FAQ Category: Elbow

Compression neuropathy of the upper extremity (arm) is a common problem. Compression indicates that something is putting enough pressure on the nerve to cause sensory and/or motor symptoms. Neuropathy refers to any damage, injury, or pathology to a nerve.

Sensory changes can include loss of sensation, tingling, and/or pain. Motor involvement is seen as muscle weakness and atrophy. Either or both of these changes can occur depending on which part of the nerve is compressed.

Usually, there is a combination of factors contributing to the problem. Positioning or prolonged use of a tourniquet during surgery can be at fault. Many times patients have slight variations in anatomy that are aggravated by staying in one position too long.

Compression neuropathy can occur if the nerve is accidently cut or crushed during the operation. Sometimes a clear cause just can’t be identified. Treatment as early as possible to relieve the pressure and keep the nerve moving can help. Protection of the nerve during movement can prevent worsening of symptoms from scar formation and adhesions.

When patients undergo surgery to repair a torn tendon or a biceps tendon avulsion, how long it takes before they can resume their usual activities depends on many factors.

1) When did the injury occur? Studies have shown that biceps tendon avulsions that are not repaired within 3 to 4 weeks of the injury can become more difficult to repair and the success rate is not as high.

2) How successful was the surgery? While biceps tendon avulsion surgery generally shows good results, every patient is different and may have to adjust the return to usual activities according to the recovery process.

3) What activities are considered usual? Someone who is doing heavy lifting regularly, for sports or for work, may have to wait longer before being able to resume their level of usual activities.

Orthopedic surgeons are doctors who specialize in operating on the areas of the musculoskeletal system. This includes bones, ligaments (tissue that holds the bones/joints together), tendons (tissue that holds muscle to bone), and muscles.

Surgeons who choose this specialty go through medical school as do other doctors. They then choose to follow a residency (specialization) in orthopedics. Orthopedic surgeons can perform procedures that range from amputating an arm or a leg, to using a tiny camera and surgical instruments to see inside a knee to repair a tear in the knee cartilage.

The surgeons can also specialize within the specialty. This means they can be pediatric orthopedic surgeons, work in sports medicine, focus on reconstruction, or work with patients who have been in accidents, to name a few.

The biceps tendon, the strong tissue that connects the biceps muscle to the bone can become avulsed or torn away as the result of a trauma. There are two types of avulsions that can happen: the proximal avulsion (close to the shoulder) or the distal avulsion, closer to the elbow.

The typical patient with a biceps tendon rupture is a male, over 35 to 40 years old, who do strength type exercises, body building, or heavy lifting. The tendon will snap, sometimes causing a snapping sound that the patient can hear. It doesn’t usually happen all of a sudden, but to a tendon that is already injured or prone to injury.

Someone with a snapped biceps tendon will likely have bruising and swelling, and the muscle will look unnaturally bunched up or cramped.

It is very important that a ruptured biceps tendon, or an avulsion be repaired as quickly as possible because studies have shown that if the injury is more than three to four weeks old, surgery may not be successful. The surgeon makes an incision at the site of the tendon and anchors the tendon back.

If the injury is older, it may be more difficult to retrieve the tendon and anchor it, so the surgeon will likely have to make a second incision to reach it. As well, the surgeon may have to graft or add a tendon alongside the biceps tendon to add strength.

There are no easy answers to this question. Since the cause(s) of lateral epicondylitis (tennis elbow) remain unknown, finding the best treatment has been difficult.

Most studies show that the majority of people are helped by conservative care. However, it can take up to a year or more for symptoms to resolve. For those patients who do not get better, surgery is another option.

Again, since the pathology behind tennis elbow is unknown, the best type of surgery is also a mystery. Arthroscopy is preferred by some surgeons. This type of operation allows the surgeon to see inside the joint. This ability makes it possible to treat any abnormalities that can be seen.

Other surgeons prefer to cut the soft tissue structures using a smaller incision. This is referred to as a percutaneous release. A smaller incision means less pain and faster recovery. But this method doesn’t allow the surgeon to inspect the joint for other problems.

Your surgeon may be able to offer some insight specific to your case. Your history, symptoms, and lack of response to nonoperative care may point to the type of surgery that would be best for you.

There are several ways to measure or monitor strength. Your subjective sense is that there is some weakness on that side. This is a valid measurement. But more specific tests can be done to measure actual arm strength.

A handheld device called a dynamometer measures grip strength. This is a measure of forearm strength. A physical therapist can also test the strength of individual muscles. Some examiners use resistance to extension of the middle finger as a valid measurement.

Strength measurements are compared to the other side and to preinjury levels (if known). The results must be evaluated depending on whether it’s your dominant arm that was affected.

Normal strength should be within 90 per cent of the opposite side. Equal strength from side to side may be a sign of weakness. The dominant arm is almost always stronger than the nondominant side.

You may need a specific strength-training program to restore full strength and function to the operative side. See a physical therapist for a strength evaluation and training program. It should take six to eight weeks to see the results you are looking for.

Adolescents and young adults who are active and use their arms in repetitive and forceful motions can develop problems with the elbows. It’s for this reason that many organized sports, such as some baseball leagues, draw up rules to reduce the risk. For example, many leagues have “pitch counts” that only allow their pitchers to pitch so many times within a given period of time.

Proper conditioning will help keep the limbs strong and reduce the chance of injury. If your son has any signs of pain or discomfort in his elbow, he should rest it and not play through the pain. He should also see a doctor if he has any recurrent pain, difficulty moving his arms, extending his elbow, or if he hears clicking noises from the elbow.

Loss of motion in a joint after an injury is called a joint contracture. Sometimes the person can’t bend or flex it all the way. In other cases, the elbow won’t straighten or extend fully. Motion may be limited in both directions at the same time. It may be difficult to turn the palm all the way up toward the ceiling or down toward the floor.

Anytime joint motion is stiff or limited, a medical exam is advised. The doctor will perform an exam and possibly order X-rays. Damage to the joint capsule or surrounding soft tissues may be the problem. Sometimes the joint isn’t completely reduced (relocated). A second manipulation may be needed.

If the joint is intact and there is a contracture, then you may need physical therapy. The therapist uses various ways of increasing motion. Splints may be helpful as well. These may be worn at night or day and night if needed.

If motion is not restored after a reasonable length of time, then surgery may be needed. The type of surgery depends on the type of motion limitation and the cause of the problem.

Heterotopic ossification (HO) is the formation of bone fragments within the soft tissues around a joint. This condition is called myositis ossificans when it occurs in inflamed muscles.

HO appears to be directly linked to the severity of the trauma. Nerve damage or burns are especially susceptible to the formation of HO. Direct trauma to the elbow such as a dislocation and/or fracture can also lead to HO.

When a person is known to be at risk for HO, chemotherapy or low-dose radiation therapy can be used to prevent it. Non-steroidal antiinflammatory drugs such as indomethacin can also be effective preventive therapy.

But when joint contracture occurs and motion is limited, then surgery may be needed. At one time, it was thought that surgery should be delayed until no further bone growth occurred. More recent studies suggest this may not be so.

Early excision can be done without recurrence of HO. Contracture release and removal of the bone fragments can be done as early as three to six months after the injury.

You surgeon is the best one to advise you on the timing of this surgery. He or she will review your records and CT scans. Results of removing bone growth are best when only one plane of tissue is involved. When more layers are affected, the results are less predictable.

Tennis elbow, or lateral epicondylitis, is a painful condition of the outside of the elbow. The pain is usually felt just below the spot where the elbow’s bone sticks out.

Some people can feel the pain from tennis elbow from the spot below the elbow all the way down to the wrist. It can be painful to straighten out your arm, as well. The pain, caused by repetitive lifting or bending, can last for several weeks or longer.

Steroid injection can be a very helpful treatment for some conditions. Bursitis is often the cause of pain and limited motion in the elbow. An inflamed joint or bursa can respond well to a steroid injection.

Keeping the elbow joint quiet for the first 24-hours has one distinct benefit. And that is to keep the steroid in and around the joint. Movement, especially turning the palm up and down, disperses the antiinflammatory agent.

This means it seeps out of the joint. The body then absorbs it and the effect is much less than intended. So give yourself the extra time in hopes of a better result out on the court or on the golf course next week!

As you have seen, elbow bursitis can be a very painful condition. But it can be treated. It doesn’t have to be disabling.

The first step is to make an appointment with her physician. It’s best to make sure of the diagnosis. Sometimes what seems like bursitis can really be a septic (infected) joint. Rheumatoid arthritis can also bring about similar symptoms. The treatment depends on the exact problem.

Elbow bursitis can be caused by acute or repetitive trauma. The doctor will help identify what actions might be contributing to her symptoms. Modifying, but not necessarily eliminating, such activities can help.

If it turns out that she truly has an elbow bursitis, she may benefit from a steroid injection. The doctor uses a needle to remove any fluid build-up. Then an antiinflammatory drug (steroid) is injected directly into the joint or the bursa.

Motion may be limited for a day or two to help keep the steroid in the joint. After that, patients are advised to resume normal activities but not to overdo it. She may be given some stretches and exercises to do to help prevent the bursitis from coming back.

The main goal of this type of injury is to allow the bone and soft tissues to heal. At the same time, it’s important to keep the elbow joint from freezing up. Usually, the device, called an external fixator allows elbow flexion and extension. It prevents torque or load from side to side.

This side-to-side stress is called varus or valgus load. It occurs most often when the bones of the elbow are rotated. This happens when you turn your hand palm up (supination) and palm down (pronation).

Without these motions, the hand is fairly limited in function. The fixator helps maintain motion without stiffness while protecting the healing tissue.

Elbow injuries are notoriously difficult to heal. Any extra stress or load can cause a disruption of the healing tissues. Very often when the elbow is dislocated, the ligaments on one (or even both) side(s) of the joint are damaged, too.

These are the medial and lateral collateral ligaments. They keep the elbow moving in a straight plane of motion even when outside forces push it to one side or the other. This type of side-to-side displacement is called a varus or valgus stress. The name describes which direction the joint is pushed.

Studies show that the external fixator can support and stabilize the unweighted joint. The weight of the hand plus about 12 ounces is all the healing tissues can handle. Any more than that and you risk re-injuring the soft tissues.

Most people are eager to get out of the fixator. Reinjury may increase the length of time needed for healing. Too much stress may result in the need for further surgery to stabilize the joint.

Fractures of the elbow can be very challenging to treat. Sometimes there’s nothing to do but wait until the bone knits itself together. This is especially true with comminuted fractures such as you described. The bone is broken into many fragments. If they dont’shift out of place, the body will fill in with new bone and heal itself.

There are elbow joint replacements. There are different types depending on the problem. A displaced comminuted fracture is a good candidate for joint replacement when stable internal fixation with plates, wires, and/or screws isn’t possible. Elbow joint replacement is strongly considered when the ligaments around the joint have also been torn.

There are two bones in the forearm that form the bottom half of the elbow: the ulna and the radius. Sometimes just the top of the radius bone called the radial head is fractured. There are implants that just replace the radial head.

In some cases, the radial head is just removed altogether. This procedure should not be done if the soft tissues are torn. There are problems with each treatment choice for elbow fractures. Pain, joint instability, elbow stiffness, and decreased strength are possible. Long-term complications can include deformity and arthritis.

It’s likely the surgeon has suggested the best course of action given the type of fracture. More information would be needed to understand what is going on and what to expect in the next few weeks.

ORIF stands for open reduction and internal fixation. Open reduction means the surgery is done with an incision to open the area and perform the operation. This is instead of a minimally invasive (MI) approach.

With MI, the surgeon makes a tiny incision and slips an arthroscope through the opening and into the area. The scope has a very small TV camera on the end that allows the surgeon to see on a video screen what’s going on inside. Surgical instruments can be passed through the scope to do what needs to be done.

Internal fixation refers to the hardware used to hold everything together. This could be metal wires, screws, or plates The hardware stabilizes the bones or joint until healing can take place. Depending on which part of the body is involved, the hardware is later removed. In the case of the elbow, removal is common after healing is complete.

With an elbow fracture, it’s likely your employee will be in a rehab program. This will help him regain motion and strength. Stiffness is a very common and difficult problem post-operatively for any elbow injury.

If it’s a simple fracture, rehab may not be needed. Most often there is damage to the ligaments and soft tissues around the joint. Sometimes the bone breaks, the joint dislocates, and the ligaments rupture. These types of injuries require surgery and rehab to obtain full recovery.

That’s not a silly question at all. One would think that tennis elbow is caused by playing tennis – and it is. But it is also caused by any repetitious movement of the elbow or wrist.

The pain from tennis elbow is on the outside of the elbow, and if you do anything that repeats, like using a screwdriver, lifting, and playing racquet sports, you can develop tennis elbow.

Treatment of tennis elbow depends on how severe it is and what has already been tried. The doctor may decide to injects a corticosteroid (medication) directly into the area. Some people do well with medications called nonsteroidal anti-inflammatory drugs (NSAIDs). Over-the-counter NSAIDs include ibuprofen and aspirin. Physical therapy is often recommended that the physiotherapist may want the person to wear a splint, minimizing the movement of the forearm. If someone seems prone to tennis elbow, wearing a splint while doing activities that could aggravate tennis elbow may be a good idea.

In conservative treatment doesn’t work, surgery may be needed.

The location and type of injury you had may be clues to the possible cause of your symptoms. A full history and exam would be helpful in identifying what’s going on.

Nerve damage is always a possibility with elbow injuries. The ulnar nerve is very close to the surface and often involved with trauma to the elbow. In fact, recent studies have shown that dysfunction of the ulnar nerve is a major part of ongoing elbow problems.

Pain and stiffness are typical. But numbness, tingling, loss of sensation, muscle atrophy, and weakness are also possible symptoms. If you were seen by a doctor or therapist for care of your elbow, it may be a good idea to go back for a follow-up appointment.

It’s best not to let these kinds of symptoms go too long. Early diagnosis and intervention may have the best result. Management with conservative care can help the nerve heal. Waiting too long can result in chronic nerve dysfunction. At that point, surgery may be needed to take pressure off the nerve.