FAQ Category: Elbow

Sports medicine doctors have long noticed changes in elbow range of motion (ROM) for baseball pitchers. It’s such a common thing, nothing much is thought about it. Several studies show that 50 to 80 percent of all baseball pitchers at the professional level have a fixed elbow flexion contracture. This means the elbow doesn’t straighten all the way — it is stuck in a slight amount of flexion all the time.

Should something be done about this? No study has been done to compare pitchers with and without elbow flexion contractures to help answer this question. A recent study of 33 professional pitchers was done. The players’ records were reviewed and compared based on the amount of elbow motion present.

Age, number of years played, and number of innings pitched were all studied in relation to elbow motion. None of these factors seemed to make any difference in elbow motion. A mild loss of elbow extension doesn’t seem to negatively affect players’ performance.

You may want to keep a record for yourself. Keep track of your elbow motion each year. Compare any increases or decreases in motion with your pitching stats. Talk to your doctor if you see a decline in pitching ability as the elbow flexion contracture gets worse. A program of physical therapy and stretching may be helpful.

Many semi-professional and professional baseball pitchers have noticed differences in elbow motion from one side to the other. The dominant (pitching) arm usually doesn’t extend or straighten as much as the nondominant arm.

Sports medicine doctors have suggested this difference occurs because of the player’s age or number of innings pitched. They also think maybe arm dominance or history of surgery on the pitching arm makes a difference on elbow motion. But a recent study of 33 pitchers for the Chicago Cubs and St. Louis Cardinals showed no link between elbow range of motion and any of these factors.

We still don’t know what causes these changes in elbow motion. But reviewing the records of the pitchers from this same study showed no negative effect of a mild loss of elbow extension on pitchers’ stats.

Iatrogenic is a medical term to describe something that happens to a patient while in the care of a doctor or hospital. Iatrogenic pneumonia means the patient got pneumonia from being exposed to germs in the hospital.

An iatrogenic injury refers to a condition that occurred because of her living conditions in the nursing home. Many adults in nursing homes injure themselves when they try to get up without help or assistance. They forget they can no longer walk alone.

Neuropraxia refers to a mild nerve injury. The covering over the nerve called the nerve sheath is okay but the nerve itself has been compressed or traumatized. In this type of injury messages from the nerve will be slowed down for a few weeks. Full recovery can be expected in one to three weeks.

Getting a second opinion is always an option though you may have to pay for the appointment yourself. The management of elbow injuries can be complicated. Your symptoms suggest at least one of the nerves may have been compressed. Weakness and numbness are symptoms of nerve involvement.

A wait-and-see approach is often best with mild nerve injuries. Testing nerve function too soon doesn’t always give all the needed information. It takes time for the degree of nerve injury to show up.

Most mild nerve injuries heal by themselves in one to three weeks. A more moderate injury may take up to six or eight weeks. If the nerve is damaged beyond repair then surgery may be needed. Most patients have excellent results if the repair is done within 12 months of the injury.

If you know there are no fractures then you are probably safe waiting to see if the nerve will heal on its own. Full recovery takes about 18 months when the nerve has been cut through. It doesn’t sound like you had this type of serious damage so a little wait-and-see time is appropriate.

Cubital tunnel syndrome refers to a group of symptoms very much like carpal tunnel syndrome but in the elbow instead of the wrist and hand. The cubital tunnel runs alongside the elbow. It’s not really a tunnel as much as it’s a shallow groove where the nerve travels.

Anything that puts pressure on the ulnar nerve here can cause pain, numbness, tingling, and weakness. A tight muscle, scar tissue, or thickening of the fascia can contribute to the problem. Keeping the elbow bent for long periods of time while working at a computer can also make matters worse.

Other workers at risk include those who use repetitive elbow motions like to shovel or hammer. Lifting, using power tools, and leaning on a desk or table can cause or aggravate the symptoms. Drivers, shoemakers, and musicians can be added to the list of workers at risk for this condition.

Researchers haven’t been able to find the perfect treatment for tennis elbow. Studies show it is a long-term problem for many people. The latest research shows it isn’t an inflammatory process as was once believed.

We now know that damage to the tendon fibers results in scarring and fibrous healing. The healing tendon fibers don’t line up so movement keeps causing tiny tears where the tendon joins the bone.

Some people do better with a brace while others respond well to physical therapy (PT). A recent study from the Netherlands compared both treatments. There wasn’t an advantage to combining bracing with PT. They found that using a simple test called the Extensor Grip Test (EGT) helps predict who can benefit from the use of a brace.

Talk to your doctor or therapist about this test. Although a brace is a relatively inexpensive treatment tool, a negative EGT would save you the extra cost.

There’s a good way to find out. A new study suggests using the Extensor Grip Test (EGT). You’ll need someone to help you with this. First pull your wrist and hand back toward your face. This motion is called wrist extension or dorsiflexion.

Now have someone else grip firmly around the forearm just below the elbow. The other person’s hand gripping your forearm should mimic a brace.

Rest one minute. Repeat the test in reverse order. Have the other person grip your forearm just below the elbow. While the helper is holding the grip, extend your wrist. Is the pain better or worse? If it’s better, that’s a sign that a brace might help.

If your painful symptoms are NOT any better, then you may be helped more by physical therapy. At least that’s the advice of a group of Dutch researchers who studied the EGT. They tested three groups using the EGT. One group used only a brace. A second group had only physical therapy (PT). The third group had both a brace and PT.

About half the patients with a positive EGT got much better or completely recovered with a brace. Likewise, at least half the group with a negative EGT had success with PT.

You’re describing what’s called an external fixator for the elbow. The idea is to allow normal motion while still protecting the joint. During the healing process, it’s important to avoid compression through the joint surfaces or overload the healing soft tissues.

Without the fixator your husband would not be allowed to move at all while the bone heals. The problem with that idea is then the joint loses its motion. Regaining lost motion is even more difficult than healing fractured bones.

The rigid fixation of a pinned brace gives better control of motion. Even a small amount of torque can cause the tissues to heal with the wrong angle.

You’re right to be concerned about correct placement of the pins. During the operation an axis pin is used to guide the location of the fixator pins. The axis pin is put in place parallel to the axis of the joint. The axis is the central point around which the bones on each side of the joint move. It doesn’t actually go through the joint itself.

Using the axis pin as a guide, smaller half pins are placed on either side. These are called fixator pins. Once all the connections are made and are secure, the axis pin is taken out.

With a hinged elbow external fixator the pins follow the same axis of joint rotation. In the elbow this axis is straight across but slightly tilted or angled. You should see the pin on the outside of the elbow is slightly lower on the forearm compared to the pin on the inside (medial) of the elbow.

The surgeon uses a special form of X-ray called fluoroscopy to advance the pin into the bone. Careful measurements are taken to make sure there is a proper position. Some slight variation may occur from patient to patient as the surgeon avoids putting the pin through the nerves located on either side of the elbow.

The idea behind bracing is to restrict the muscle from expanding. In this way there is less force or stress put on the muscle fibers. No one has really proven or disproved bracing as an effective treatment for tennis elbow.

A brace gives your elbow, forearm, and wrist support during everyday activities. It also limits the pain during daily activities. The idea is to give the arm a rest while it heals but still allow you to do what you need to do on a day-to-day basis.

The brace should be worn throughout the day at all times. It can be taken off at night. Give it about four to six weeks to allow time for the microdamage at the elbow to heal. If you aren’t healed or at least better, then a short-course of physical therapy may be needed.

The elbow is made up of three bones: the humerus (upper arm bone) and the radius and ulna (forearm bones). At the bottom of the humerus on the inside of the arm is a bump called the medial epicondyle. Some people call that your “funny bone.”

The ulnar nerve of the arm passes around the medial epicondyle. There’s a slight indentation or groove in the bone where the nerve fits. The muscles and ligaments around this area form a tunnel through which the nerve passes. The tunnel is called the cubital tunnel.

Even though these structures protect the nerve, the groove is very shallow so the nerve is close to the surface. Any time you bump or hit the medial condyle or the nerve underneath it the nerve gets dinged and you get a strange sensation. Some people describe it as painful; others say it’s a sharp sensation of pins and needles.

Either way, it’s not very funny. Most likely it gets its name as the “funny bone” because someone else finds it funny to watch the person who bumped it jump around in pain.

Friction on the ulnar nerve as it passes through the elbow can cause symptoms of pain, numbness, and tingling. The space or tunnel the nerve passes through at the elbow is called the cubital tunnel (CTS). The group of symptoms make up the syndrome of CTS.

Frequent throwing is a common cause of CTS. Baseball pitchers, catchers, and infielders are affected most often. When the elbow is bent or flexed, the ulnar nerve is stretched to its fullest. It may get pushed against the bone in the elbow.

Anything that strains the nerve beyond its ability to stretch or cuts off its blood supply can bring about these symptoms. Treatment usually begins with eliminating the repetitive motions and positions causing the problem.

Nonathletes with CTS may have a habit of sleeping with their arms bent and/or up overhead. These positions put the most strain on the nerve.

Revision surgery to repair, remove, or replace a joint implant happens in all joint replacements. The most common problem requiring this step is implant loosening. Bone fracture, dislocation, or infection are also possible problems.

Elbows that dislocate once can usually be treated without surgery. A rehab program to strengthen the arm is important to prevent future dislocations. Chronic dislocations may require revision surgery.

Loosening of the implant can cause pain, deformity, and loss of function. Sometimes the implant collapses or sinks into the bone, a process called subsidence. Revision is needed for this problem, too. More rarely the implant breaks and must be removed and replaced.

These problems can occur early after implantation up to years later. The patient may not have any symptoms early on with some problems. It’s best to keep your regular follow-up appointments and check for loosening with X-rays every couple of years.

There isn’t exactly an elbow transplant, but an elbow replacement is possible. Most orthopedic surgeons who do elbow joint replacements will consider you for this operation if you meet certain requirements:

Elbow replacements are done much less often than other joints such as the hip or knee. The number of studies with results are far fewer. Rehab programs afterward may vary from surgeon to surgeon. Sometimes there are differences from one part of the U.S. to another or one country to another.

In a recent report from Oxford, England, surgeons advised patients with elbow replacements to begin elbow motion the first day after surgery. The patient could progress the program as much as pain and discomfort would allow. A sling was used except during exercise.

For the first six weeks patients were told to avoid lifting or any motion that would apply resistance to elbow extension. Once they reached this milestone they could advance their activities. Everything was done according to their level of pain or discomfort.

Normal activities were allowed but strenuous manual labor was banned. The patients were advised not to lift or carry heavy loads with the treated arm. Anyone in construction or heavy labor was told not to go back to that work ever.

Check with the surgeon who is going to do your surgery for any rehab or post-operative guidelines. Some restrictions are based on the kind of implant you get.

You’re probably talking about extracorporeal shock wave therapy (ESWT). This is a form of energy used to help heal areas of damaged soft tissue. The body responds to this treatment by bringing more blood to the area. You may get some bruising or soreness at the site of treatment. This is usually mild.

Overall results may depend on how long the problem has been there. In your case, symptoms have lasted over a year. This makes healing more difficult. Since there’s no surgery involved, no permanent damage occurs.

Healing is expected from the first day. Each person heals at a different speed. Some people feel better right away. For others it can take up to six weeks or more.

Tennis elbow is common in adults who have never played tennis before. People over 40 years old are most likely to get tennis elbow. It could be you are using a racket that’s too stiff. Have someone with good experience check this out for you.

Studies show players who hit the ball late or who “frame” the ball are more likely to get hurt. Framing the ball means the player has miscalculated the swing and hit the ball with the frame of the tennis racquet instead of the strings. Ask someone who plays tennis to watch your swing and offer suggestions.

Every physical activity or sport requires strength in certain muscles. In tennis, weakness in the muscles of the forearm can lead to tennis elbow or other injury. Make sure you are warming up properly before playing. An exercise program to build up strength is also a good idea.

You may want to consider taking some lessons through your local parks and rec department, a tennis club, the YMCA, or other health club in your area.

Extracorporeal Shock Wave Therapy known as ESWT was first used to break up kidney stones in the body. Doctors found out it also works to treat soft tissue and some bone injuries.

Waves of energy are sent through the body using a special machine. No surgery is needed. The patient is awake when the treatment is done. A local anesthetic may be used to numb the area being treated. The patient feels no pain or discomfort during the procedure.

The shock waves stimulate the damaged tissue. Your body starts its own healing process by sending blood and nutrients to that area. Healing takes place by the growth of new tissue around the area of injury.

It’s a fairly new treatment developed in the last 10 years. Doctors are using it for tennis elbow, plantar fasciitis, heel spurs and other conditions.

Shoulder, knee, and wrist cysts are often removed using an arthroscope. This tool
is inserted into the joint with a small puncture wound. An open cut isn’t needed. The arthroscope has a tiny TV camera on the end, which allows the surgeon to see inside the joint.

Arthroscopy is being used more now for elbow problems. Arthritis, bone chips, and other lesions can be treated this way. It takes more advanced skill to use the arthroscope in the elbow region. The doctor must be able to see and avoid damage to structures like the nerves and blood vessels.

Surgeons will operate on the elbow with arthroscopy more as technology and skill improve.

Lumps of any kind must be examined and diagnosed by a medical doctor. This could be a benign tumor, ganglion cyst, lymph node, or more serious lesion. It isn’t possible to tell without further testing.

Lymph nodes inside the elbow don’t usually limit motion even when swollen. It could be a ganglion cyst since your motion is limited. A ganglion cyst is a pouch filled with fluid from the joint. A tiny hole in the joint capsule allows fluid to escape into a side pocket. A cyst forms to hold the fluid.

Benign fatty tumors called lipomas can also form a soft, moveable mass such as you describe. These aren’t malignant but they can put pressure on the nerve or take up space in the joint causing problems.

Have it checked out before it gets any bigger. Early diagnosis and treatment for most conditions means a better result in the end.