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Elbow

ELBOW

Causes of Elbow Pain

263x252Elbow pain is an extremely frequent complaint, and there are many common causes of this problem. The most well known chronic conditions are “Tennis Elbow” and “Golfers Elbow”, which are types of tendonitis. However, there are several other fairly common conditions that are responsible for elbow pain, including sprains, nerve entrapments, arthritis, and bursitis.

The elbow is the joint where three long bones meet in the middle portion of the arm. The bone of the upper arm (humerus) meets the inner bone of the forearm (ulna) and the outer bone of the forearm (radius) to form a hinge joint. The radius and ulna also meet in the elbow to allow for rotation of the forearm. The elbow functions to move the arm like a hinge (forward and backward) and in rotation (twisting outward and inward).

The biceps muscle is the major muscle that flexes the elbow hinge. The triceps muscle is the major muscle that extends the elbow hinge. The outer bone of the elbow is referred to as the Lateral Epicondyle and is a part of the humerus bone. Tendons are attached to this area which can be injured, causing inflammation or tendonitis, called Lateral Epicondylitis, or “Tennis Elbow”. The inner portion of the elbow is a bony prominence called the Medial Epicondyle. Additional tendons from the muscles attach here and can be injured, causing Medial Epicondylitis, or “Golfer’s Elbow.”

A fluid-filled sac (bursa), which serves to reduce friction, overlies the tip of the elbow (olecranon bursa). The elbow can be affected by inflammation of the tendons or the bursa, called Bursitis. And, of course, Arthritis can occur, as it can in any joint in the body, although it is not as common as it is in larger joints such as the knees and hips

Lateral Epicondylitis (Tennis Elbow)

The most common cause of elbow pain is Lateral Epicondylitis, also called Tennis Elbow. Patients with Lateral Epicondylitis have pain over the outside of the joint and difficulty gripping objects. Interestingly, most patients with Lateral Epicondylitis are not tennis players. While tennis elbow affects up to half of people who participate in racquet sports, most people who develop tennis elbow do not play racquet sports. Work activities that involve frequent use of the forearm muscles, such as meat cutting, painting, plumbing, or weaving are also associated with the development of Tennis Elbow. Tennis Elbow is a condition that produces severe, burning pain over the bone at the side of the elbow. The pain results from inflammation of the tendon that attaches muscle to the bony projection (called the Epicondyle) on the outside of the elbow. Tennis Elbow usually begins with mild pain and can worsen over time. The pain is worsened by pressing on the affected area, by lifting objects particularly with extension of the wrist. Using a screwdriver can worsen the injury and cause pain. In advanced cases, even simple movements of the elbow joint can produce pain

Medial Epicondylitis (Golfer’s Elbow)

Medial Epicondylitis is inflammation at the point where the tendons of the forearm attach to the bony prominence of the inner elbow. Avid golfers are often affected by this condition because of the mechanics involved with the golf swing, but many other repetitive motions can injure this tendon. Golfer’s Elbow is characterized by local pain and tenderness over the inner elbow. The range of motion of the elbow is preserved because the inner joint of the elbow is not affected. Those activities which require twisting or straining the forearm tendon can elicit pain and worsen the condition.

Elbow Sprains

A sprain is a stretch or tear injury to a ligament. One or more ligaments can be injured during a sprain. This might occur when the elbow is hyperextended or simply jammed, such as in a “stiff-arm” collision. The severity of the injury will depend on the extent of injury to a single ligament (whether the tear is partial or complete) and the number of ligaments involved.

Arthritis of the Elbow

Inflammation of the elbow joint cartilage can result from “wear and tear” from repetitive motions. Joint surfaces consist of bone covered with a smooth lining of cartilage. Cartilage is a smooth material that is found throughout your body, and it allows the joint to move freely. When one smooth cartilage surface glides against another, the amount of friction between the surfaces is five times less than the friction of ice gliding on ice! Individuals who suffer from Osteoarthritis, the most common type of Arthritis, experience a loss of this cartilage surface. As the cartilage is worn away, the bone becomes exposed, and the unprotected joint surfaces rub against each other. Also known as Degenerative Joint Disease, or Wear-and-Tear Arthritis, Osteoarthritis occurs more frequently in older populations, but can also affect younger individuals. When Arthritis occurs, signs of inflammation of the elbow joint, including heat, warmth, swelling, pain, tenderness, and decreased range of motion. Range of motion of the elbow is decreased with Arthritis of the elbow because the swollen joint impedes the range of motion.

Nerve Entrapments

There are several different types of Nerve Entrapment syndromes associated with the elbow and forearm. These include conditions such as Ulnar Nerve Entrapment, Carpal Tunnel Syndrome, Radial Tunnel Syndrome, and Cubital Tunnel Syndrome. The differences between these different syndromes are merely the nerves which are affected and the surrounding tissues that cause inflammation or pinching of those nerves. This will result in similar symptoms of numbness, tingling, and pain, and the locations of these symptoms will vary based on the nerves which are affected. Also, certain movements will exacerbate each particular condition.

Bursitis

Olecranon Bursitis is a relatively common condition caused by inflammation of the bursa overlying the Olecranon Process at the proximal aspect of the ulna. The superficial location of the bursa, between the ulna and the skin at the posterior tip of the elbow, makes it susceptible to inflammation from acute or repetitive (cumulative) trauma. The bursa allows the skin to glide freely over the Olecranon process, thereby preventing tissue tears. Acute injuries during sports activities can include any action that involves direct trauma to the posterior elbow, like landing directly on it during a fall. Common causes of Olecranon Bursal inflammation that are unrelated to sports activities include repetitive microtrauma (eg, the elbow constantly rubbing against a table during writing).

“Traditional” Treatment Options

These different conditions in the elbow can be very difficult to completely eradicate. Even when incremental improvements are made, it is very easy to exacerbate the conditions and suffer major set backs. Traditionally, Rest, Physical Therapy, Steroid Injections Non-Steriodal Anti-inflammatory Drugs (NSAID’s) and Opiates have been the mainstay of treatment. And some of these can be very helpful–specifically rest and physical therapy can help and is always worth trying.

However, often your body is overwhelmed by the degree of accompanying inflammation or degeneration in the joint, and is not able to repair itself on its own.

The problem with some of these treatments (namely NSAID’s, Steroids, and Opiates) is that they often allow a quick return to the activities that caused the injury in the first place before the affected area is fully healed. This often leads to continued additional micro-trauma to the ligaments and tendons making it very difficult to ever achieve the permanent pain relief and improved function that patients seek.

Elbow surgeries are not as commonly performed as with other major joints in the body because results are often less satisfactory than non-surgical methods, are associated with prolonged recovery periods, and potential complications. They can be necessary, however, in certain cases of Nerve Entrapment syndromes when other non-surgical treatment modalities are unsuccessful.