Elbow

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ELBOW PROBLEMS AND TREATMENT

Tennis/Golfer’s Elbow

What is Tennis/Golfer’s elbow?  Tennis elbow is a clinical condition that causes pain over the outer aspect of the elbow. It is also called lateral epicondylitis. The pain is worse with gripping, twisting or lifting using the affected side. Golfer’s elbow is a similar condition, which causes pain over the inner aspect of the elbow, and it is less common compared to tennis elbow. Both these conditions are caused by degeneration and repetitive use.

Do I need more tests?  The diagnosis is mostly clinical. Further imaging using plain X-Ray, ultrasound or MRI may be performed if the diagnosis is not clear.

What is the treatment?  Avoiding repetitive activity, cold compress, painkillers like non-steroidal anti-inflammatory tablets may be tried initially. Physiotherapy and splinting may be tried as next step. If not responding, a steroid injection may be beneficial for symptomatic relief. Recently, Injection with PRP (platelet rich plasma) from patient’s own blood prepared by centrifugation has shown promising results in the treatment of Tennis elbow. Tennis/Golfer’s elbow release surgery may be required in small proportion of the patients.

Ulnar Nerve Entrapment / Cubital Tunnel Syndrome

What is this?  This is a condition caused by the pressure or tightness on the ulnar nerve at the cubital tunnel (‘funny bone nerve’), which is behind the medial bony prominence of the elbow. This will cause pins and needles sensation of the little and ring finger and sometimes weakness of the hand. Some patients complain of pain from elbow downwards along the course of the nerve.

Do I need more tests?  Diagnosis is clinical. Plain X-ray is performed to look for the signs of elbow arthritis. Nerve conduction study is useful to confirm the diagnosis and severity of compression.

What is the treatment?  If symptoms are mild and intermittent then they may not require any treatment. Elbow splints that help to keep elbow straight may be used. If symptoms are persistent, surgical release of the cubital tunnel may be performed. In severe longstanding cases full recovery may not happen and surgery is performed only to prevent further worsening.

Distal Biceps Tendon Rupture

What is it?  The lower end of the biceps tendon may be ruptured from its attachment at the level of the elbow joint. This usually happens at the time of heavy lifting and occurs more commonly in men between 40 and 60 years of age. The cause for the rupture is multifactorial. Patient might feel a pop followed by pain, swelling and bruising in front of elbow following rupture of distal biceps tendon.

Do I need more tests?  Diagnosis is mainly clinical. However ultrasound or MRI scan may be performed in certain cases if the clinical diagnosis is doubtful.

Is there a non-surgical treatment option for this?  This can be treated without an operation but it would result in mild weakness of the elbow, which will be permanent. Loss of strength in supination (turning the forearm in palm up position) is around 40% and loss of strength in elbow flexion (bending) is about 30%.

What is the surgical treatment?  Surgical treatment involves reattaching the tendon to the bone distal to the elbow joint (radial tuberosity) using an endobutton.

Elbow Arthritis

What is it?  This is a condition caused by wear of the articular cartilage in the elbow joint. This causes elbow pain and reduced range of motion. This may be caused by osteoarthritis, rheumatoid arthritis or secondary to previous elbow trauma leading to post traumatic arthritis. Osteoarthritis is a progressive degenerative condition. Rheumatoid arthritis of the elbow is a condition in which body’s own immune system causes inflammation and damage to the articular cartilage and it may affect multiple joints.

Do I need more tests?  Plain X-Ray is enough to confirm the diagnosis. CT scan may be performed to assess the damage in more detail.

What is the treatment?  Initial treatment is by painkillers, rest and activity modification. A steroid injection into the elbow joint may be considered to reduce inflammation and relieve pain.
Surgical treatment may be considered depending upon the type and severity of arthritis. Elbow arthroscopy (key hole) surgery is useful for debridement of the joint and to remove loose fragments from the inside of the joint. Open surgical debridement of the elbow joint is an option if stiffness is the main issue. Elbow joint replacement surgery is considered as the last option and is mainly reserved for low functional demand patients and is performed commonly for rheumatoid arthritis and in some cases of osteoarthritis.

Elbow Replacement

What is elbow replacement?  This is a surgical procedure in which the damaged natural elbow joint is replaced using artificial metal joint with plastic in between. This is mainly performed for patients with rheumatoid arthritis of the elbow and for osteoarthritis in low functional demand patients. This surgery is also performed in elderly patients with badly damaged elbow joint due to fracture.

Radial Head Replacement

What is radial head replacement?  This is a surgical procedure performed to replace badly damaged radial head with a metal radial head component. This is an option if the radial head fracture cannot be repaired using conventional technique.