Elbow Pain

Arthritis

Forms of arthritis such as Osteoarthritis and rheumatoid Arthritis affect predominately joint cartilage that lines the bone within the joint. Arthritis can affect elbow function and result from a trauma to the elbow or the degenerative affects of aging. When the cartilage loss is great, there may be severe pain in the joint during use or at rest. Other symptoms may include: loss of movement; stiffness and swelling in the joints; snapping of the joints; or bony growths at the joints.

Initial treatment is usually conservative. Anti-inflammatories and nutritional supplements for cartilage support are often effective. Physical measures such as bracing and stretching are helpful for cases in which instability or stiffness predominate. In some cases, such as loss of extension, arthroscopic surgery is performed in order to release the anterior capsule and remove loose bony bodies when present. In severe cases, the joint surfaces are “resected” and an artificial elbow joint is installed.

Bursitis
Olecranon Bursitis is the inflammation of the bursa, a tiny fluid-filled sac that functions as a gliding surface to reduce friction between tissues of the body. Bursitis in the elbow can result from a sudden injury, or a continuous pressure over time such as leaning on a desk. Most times it is caused by a small spur which as grown on the extraarticular, back, surface of the olecranon, which is the point of the elbow. Occasionally this bursa gets infected and will require antibiotics. Less frequently, gout can present with a enlarged painful bursa.

Conservative treatments such as rest and anti-inflammatory medication usually resolve this problem. In cases which refuse to get better with the usual measures, the sharp spur is smoothed in the operating room, and the bursitis goes away without any further attention.

Cubital Tunnel Syndrome

This occurs when the ulnar nerve, which runs from the side of the neck to the fingers and passes through the cubital tunnel on the inside of the elbow, becomes irritated as a result of an injury or repetitive stress. It occurs when the elbow is often bent in lifting or pulling activities, subjected to continuous pressure of leaning on a hard surface or sustains injury. The pain experienced is similar to that which is described when hitting the “funny” bone in the elbow. Other symptoms may include numbness in the side or back of the hand, or tingling in the ring and little fingers. The symptoms worsen when the elbow is bent and may cause difficulty when opening jars or holding things. Treatment is most often non-surgical, usually requiring anti-inflammatory medication and nutritional supplements such as Vitamin B6. Patients are also instructed on better ways of regularly positioning their arm to avoid excessive stretching. In more severe cases, the diagnosis is confirmed with an electrical test and may result in a minor procedure to decompress the ulnar nerve. Following the procedure, the patient is instructed to begin immediately moving the arm and to begin a series of exercises.


Lateral Epicondylitis (Tennis Elbow)

Lateral epicondylitis, or tennis elbow, is a common problem that affects the outside (lateral) part of the elbow and results from degeneration and inflammation of the origin of the extensor carpi radialis brevis (ECRB) tendon. It often occurs when the tendon is repetitively overused or overstressed.

Although it is called tennis elbow, the majority of those suffering from the condition incurred the injury while performing an everyday activity. The repeated use of a hammer or activity requiring constant squeezing, or gripping is likely to result in tennis elbow. A small percentage is the result of a severe injury such as a fall or direct hit to the elbow.

Symptoms include recurring mild to debilitating pain felt on the outside of the upper forearm just below the bend of the elbow, which radiates down the arm towards the wrist. Extending the wrist against resistance, or passive flexion of the wrist, makes the pain worse.

If the initial pain continues for several weeks, a number of noninvasive treatment options are available to avoid further damage and strengthen the wrist and forearm. These treatments include activity modifications, a session with a golf or tennis professional when associated with an overuse injury in sports, a wrist brace, anti-inflammatory medicines, and nutritional supplements. In refractory cases, a local injection of a corticosteroid is used.

The vast majority of cases resolve with the measures noted above. A few require a second injection, and fewer still ever require a minor surgical procedure to debride and reconstruct the ECRB tendon. Following such a surgery, an immediate program of Range of Motion exercises and strengthening is instituted. Results of conservative as well as operative treatment are usually superior.

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