Elbow

The elbow generates enormous stresses across the joint while throwing and other activities. This makes it at risk for overuse injuries.

Loose Bodies

Occasionally, small pieces of cartilage or bone chips may break off in the elbow joint, and catch or get stuck in the joint.

Common Causes

Elbow trauma, such as a direct blow to the elbow, or a fall on the outstretched arm. Sometimes a long period of time elapses between the initial injury and the development of loose bodies.

Symptoms

Pain in the elbow. A sense of catching, or getting ‘stuck’. There may be loss of motion, or actual locking of the elbow.

Physical Findings

There may be areas of tenderness on physical examination, loss of joint motion, or swelling in the elbow. Often the exam is surprisingly unremarkable.

Workup

History and physical examination. X-rays may show bony loose bodies (cartilage is invisible on x-ray). Rarely, an MR scan or CT scan may be ordered to assist in locating loose bodies.

Non-Operative Treatment

Generally not too helpful. Anti-inflammatory medication, and corticosteroid injections my reduce symptoms.

Surgical Treatment

Arthroscopy, with removal of the loose body, is the treatment of choice.

Injury Comment

Arthroscopy is usually curative for this problem, and leaves minimal scars while allowing rapid return to work and sports. Even after successful removal of loose bodies, new loose bodies may occur later on.

Tendonitis / Medial and Lateral Epicondylitis / Tennis Elbow / Golfer’s Elbow

The forearm muscles that are involved in gripping, squeezing, and lifting are attached both to the wrist and to the elbow. If those muscles are overloaded, or overstressed, they can partially tear at either end. Frequently the muscle attachment (tendon) becomes injured at its insertion on either the inside or outside of the elbow (epicondylitis).

Common Causes

Excessive gripping or squeezing; too much tennis, golf, weightlifting, gardening, hammering, etc. Chronic overuse of the wrist extensor muscles; excessive keyboarding.

Symptoms

Pain in the outside (lateral) or inside (medial) aspect of the elbow, exacerbated with gripping or squeezing. Usually pain free at rest.

Physical Findings

Tender at either the medial or lateral epicondyle of the elbow.

Workup

Diagnosis is almost entirely made by history and physical examination. Occasionally x-rays are helpful.

Non-Operative Treatment

Rest and anti-inflammatory medication will reduce symptoms. The use of forearm bands and wrist splints allows the injured tendon to rest. Corticosteroid injections are often very helpful in speeding recovery. Physical therapy too early can actually aggravate symptoms; Gentle strengthening is helpful once the pain has resolved.

Surgical Treatment

Fasciotomy, or the release/removal of injured tissue.

Radial Nerve Neuritis / Radial Tunnel Syndrome

The Radial nerve controls the muscles that extend, or straighten the wrist and fingers. Radial tunnel syndrome is a painful condition that occurs when the nerve is compressed just beyond the elbow, as it runs under the muscles down the back of the forearm to the wrist.

Common Causes

Often seen with weightlifting, or other exercises that cause increased forearm muscle bulk. May occur with repetitive upper arm activities, especially gripping and squeezing.

Symptoms

A deep aching running down the back of the forearm, sometimes to the wrist. Usually aggravated with lifting and gripping. Occasionally there is tingling, or a ‘funny feeling’ on the back of the arm or hand.

Physical Findings

Tenderness over the radial tunnel, where the radial nerve passes under some of the forearm muscles. The discomfort may be worsened by certain physical exam tests.

Workup

The diagnosis is primarily based on history and physical examination. Electrodiagnostic studies may be helpful, although are often interpreted as ‘normal’ in patients with this condition.

Non-Operative Treatment

Rest, avoidance of aggravating activities, and anti-inflammatory medication will generally resolve most cases. A well placed corticosteroid injection is often curative.

Surgical Treatment

Decompression of the nerve by releasing all of the constricting structures on top of the nerve.

Injury Comment

Surgery is rarely indicated with this condition. All nerve decompression surgeries work by taking the pressure off of the nerve, and allowing it to heal on its own. This is much like taking a ‘pot-bound’ plant, and repotting it in a larger pot. The goal of surgery is to prevent progression, and allow for the nerve to recover. Prolonged compression of a nerve may cause permanent damage. Think of a garden hose after your car has parked on it for a very long time. Even after you decompress a nerve, it may not recover completely.

Ulnar Nerve Neuritis / Cubital Tunnel Syndrome

Cubital tunnel syndrome is due to excessive pressure on one of the major nerves to the arm and hand (the ulnar nerve), as it crosses around the back of the inside of the elbow.

Common Causes

Repeated activities with a flexed elbow, including driving, sleeping, keyboarding, weightlifting, etc.

Symptoms

Earliest symptoms are numbness, tingling, or pain in the ring and small fingers, at night or with the aggravating activity. Later on, weakness and coordination difficulties develop.

Physical Findings

History and physical examination, with a positive ‘Tinel’s sign’, and ‘Elbow Flexion Test’. Impaired function of the muscles innervated by the Ulnar nerve are found late.

Workup

Occasionally, electrodiagnostic studies (nerve conduction tests and electromyography) will be required to confirm the diagnosis, and its severity.

Non-Operative Treatment

Splinting, including nighttime elbow splints. Avoidance of specific activities. Anti-inflammatory medication. A single trial of a corticosteroid injection in the cubital tunnel may by quite helpful.

Surgical Treatment

Several surgical procedures are available, depending on the anatomy of the arm, severity of the disease, specific source of nerve entrapment, and surgeon preference. All work by taking the pressure off of the ulnar nerve, and moving it to a safer, and less compressed location.

Injury Comment

All nerve decompression surgeries work by taking the pressure off of the nerve, and allowing it to heal on its own. This is much like taking a ‘pot-bound’ plant, and repotting it in a larger pot. The goal of surgery is to prevent progression, and allow for the nerve to recover. Prolonged compression of a nerve may cause permanent damage. Think of a garden hose after your car has parked on it for a very long time. Even after a nerve is successfully decompressed, it may not fully recover.