Elbow

Tennis elbow (Lateral Epicondylitis)
Tennis elbow is a degenerative condition of the tendon fibers that attach on the bony prominence (epicondyle) on the outside of the elbow. These tendons anchor the muscles that extend or lift the wrist and fingers.

Cause:
Tennis elbow can affect any age group, but is most often seen in patients between the ages of 30 and 50. Many people with tennis elbow participate in work or recreational activities that require repetitive and vigorous use of the forearm muscles. Some patients develop tennis elbow without any specific recognizable activity before symptoms appear. Tennis elbow affects as many as half the athletes who play racquet sports.

Prevention:
Modify activities that create the pain.

Treatment:
Relieving the pain is the first concern. The doctor may recommend stopping any activities that cause symptoms, and applying ice to the outside of the elbow. Acetaminophen or an anti-inflammatory medication may help relieve pain. The patient may also wear a counterforce brace and wrist splints. Applying ice to the painful area and resting the muscles and tendons can reduce pain. Symptoms should improve significantly within four to six weeks. If there is no improvement, a corticosteroid injection may be helpful.

After pain is relieved, physical therapy may be started, including stretching and range of motion exercises. Physical therapy can help complete recovery, resulting in a painless, normally functioning elbow. This course of treatment leads to recovery for 85 percent to 90 percent of patients.

Elbow (Olecranon) fracture
When bending the elbow, its tip, a bony prominence that extends from one of the lower arm bones, can be felt easily. It is positioned directly under the skin of the elbow, without much protection from muscles or other soft tissues. If a fracture occurs, depending on the xray alignment of the fracture, surgery may or may not be recommended.

Cause:
The elbow can easily break from a direct blow or fall on a bent elbow.

Prevention:
Maintain muscle mass, as it helps to prevent falling. Participation in sports like football, hockey, wrestling and gymnastics may cause a fall resulting in an elbow fracture.

Treatment:
Treatment depends on the type of fracture. A non-displaced fracture can usually be treated with a splint or sling to hold the elbow at a 90-degree angle.

A displaced fracture is best treated surgically. A plate or a combination of wires and pins or screws will hold the bones in place. Physical therapy will usually start after the operation to maintain range of motion.

If the joint is not involved, fractures of the tip of the olecranon may be treated by removing the small fragment and repairing the tendon that has pulled off. Elderly people with a displaced fracture may be treated with a sling and early range of motion instead of surgery.

Supracondylar humerus fracture
This is one of the most common kinds of broken elbows in children between the ages of 2 and 12. A supracondylar fracture is a broken elbow that involves the growth plate of the humerus bone. Because these plates are actively growing around the elbow joint, they are susceptible to injury.

Causes:
Most often, a supracondylar fracture of the humerus is caused by a fall. The child may stretch out his or her hand and the force from the impact may be enough to cause a break in the bone. However, any trauma to the area, such as an injury from a car accident, can also cause this injury.

Prevention:
Minimize the risk of falling.

Treatment:
The arm will be checked for signs of damage to the blood vessels and nerves, as well as evaluating the wrist and shoulder for related injuries. X-rays will reveal details about the injury.

If there is no displacement of the bone, the most common form of treatment is to immobilize the arm with a splint, which will stay on for about three weeks so the bone can heal. If the bones need to be moved back into position, a pin(s) may be needed to hold the bones in place while they heal. Appropriate pain medication may be prescribed.

With a fractured bone it is important to keep follow-up appointments to be sure that the bone heals in the correct position. There is also a small chance of infection from the pin(s).

Radial head fracture
When a person puts a hand out to break a fall, the force of the fall can travel up lower forearm bones and dislocate the elbow. Breaks can also occur in the smaller bone of the forearm and the wrist. Radial head fractures are common injuries, occurring in about 20 percent of all acute elbow injuries. They are more frequent in women than in men and occur most often in people between 30 and 40 years of age. Approximately 10 percent of all elbow dislocations involve a fracture of the radial head. As the upper arm bone slides out of joint, it can chip off a piece of the radial head, resulting in a fracture.

Cause:
Generally caused by falling or trauma.

Treatment:
Radial head fractures are treated according to the degree of displacement. Non-displaced and slightly displaced fractures are generally treated with a short tern of splinting followed by range of motion exercises. Displaced fractures have more than three breaks, which cannot be fitted back together for healing. Usually, there is also significant damage to the joint and ligaments. Surgery is required to repair or remove the broken bits of bone and repair any associated soft-tissue damage.

Even the simplest of fractures will result in some loss of extension in the elbow. Physical therapy may be needed before resuming full activities.

Chronic instability
Acute instability is usually quite easily diagnosed and treated, but the chronic condition is much more problematic to identify. The outside ligament of the elbow being detached or thinned usually causes instability. There is almost always a history of trauma or prior elbow surgery. It may also be associated with soft tissue and collagen disorders.

Cause:
Elbow instability or ligament injury in the elbow often occurs when someone sustains a fracture or dislocation to the elbow in the past.

Treatment:
A thorough knowledge of the anatomy, as well as a clear understanding of the reconstructive options is essential for the proper management of recurrent and chronic elbow instability. Surgery is typically required and often involves the reconstruction of the ligaments on the inside and outside of the elbow.

Dislocation
Cause:
Elbow dislocations typically occur when a person falls onto an outstretched hand. When the hand hits the ground, the force is sent to the elbow. Usually there is a turning motion in this force. This can drive and rotate the elbow out of its socket. Elbow dislocations can also happen in car accidents when passengers reach forward to cushion the impact. They can happen in sports, such wrestling or gymnastics.

When an elbow dislocates, bones, ligaments and muscles can be injured to different degrees. A simple dislocation does not have any major bone injury. A complex dislocation can have severe bone and ligament injuries.

Prevention:
Some people are born with greater laxity or looseness in their ligaments. These people are at greater risk for dislocating their elbows. Some people are born with an ulna bone that has a shallow groove for the elbow hinge joint. They have a slightly higher risk for dislocation. Nothing can be done to alter these risk factors.

Treatment:
The immediate goal of treatment is to put the elbow back in joint. The long term goal is to restore function to the arm, focusing first on the alignment of the elbow. This can usually be done in an emergency department. The patient will receive sedation and pain medications. The act of restoring alignment at the elbow is called a reduction maneuver.

Simple elbow dislocations are treated with early motion after a short period in a splint or sling. Physical therapy can be helpful during this period of recovery. Some people will never recover full elbow motion even after a course of therapy. Fortunately, the elbow can work very well even without full motion. Once the elbow's range of motion improves, the doctor or physical therapist may add a strengthening program. X-rays may be necessary to ensure that the elbow joint remains well aligned. In a complex elbow dislocation, surgery may be necessary to restore bone alignment and repair ligaments.

Arthritis
Osteoarthritis occurs when the cartilage surface of the elbow is damaged or becomes worn. This can happen because of a previous injury such as elbow dislocation or fracture. It may also occur due to degeneration of the joint cartilage from age or from diseases such as rheumatoid arthritis.

Causes:
Result of disease that is present in the body.

Prevention:
The best way to prevent elbow arthritis is to avoid injury to the joint. When injury does happen, it is important to recognize it right away and get treatment. Individuals involved in heavy work or sports activities should maintain muscular strength around the elbow. Always use proper conditioning and technique. Most patients who are diagnosed with elbow osteoarthritis have a history of injury to the elbow.

Treatment:
Treatment options depend on the stage of the disease, prior history, overall medical condition, and what X-rays show. For early stages, the most common treatment is nonsurgical, including oral medications such as Tylenol® or Advil®, physical therapy, and activity modification. Sometimes corticosteroid injections are used to treat arthritis symptoms. When nonsurgical interventions are not enough to control symptoms, surgery may be needed.