Managing elbow pain

health todayThe elbow — the joint which connects the arm to the forearm — is very important in the performance of activities of daily living and participation in many different sports.

Three different bones come together to form the bony parts of the elbow joint. The humerus (arm bone) meets the ulna (inner forearm bone) and the radius (outer forearm bone) to form a hinge type of joint which allows flexion (bending) and extension (straightening) of the arm.

The ulna and radius also meet in the elbow to allow for supination (rotating the palm upward) and pronation (rotating the palm downward) of the forearm. The bony parts that make up the elbow are stabilized by multiple strong ligaments.

The elbow region is also the origin of many of the muscles in the forearm which then act to flex or extend the wrist and fingers.

There are multiple possible causes of elbow pain. An individual’s prior medical history, history of trauma (whether on a single occasion or repetitively) and history of repetitive use of the elbow for work-related or sporting activities are all useful indicators of the likely cause of his/her elbow pain.

This week, we will discuss a few of the more common conditions affecting the elbow:

1)    Lateral epicondylitis (tennis elbow)

2)    Medial epicondylitis (golfer’s elbow)

3)    Ligament sprains

4)    Osteoarthritis

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Lateral epicondylitis refers to degenerative changes in the origin of the tendon of one of the muscles which extends the wrist. This condition usually has a gradual onset and is characterized by pain and tenderness on the outer part of the elbow.

It was first described in tennis players but it can affect persons in other sports and can also be caused by repetitive wrist extension in some occupations such as mechanics, carpenters and plumbers. In sports persons, it is usually the result of equipment issues or faulty technique.

Medial epicondylitis has similar degenerative changes as lateral epicondylitis but these occur in tendons on the inner part of the elbow. These tendons are responsible for pronation or wrist flexion. The onset is gradual and there is pain and tenderness on the inner part of the elbow.

Pain can be worsened by making a tight fist or activities requiring repetitive wrist flexion. It is a common injury in golf, baseball and occupations requiring repetitive use of tools such as carpentry.

There are multiple ligaments around the elbow which help to provide stability to the joint. Ligament sprains can occur as a result of trauma to the elbow or repeated stress. The ligament may be stretched, partially torn or completely torn.

The most common ligament injured in the elbow is the ulnar collateral ligament. This can be injured by a single traumatic incident or more commonly, as a result of repetitive stress caused by throwing such as in baseball.

Symptoms of a ligament sprain include pain and swelling over the affected area, instability if the injury is severe enough and sometimes an audible “pop” if the ligament tears completely.

Primary osteoarthritis (OA) in the elbow is uncommon but OA can occur secondary to trauma or medical conditions such as rheumatoid arthritis. Symptoms include pain, swelling, decreased range of motion, locking of the joint and possible instability. Bone spurs from OA may also compress nerves in the region of the elbow and cause neurologic symptoms such as numbness, tingling, weakness and muscle wasting in severe cases.

The rehabilitation specialist has an important role to play in management of elbow pain. A thorough evaluation will suggest the cause of the elbow pain in most patients. Where necessary, imaging such as x-rays, ultrasound or MRI will be ordered to confirm the diagnosis.

The treatment plan can then be created for each patient. Oral medications or steroid injections will be used for pain control and occupational therapy will have an important role in recovery. Sports persons will be counselled on correcting techniques and replacing faulty equipment and workers educated on ergonomic adjustments to help prevent recurrences.

Medial and lateral epicondylitis can both benefit from the use of braces. Surgery may be required in cases of epicondylitis not responding to conservative treatment as well as in complete ligament tears and severe OA. In these cases, patients will be referred to an experienced orthopaedic surgeon.

If you have elbow pain which is not resolving in a short period of time, a thorough evaluation is the first step to regaining optimal physical function.

Dr Shane Drakes is a Specialist in Physical Medicine and Rehabilitation and Sports Medicine.
He can be contacted at sdoptimalfunctioning

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