Elbow

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Tennis Elbow

Tennis elbow (lateral epicondylitis) is a painful condition of the elbow that occurs when tendons in your elbow are overloaded, usually by repetitive motions of the wrist and arm.

This results in inflammation, and occasionally,  microtearing of the tendons that join the forearm muscles on the outside of the elbow. Healing can often be prolonged due to the reduced blood supply to the tendon.

Tennis elbow involves the muscles and tendons of your forearm that are responsible for the extension of your wrist and fingers. Your forearm muscles extend your wrist and fingers. Your forearm tendons — often called extensors — attach the muscles to bone.  The tendon usually involved in tennis elbow is called the extensor carpi radialis brevis (ECRB).

Despite its name, athletes are not the only people who develop tennis elbow. People whose jobs feature the types of motions that can lead to tennis elbow include plumbers, painters, carpenters and butchers.

Tennis Elbow

  • The symptoms of tennis elbow develop gradually. In most cases, the pain begins as mild and slowly worsens over weeks and months. There is usually no specific injury associated with the start of symptoms.

    Common signs and symptoms of tennis elbow include:

    Pain or burning on the outer part of your elbow

    Weak grip strength

    Sometimes, pain at night

    The symptoms are often worsened with forearm activity, such as holding a racquet, turning a wrench, or shaking hands. Your dominant arm is most often affected; however, both arms can be affected.

  • Clinical assessment will include taking a detailed history and a thorough examination of your elbow.

    Further imaging tests like X-rays, MRI scans and ultrasound scans may occasionally be required.

  • If you have any of the symptoms above, it is advisable to see an orthopaedic specialist for further assessment.

    The appropriate treatment is decided after assessment and a collaborative discussion based on your needs.

    They can be broadly divided into conservative (non-surgical) and surgical options.

  • Non-surgical measures will usually be recommended first if you have not had any prior treatment for your tennis elbow. Majority of patients do well with non-surgical management.

    Rest
    minimise activities which aggravate the pain (sports, manual work, housework)

    Medications
    anti-inflammatory drugs to reduce pain and swelling

    Brace
    using a brace centred over the back of your forearm may reduce symptoms by resting the muscles and tendons

    Cortisone injection
    steroids are very effective anti-inflammatory medicines. This may be necessary if the pain is persistent despite the above measures

    Platelet-rich plasma (PRP)
    this is a biological treatment designed to improve the biologic environment of the tissue. While some studies about the effectiveness of PRP have been inconclusive, others have shown promising results.

  • If your symptoms remain persistent despite all the above measures, surgery may sometimes be required.

    Most surgical procedures for tennis elbow involve removing the unhealthy tendon, improving the blood supply, and reattaching the healthy tendon back to bone.

    The appropriate surgical treatment will depend on the nature of the tear as well as your needs (age, functional demands).

    Open surgery
    this involves making a small incision over the lateral epicondyle. The unhealthy tendon is removed and the remaining healthy tendons are reattached.

    Arthroscopic surgery (keyhole)
    this is performed using small incisions and instruments. This is useful when there are other issues within the elbow joint that needs to be treated (ie loose bodies, bone spurs).

Cubital Tunnel Syndrome

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Cubital tunnel syndrome is a condition that affects the ulnar nerve as it passes through the cubital tunnel, which is a narrow passage on the inside of the elbow. The ulnar nerve is responsible for providing sensation and controlling certain muscles in the hand and forearm. When the ulnar nerve becomes compressed or irritated at the cubital tunnel, it can lead to a range of symptoms. Here's an overview of cubital tunnel syndrome.

Some of the causes for cubital tunnel syndrome include:

  • Prolonged or repeated bending of the elbow.

  • Pressure on the elbow, such as leaning on the elbow for extended periods.

  • Anatomical variations that cause the nerve to be more vulnerable to compression.

  • Previous injuries to the elbow.

  • Medical conditions like arthritis.

Cubital Tunnel Syndrome

  • Numbness and tingling in the ring and little fingers.

    Weakness in the hand, particularly with gripping or pinching.

    Pain or discomfort in the elbow region.

    Difficulty extending the fingers fully or controlling fine movements.

    Symptoms may be worse during activities that involve prolonged elbow flexion.

  • A physical examination by a healthcare provider, often an orthopedic specialist or a neurologist.

    Nerve conduction studies to assess the nerve's function and determine the extent of compression.

  • If you have any of the symptoms above, it is advisable to see an orthopaedic specialist for further assessment.

    The appropriate treatment is decided after assessment and a collaborative discussion based on your needs.

    They can be broadly divided into conservative (non-surgical) and surgical options.

  • Non-surgical measures will usually be recommended first if you have not had any prior treatment for your cubital tunnel syndrome. Majority of patients do well with non-surgical management.

    Avoiding activities that exacerbate symptoms.

    Using elbow pads or cushions to reduce pressure on the nerve.

    Wearing a splint at night to keep the elbow in a straight position.

    Physical therapy to improve strength and flexibility.

  • Surgery may be recommended if conservative treatments don't provide relief or if the condition is severe. Surgical options include:

    Ulnar Nerve Transposition: The ulnar nerve is repositioned from behind the medial epicondyle (funny bone) to a new location in front of it, relieving pressure on the nerve.

    Cubital Tunnel Release: The cubital tunnel is opened to create more space for the nerve, reducing compression.

Elbow Arthritis

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Elbow arthritis is a condition where the cartilage that cushions the joint surfaces in the elbow begins to wear away, leading to pain, stiffness, and reduced joint function. There are different types of arthritis that can affect the elbow joint. Here's an overview of elbow arthritis:

Types of Elbow Arthritis:

  1. Osteoarthritis: This is the most common type of arthritis. It occurs when the protective cartilage on the ends of bones wears down over time. Osteoarthritis of the elbow can result from wear and tear, previous injuries, or natural aging.

  2. Rheumatoid Arthritis: This is an autoimmune disease where the body's immune system attacks its own joint tissues. Rheumatoid arthritis can affect multiple joints, including the elbow.

  3. Post-Traumatic Arthritis: This can develop after an injury to the elbow, such as a fracture or dislocation. The injury can disrupt the normal joint mechanics, leading to arthritis over time.

Elbow Arthritis

  • Pain, often aggravated by movement and activity.

    Stiffness and reduced range of motion in the elbow joint.

    Swelling and tenderness around the joint.

    Weakness in the arm and hand.

    Grating or clicking sensation in the joint.

    Difficulty with gripping, lifting, or carrying objects.

  • Physical examination by a healthcare provider, often an orthopedic specialist.

    X-rays to assess joint damage and changes in the bone.

    MRI or CT scans for a more detailed view of the joint and surrounding structures.

  • If you have any of the symptoms above, it is advisable to see an orthopaedic specialist for further assessment.

    The appropriate treatment is decided after assessment and a collaborative discussion based on your needs.

    In some cases, cortisone injection may be helpful to reduce pain.

    They can be broadly divided into conservative (non-surgical) and surgical options.

  • Pain relief with over-the-counter or prescription medications.

    Rest and avoiding activities that exacerbate symptoms.

    Physical therapy to improve joint range of motion and strength.

    Corticosteroid injections to reduce inflammation and pain.

    Using braces or splints to provide support and reduce strain.

  • Surgery is considered when non-surgical treatments do not provide relief or when joint damage is severe.

    Surgical options may include joint debridement (removing damaged tissue), joint fusion (arthrodesis), or joint replacement (arthroplasty).

Elbow Dislocation

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Elbow dislocation is a traumatic injury that occurs when the bones of the elbow joint are forced out of their normal positions due to a sudden impact, fall, or other high-energy event. It's a serious injury that requires immediate medical attention. Here's a detailed overview of elbow dislocation injury.

Types of Elbow Dislocations:

  1. Posterior Dislocation: This is the most common type, where the forearm bones (radius and ulna) are pushed backward in relation to the upper arm bone (humerus).

  2. Anterior Dislocation: In this less common type, the forearm bones are forced forward in relation to the humerus.

  3. Lateral Dislocation: The forearm bones are pushed to the side of the humerus, resulting in a dislocated elbow.

Some of the causes of elbow dislocation include:

  • Falls onto an outstretched hand.

  • Direct impact to the elbow, such as in contact sports or accidents.

  • High-energy traumas like motor vehicle accidents or falls from a height.

Elbow Dislocation

  • Immediate and severe pain at the time of injury.

    Visible deformity or abnormal positioning of the elbow joint.

    Swelling, bruising, and tenderness around the elbow.

    Limited or complete loss of movement in the elbow.

    Numbness, tingling, or loss of sensation in the hand or fingers due to potential nerve involvement.

  • Dr Bryan will perform a physical examination and may order X-rays to confirm the diagnosis and assess the extent of the dislocation.

  • If you have any of the symptoms above, it is advisable to see an orthopaedic specialist for further assessment.

    The appropriate treatment is decided after assessment and a collaborative discussion based on your needs.

    They can be broadly divided into conservative (non-surgical) and surgical options.

  • Emergency Care: Seek immediate medical attention for proper evaluation and treatment. Do not attempt to manipulate the joint back into place on your own.

    Closed Reduction: In most cases, the dislocated joint needs to be manually manipulated back into its proper position through a procedure called closed reduction. This is often performed under anesthesia to relax the muscles and minimize pain.

    Immobilisation: After the dislocation is reduced, the elbow is typically immobilised with a splint, cast, or brace to allow healing.

    Rehabilitation: Physical therapy is crucial during the recovery period. It helps restore joint range of motion, strength, and function. Gradual exercises and stretches are introduced to prevent stiffness and promote healing.

  • In some cases, surgery may be necessary if the elbow remains unstable despite the immobilisation.

Elbow Fractures

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An elbow fracture injury refers to a break or crack in one or more of the bones that make up the elbow joint. The elbow joint consists of three bones: the humerus (upper arm bone), the radius, and the ulna (forearm bones). Fractures in these bones can occur due to various causes, including falls, accidents, direct impact, or high-energy trauma. Here's an overview of elbow fracture injuries:

Types of Elbow Fractures:

  1. Radial Head Fracture: This involves a break in the head (top) of the radius bone, often caused by a fall onto an outstretched hand.

  2. Olecranon Fracture: This is a fracture of the olecranon, the bony prominence at the back of the ulna. It can result from a direct blow to the elbow or a fall on the elbow.

  3. Distal Humerus Fracture: This type of fracture occurs at the lower end of the humerus bone and can involve various patterns.

Elbow Fractures

  • Pain, swelling, and tenderness around the elbow.

    Visible deformity or abnormal positioning of the elbow.

    Limited or complete loss of movement in the elbow joint.

    Bruising and discoloration of the skin.

    Numbness, tingling, or loss of sensation in the hand or fingers due to potential nerve involvement.

  • A physical examination and order of X-rays will be necessary to confirm the diagnosis, assess the type of fracture, and determine if there are any associated injuries.

  • If you have any of the symptoms above, it is advisable to see an orthopaedic specialist for further assessment.

    The appropriate treatment is decided after assessment and a collaborative discussion based on your needs.

    They can be broadly divided into conservative (non-surgical) and surgical options.

  • Some fractures may be able to manage non surgical way such as immobilisation, depending on the type and severity of the fracture. The elbow may be immobilised with a splint, cast, or brace to allow healing.

  • Complex fractures or fractures that result in joint instability may require surgical intervention. Surgery involves realigning the bone fragments and using plates, screws, or other hardware to hold them in place.