Elbow Questions:


Lateral Epicondylitis
Medial Epicondylitis
Bursitis









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What are common elbow problems?

The elbow is a complex joint that is often asked to perform repetitive tasks under significant stress.  The elbow is made up of the distal end of the humerus and the proximal ulna and radius.  Mscles that cross the elbow allow us to flex and bend the elbow as well as perform many of the motions of our hands.  This includes flexion/extension and the turning motion of the wrist and hand.

If pain is located along the inside of the elbow, this is often due to medial epicondylitis.  Pain along the lateral aspect of the elbow is most commonly lateral epicondylitis.  Pain with swelling in the back of the elbow may be due to olecrenon bursitis.  People that perform a throwing motion are vulnerable to a host of sport specific elbow injuries that must be evaluated carefully.  Children and adolescents are especially vulnerable secondary to the fact that they are growing and have open growth plates.



















What is Lateral Epicondylitis?


Lateral epicondylitis, also referred to as "tennis elbow".  This condition occurs in response to cumulative trauma and injury of the tendon that attaches to the muscles of the forearm, specifically, the origin of the extensor carpi radialis brevis muscle.  Pain on the outside of the elbow, usually during or after intense use, usually indicates lateral epicondylitis.  In some cases, lifting, grasping even light use may be difficult or painful.  Because people who play tennis or other racquet sports sometimes develop this problem it has become known as "tennis elbow".


What causes Lateral Epicondylitis?


Overuse of the wrist extensors (muscles that pull the hand up) can create cumulative stress on the tendons that attach to the elbow at the outer part (the lateral epicondyle).  This excessive stress may damage the muscle attachment and cause inflammation and pain.  Generally, those who experience lateral epicondylitis perform activities with motion of the wrist and arm, or lifting while the palm is facing down.  The condition is quite common in the late 30's and early 40's.
















In racket sports, intense gripping can lead to tennis elbow.  It appears to be caused by lack of strength, inefficient technique, improper equipment or increasing playing time and intensity too quickly.  In tennis, a common cause is a racquet's inappropriate string tension and grip circumference.

Rarely the inflammation comes on without any definite cause, and this may be due to arthritis, rheumatism or gout.  Sometimes the problem is partly or completely due to a neck problem, which is causing pain in the elbow via the nerves from the neck.

The area of most pain is usually near the bone on the outer side of the elbow known as the lateral epicondyle.  This area is usually tender when touched and may be uncomfortable when gripping.  In severe cases, almost any elbow movement can be uncomfortable.


What is the treatment for Lateral Epicondylitis?


Discontinuing activities that cause the pain is the first step to proper treatment of lateral epicondylitis.  Icing the elbow for 10-15 minutes at a time will decrease the inflammation and swelling and relieve pain.  A tennis elbow strap can often improve symptoms by dampening the vibration along the extensor tendons.  Anti-inflammatoory medication may help reduce inflammation and pain.  In chronic or intense cases, a steroid injection may relieve the discomfort.

Exercises that stretch and strengthen the muscles will help prevent the condition from returning.  The goal is to place the extensor tendons on a slow controlled stretch.  This allows the tendons to regain their normal length.  Recurrence of this condition is common, and return to activity should not occur too quickly.

If nonsurgical forms of treatment do not eliminate the pain of this condition, surgery may be recommended.  Surgery consists of an arthroscopic debridement of the insertion of the extensor carpi radialis brevis tendon.  Lateral epicondylitis is often a nagging or chronic condition sometimes requiring many months for healing to occur.


What is Medial Epicondylitis?


Medial epicondylitis, also referred to as "golfer's elbow".  The muscles
that are used to pull the hand down, the wrist flexors, are located on
the palm side of the forearm.  These muscles join together and attach
to the common flexor tendon, which attaches to the medial epicondyle
(the inside of the elbow).  When the wrist flexors are overused, the
common flexor tendon becomes inflammed and painful.

Pain on the inside of the elbow, usually during or after intense use,
usually indicates medial epicondylitis.  Because people who play golf
sometimes develop this problem it has become known as "golfer's elbow".


What causes Medial Epicondylitis?


Overuse of the wrist extensors can create cumulative stress on the tendon.  This excesive stress may damage the muscle attachment and cause inflammation and pain.  As the tendon tries to reapair itself, scar tissue may form.  Some physicians believe that a lack of blood flow to the aging tendons make them weak and prone to injury.

Pain at the medial epicondyle signals medial epicondylitis.  The pain will increase when flexing the wrist, and may radiate down the forearm.  Activities that use the flexor muscles in a bending motion or grasping with the hand can increase the symptoms.


What is the treatment for Medial Epicondylitis?


Discontinuing activities that cause the pain is the first step to proper treatment of medial epicondylitis.  Icing the elbow for 10-15 minutes at a time will decrease the inflammation and swelling and relieve pain.  In some cases, a wrist splint may be recommended.  Anti-inflammatory medication may help reduce inflammation and pain.  In chronic or intense cases, a steroid injection may relieve the discomfort.

Exercises that stretch and strengthen the muscles will help prevent the condition from returning. Recurrence of this condition is common, and return to activity should not occur too quickly.

If nonsurgical forms of treatment do not eliminate the pain of this condition, surgery may be recommended.  Medial epicondylitis is often a nagging or chronic condition sometimes requiring many months for healing to occur.


What is Bursitis of the elbow?


The elbow contains a fluid filled sack called the bursa to help the skin slide over the bone in that area.  The olecranon bursa, covers the olecranon process.


What causes Bursitis of the elbow?


Normally, the bursa acts as a cushion between the skin and the bone.  But if the elbow is hit, or if it is constantly irritated, the bursa can become inflamed and fill with fluid.  This is called bursitis.  The bursa starts to swell, and my create a lump over the end of the elbow.

Gradual swelling indicates a chronic or long-lasting condition, while sudden swelling may signal a traumatic injury or an infection in the elbow.  Red and hot skin may indicate an infection.  Motion in the elbow may be limited, especially if there was a traumatic impact to the elbow.


What is the treatment for Bursitis of the elbow?


Generally, rest, ice, elevation and compression (RICE) is recommended for bursitis.  Usually bursitis will resolve on its own.  Depending upon the cause of the swelling, your doctor may recommend aspirating, or draining, the bursa.  Often you are left with a bursa sac that has stretched and is too large for the space it now occupies.  Occasionally, the physician will recommend surgical excision of the sac.

What are common throwing injuries of the elbow?


The throwing motion places the elbow under extreme stresses.  Near the end of arm cocking, the medial side of the elbow (ulnar collateral ligament-UCL) is placed under significant tension.  Overthrowing, especially with poor mechanics, may cause damage or even failure to the UCL.  In young throwers with open growth plates, a fracture through the medial epicondyle may even result.

The lateral side of the elbow is susceptible to injury during late cocking, when significant compressive forces between the humeral capitellum and radial head are generated.  This may cause a microfracture or injury to the bone if untreated.






















The posterior elbow is susceptible during the acceleration phase when the posteromedial olecranon can wedge into the olecranon fossa, causing impingement.  This can cause the formation of a spur, loose bodies, and loss of extension with pain along the posteromedial elbow.

Treatment generally consists of rest and therapy.  Occasionally, surgery is required.  It is important to have throwing injuries closely evaluated especially in the young athlete.  This is a leading reason why young pitchers should follow a pitch count to limit overuse and elbow injuries.  Pitching mechanics should also be closely evaluated.
Humerus
Radius
Ulna
Ulnar Collateral Ligament
Posterior View
Medial View
Primary area of pain
Common extensor tendon origin
Ulna
Humerus
Extensor muscles
Lateral epicondyle
Olecranon
Medial
Lateral
UCL
Bones compressed
Blair A. Rhode, M.D.
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Sports Medicine
Knee/Shoulder/Elbow
Reconstruction Specialist

*
Board Certified*
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