Elbow Problems

Golfer's Elbow Treatment

Medial epicondylitis, more commonly known as Golfer’s Elbow, is a form of tendonitis that manifests on the inner side of the elbow. It is caused by the tendon in the forearm being stressed from constant use, but is not restricted to golfers; pitchers and even those not involved in sports can develop golfer’s elbow.

Golfer's elbow is generally treated using analgesics and anti-inflammatory medication, as well as resting the elbow. However, professional athletes suffering from this condition may opt for more immediate relief in the form of glucocorticoid injections so as not to miss important career events. This treatment is risky because of the close proximity of the ulnar nerve to the affected area, damage to which could have severe ramifications.

Tennis Elbow Treatment

Tennis elbow, also known as lateral epicondylitis, is an elbow injury that occurs as a result of overuse, most commonly from playing tennis. The pain associated with this condition affects the lateral epicondyle, the area where the forearms' tendons connect with the bony outer portion of the elbow. While tennis elbow typically affects adults aged 30 to 50, anyone who continually stresses their wrists is at a higher risk of developing this condition.

Symptoms of Tennis Elbow

The symptoms of tennis elbow affect the inside of the elbow, and may include some of the following:

  • Forearm weakness
  • Pain when the wrist is extended
  • Pain during various activities, such as turning a doorknob
  • Pain that spreads from the outside of the elbow into the forearm and wrist

Diagnosing Tennis Elbow

Tennis elbow is usually diagnosed by examining the affected elbow and reviewing the patient's medical history. To assess pain, pressure may be applied to the elbow. In some cases, x-rays may be done to rule out other conditions that may be responsible for causing elbow pain.

Treatment for Tennis Elbow

In many cases, tennis elbow heals on its own within two years. Initial pain can often be managed with rest, ice and over-the-counter painkillers. Cases that don't respond to the aforementioned measures may require additional treatment, in the form of exercises, orthotics, or corticosteroids. Severe, persistent cases of tennis elbow may require surgery; however, surgery is only necessary for about ten percent of those suffering from tennis elbow. Your doctor will develop a customized treatment plan based on your individual condition.

Preventing Tennis Elbow

To prevent tennis elbow from occurring, certain preventive measures can be taken. Individuals participating in sports should train sufficiently beforehand to strengthen the muscles around the elbow and wrist. It is important to keep the wrist straight during all lifting activities, including weightlifting, so that the stronger muscles of the upper arm do most of the work. Stretching exercises before and after use of the wrist can also minimize the occurrence of tennis elbow.

To learn more about Tennis Elbow or to schedule an appointment, contact us today.

Distal Biceps Repair and Reconstruction

The biceps tendon connects the biceps muscle, which is located in the upper part of the arm, firmly to the bone. The biceps muscle allows the arm to flex at the elbow, and to rotate the forearm so that the palm faces up. The distal biceps tendon, which is located at the crease of the elbow, may separate from the bone if tremendous force is suddenly applied to the elbow. This results in a diminished ability to flex the elbow and rotate the forearm against any kind of resistance.

Surgery to repair and reconstruct a torn distal biceps tendon should be performed soon after the injury occurs because the tendon retracts farther into the upper arm as time passes, making repair more difficult. Surgery involves making either one or two incisions across the front of the elbow and repairing the tendon so it anchors to the bone. It may be anchored in a number of ways, including by running sutures through the tendon and then attaching the sutures to anchors that have been placed in the bone. Or, instead of anchors, sutures may be run through holes that have been drilled in the bone.

Recovery takes months, with movement initially restricted, possibly by a splint or cast. When the elbow is again functioning properly, strengthening exercises are begun. Complications from this type of surgery are rare.

Ulnar Collateral Ligament Reconstruction (Tommy John Surgery)

The ulnar collateral ligament (UCL) is located on the inside of the elbow and connects the bone of the upper arm to a bone in the forearm. The UCL is vital to maintaining elbow stability and function. This ligament may be torn as a result of injury or dislocation of the elbow, or damaged by overuse and repetitive movement and stress. If injuries do not heal properly, the elbow may become loose or unstable. Symptoms of a UCL injury include pain on the inside of the elbow, numbness, tingling, and decreased arm and elbow strength. A UCL injury is more common in athletes, especially baseball players, who use their arm constantly in a throwing motion.

Treatment for a UCL injury varies, and initial treatment may include rest, anti-inflammatory medication, and physical therapy. If symptoms persist and do not respond to conservative methods of treatment, surgery to reconstruct or repair the joint, may be necessary. Ulnar collateral ligament reconstruction is a procedure used to repair a torn or damaged UCL ligament. This procedure is commonly referred to as Tommy John surgery, named after the first baseball player to undergo the procedure.

The Ulnar Collateral Ligament Reconstruction Procedure

This procedure is performed through an incision that is made on the inside of the elbow joint. During the ulnar collateral ligament reconstruction procedure, the surgeon replaces the torn ligament with a tissue graft. In most cases of UCL injury, the ligament can be reconstructed using one of the patient's own tendons, commonly taken from the forearm, hamstring, foot, or knee. Sutures are used to secure the tendon graft in position. When the procedure has been completed, the incision is sutured closed and the elbow is bandaged and placed in a splint.

Risks of Ulnar Collateral Ligament Reconstruction

As with any surgical procedure, there are risks associated with ulnar collateral ligament reconstruction, which may include:

  • Reaction to anesthesia
  • Infection
  • Nerve or blood vessel damage

Some patients may continue to experience chronic pain and instability of the elbow, even after surgery.

Recovery and Results

The elbow is immobilized for one to two weeks after surgery. After that time, a physical therapy program will help the individual to regain strength, flexibility and range of motion. Full recovery from an ulnar collateral ligament reconstruction may take from 6 to 9 months.

Elbow Arthroscopy

Arthroscopy is a type of surgery that uses an arthroscope, a thin fiber optic camera, to visualize an internal area and confirm a diagnosis. If damage or abnormalities are detected during the arthroscopy, repairs can often be made during the same procedure. Arthroscopy is considered an ideal treatment option for many conditions, since it offers smaller incisions, shorter recovery times and less scarring than traditional open surgery. Patients can often return home the same day as their procedure and resume their regular activities in just a few weeks, while experiencing less pain, greater range of motion and restored joint function.

Elbow arthroscopy is generally used for simple manipulations of the joint, such as fracture care, debridement and removal of bone fragments. It is also commonly used to confirm and examine abnormalities of the joint to provide a proper diagnosis of any elbow conditions.

The Elbow Arthroscopy Procedure

During the elbow arthroscopy procedure, the surgeon makes a small incision near the affected area of the elbow and inserts an arthroscope, a long flexible tube with a camera and a tiny light on the end. This device displays magnified images of the inside of the elbow joint on a video monitor for the surgeon to view in real time. During this diagnostic part of the procedure, the elbow is examined for any signs of tearing, damage or degeneration to the ligaments, cartilage and other internal structures.

If damage is detected, it can often be repaired during the same procedure by creating a few more small incisions through which tiny surgical instruments are inserted. These instruments allow the surgeon to replace damaged cartilage, join together torn ends, remove loose tissue or realign the joint to minimize pain and inflammation. Once the repair has been performed, the tools and arthroscope are removed and the incisions are sutured closed. A dressing will be applied to the area, which will later be replaced with smaller bandages as the incisions heal.

Risks of Elbow Arthroscopy

While elbow arthroscopy is considered safer and more efficient than conventional elbow procedures, there are still certain risks associated with any type of surgery. Some of these risks may include:

  • Infection
  • Reaction to anesthesia
  • Nerve or blood vessel damage
  • Tissue damage
  • Prolonged pain
  • Blood clots

Patients should discuss these and other risks with their doctor before undergoing elbow arthroscopy.

Recovery and Results of Elbow Arthroscopy

To reduce the risk of swelling, the elbow is elevated and ice is applied intermittently for 48 hours after the initial surgery. In most cases, the arm will be put into a splint for several days. As healing begins, a physical therapy program will help the individual to regain strength, flexibility and range of motion. Depending on the type of repair that was performed, recovery times may vary, but most patients fully recover from elbow arthroscopy within several months.

While arthroscopy offers many advantages over conventional elbow surgery, it may not be appropriate for all patients, especially those with conditions affecting hard-to-visualize areas. In such cases, traditional surgery may be more appropriate.


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