Tennis elbow, also known as lateral epicondylitis, is an elbow injury that occurs as a result of overuse, most commonly from playing tennis. The pain associated with this condition affects the lateral epicondyle, the area where the forearms' tendons connect with the bony outer portion of the elbow. While tennis elbow typically affects adults aged 30 to 50, anyone who continually stresses their wrists is at a higher risk of developing this condition.
Tennis elbow is usually diagnosed by examining the affected elbow and reviewing the patient's medical history. To assess pain, pressure may be applied to the elbow. In some cases, x-rays may be done to rule out other conditions that may be responsible for causing elbow pain.
In many cases, tennis elbow heals on its own within two years. Initial pain can often be managed with rest, ice and over-the-counter painkillers. Cases that don't respond to the aforementioned measures may require additional treatment, in the form of exercises, orthotics, or corticosteroids. Severe, persistent cases of tennis elbow may require surgery; however, surgery is only necessary for about ten percent of those suffering from tennis elbow. Your doctor will develop a customized treatment plan based on your individual condition.
Pain on the inside, medial side, of the elbow is commonly referred to as golfer's elbow. The pain is typically aggravated be lifting, pulling, or carrying with the partially bent elbow. The pain results from degeneration (tendinosis) or wear and tear of the attachment of the flexor tendons that attach at the elbow. While this condition is often associated with playing golf, hockey, or racket sports, most patients with this condition are between ages 30 and 60 and never picked up a club or racket. Whether it is swinging a hammer or packing up the house to move, the common feature is that the patient lifts or uses the hand with the arm extended repeatedly.
Once the diagnosis is made, treatment begins by altering the activities and initially avoiding what aggravates the pain. Exercises that stretch the muscle tendon unit should prevent the natural progression of the condition. Depending on the severity of the condition many patients have a favorable response to stretching. In addition, there are several treatments by physical therapy that can diminish pain and hopefully slow the painful process.
For resistant golfer's elbow, there is a role for injection with cortisone which can relieve the pain. The newest therapy is the use of platelet rich plasma injection for the severe tennis elbow that fails other treatments.
Cortisone injections may be administered to reduce inflammation and relieve pain in a particular area of the body. They are most frequently delivered to a joint, including the elbow, shoulder, knee, ankle or hip. Cortisone injections can be an effective form of treatment for a wide array of painful conditions such as carpal tunnel syndrome, lupus, certain types of arthritis, tendinitis, bursitis and many more, often restoring full functionality and range of motion to the affected joint. They may offer months or years of relief and in some cases even permanently cure the problem.
Given in your doctor’s office, cortisone injections typically combine a corticosteroid medication with a local anesthetic. The corticosteroid provides effective pain relief usually over a 3 month period while the local anesthetic numbs the joint and produces an immediate feeling of respite. A topical anesthetic may be used on the skin at the injection site to reduce the discomfort of receiving an injection.
You can resume normal activities following the cortisone injection, but should take care not to overexert the affected joint. If you experience soreness at the site, applying ice may decrease the discomfort. Within two days of the injection, the joint should feel considerably better.
Arthroscopy is a type of surgery that uses an arthroscope (thin fiber optic camera) to visualize the area to be operated on, as well as multiple small portals through which the surgeon's tools are manipulated. This procedure offers patients a relatively shorter recovery time as opposed to conventional "open" surgery. Much less soft tissue is injured during the operation, leaving less room for post-surgery complications. However, this limited procedure may not completely remove all the diseased tissue.
Elbow arthroscopy is generally used for simple manipulations of the joint. For instance, a patient with a compound fracture may have multiple fragments of the bone removed through arthroscopic surgery, but a replacement prosthetic most likely would not fit through a portal. It is also very useful for arthritis as tools capable of debridement can be inserted and used to smooth out the problematic bone surfaces in a minimally invasive manner.
The arthroscopic procedures are commonly used to confirm and examine abnormalities occurring in patients. This diagnostic use is helpful in ensuring that the patient will be recovering in the shortest amount of time possible.
However, arthroscopy is not nearly as prevalent in elbow surgery as it is in other joint specialties such as the knee. This is because the small structure of the joint requires very specialized training so the surgeon does not to disturb the multiple nerves crossing the joint. This forms an inherent risk in any procedure in the elbow, but more so in arthroscopy due to its nature of camera insertion.
The elbow bone, also called the olecranon, is a relatively vulnerable part of the body. This appendage is not protected by muscle or fat and yet it contains one of the most important joints in the human body. If the bone is broken, the intense pain suffered will usually drive the victim to the emergency room. There the doctor determines through examination and X-Rays whether the bone must be surgically treated.
Surgery is usually recommended if the broken elbow interferes with the triceps muscle (which inserts into it) function or if the broken part of the bone is visible and the fracture is "open". The surgery resets the bone fragments into the correct places, removes crushed pieces that cannot be repaired, and allows the surgeon to affix the bones so that proper healing will ensue.
UCL and LUCL Ligament Injuries
The ulnar collateral ligament (UCL) is vital to maintaining elbow stability and function. However, this ligament is a common injury associated with several different sports, especially throwing sports such as baseball, javelin, and football. Although this is usually a chronic injury, the UCL can also be ruptured by a fall on an outstretched hand or similar trauma.
Surgery is not normally indicated for most patients, but may be necessary for athletes in order to help them fully recover. The ligament is reconstructed using another ligament from the patient's own body (autograft), most likely from the forearm, hamstring, or knee. The palmaris longus tendon is a commonly used replacement, and it is threaded through holes drilled by the surgeon in a figure-8, thus ensuring adequate tension.
The elbow is then immobilized for one to two weeks, after which shoulder range of motion exercises can be performed. Most athletes do not return to play for a year or more. However, most patients eventually regain full strength and function after a lengthy recovery, with some athletes playing more successfully than they did before surgery.
Cubital Tunnel Syndrome
The cubital tunnel refers to the anatomic area at the elbow at which the ulnar nerve can be compressed. The area includes from just above to just below the medial (“funny bone” area) aspect of the elbow joint, where the Ulnar Nerve passes through a passageway, formed by muscle, ligament, and bone, called the Cubital Tunnel at the inside part of the elbow. At the elbow, the ulnar experiences compression and traction with repetitive flexion of the elbow.
A review of symptoms and a detailed exam of the elbow, forearm, and hand are performed. We often use nerve conduction studies to measure how well the Ulnar Nerve works and to help specify the site of compression. Electromyography (EMG) is usually performed with nerve conduction studies. This test examines the nerve’s input into the small muscles of the hand. Sometimes advanced imaging tests (X-rays, Computed Tomography (CT scans), or Magnetic Resonance Imaging (MRI)) may be needed to identify structural factors, such as bone spurs or arthritis, which may contribute to nerve compression.
In mild cases of nerve compression, non-operative treatment is recommended initially. Treatment typically includes activity and elbow postural modifications. You should avoid repetitive elbow movements and avoid leaning or putting pressure on the elbow. Elbow pads and splints are prescribed to keep your arm straight, especially while sleeping. Anti-inflammatory medications may provide pain relief.
Surgery is recommended if there is not relief from non-surgical treatments or when compression of the nerve is more advanced. If you require surgery for Cubital Tunnel Syndrome it may take several months to recover, but generally you can achieve good results.
Platelet-rich plasma (PRP) is plasma with a high concentration of platelets, which contains a large amount of proteins. These proteins can initiate and accelerate new tissue growth within the tendons and ligaments to repair damage and relieve symptoms for patients with tendonosis or other causes of chronic pain.
Injecting platelet-rich plasma into damaged tissue is an effective yet minimally invasive treatment option used to relieve pain and other symptoms caused by this damage. By enhancing the body's natural healing abilities, patients are able to enjoy a faster and more thorough healing process that relieves symptoms and allows them to return to their regular activities.
Arthritis of the Elbow
The elbow joint is a remarkable but complex hinge joint whose major role is to move the hand around. Arthritis of the elbow may cause swelling, pain, limited motion, and locking. Proper assessment of the elbow joint includes a careful history, physical examination, and plain x-rays.
Treatment is individualized for each patient. For severe osteoarthritis of the elbow treatment begins with rest and anti-inflammatory medications. Occasionally injections of cortisone or hyaluronic acid can diminish symptoms. For patients that have persistent locking and swelling and pain that interferes with activities, minimally invasive elbow arthroscopy can often be helpful. For the very severely impaired patient, total elbow arthroplasty is a choice.
In rheumatoid arthritis with severe involvement arthroplasty is also an alternative to relieve pain and preserve some function.
Olecranon bursitis also called "student's or baker's elbow", is characterized by a collection of fluid (size of an egg) over the tip of the back of the elbow. It can be warm and red and painful. It is caused by trauma or leaning on the elbow. Treatment begins by taking any contact pressure off the back of the elbow. It occasionally can get infected which would require antibiotics and drainage.