow Network was recommended as a useful resource: Global Elbow.

Presentation Recording

The recording of Joideep’s presentation is available to watch here.

2026 Injury Rehab Network events

The final Injury Rehab Network event is a session led by Dr David White, a Consultant Physician in Sport, Exercise and Musculoskeletal Medicine, who will outline approaches to managing and treating exercise-induced leg pain, informed by his extensive work across elite football and SEM clinics. You can register for this event by clicking here.

Find out about and register your interest for all the Injury Rehab Network events with BASRaT planned for 2026.

Please enter your details into the form below along with any questions or comments and a member of our team will be happy to provide you with more information: