FAQ Category: Elbow

With a little time and patience you have a 95 percent chance of complete recovery. Tennis elbow (lateral epicondylitis in medical terms) is a common problem after overuse. Yard work, weekend sports, or other repetitive activity is the usual cause of the problem.

If you use rest, ice, and compression in the early recovery period, the inflammation can be brought under control quickly. An ACE wrap or splint can give good support early on. If you must continue the activity or if the symptoms don’t go away, formal treatment may be needed.

Learning how to grasp and lift is important. The forearms must stay in a position with the thumbs or palms facing up. Proper stretching after prolonged positions or repetitive motions is helpful.

Strengthening exercises for the muscles of the forearm and wrist can make a big difference. These exercises are done in the pain free range of motion. They are resistive exercises and can be progressed according to the patient’s tolerance.

It might. You may also need some other intervention. If your symptoms are better after a couple days off work (or after a longer break or vacation), then changing jobs may be the answer. Changing to a lighter-duty job is advised.

In a recent study comparing worker’s compensation (WC) patients with non-WC patients, both groups went back to work after surgery for tennis elbow. The WC group had to change jobs more often. Some patients could find other work with the same employer. Others had to go outside the place of business and find a different job.

There are other ways to treat this problem, too. Anti-inflammatories, bracing or splinting, cortisone injections, and physical therapy are all treatment methods that can work.

f you haven’t seen a doctor or physical therapist for the problem, consider making an appointment and getting an evaluation. After three years you have a chronic problem that may require longer to treat.

Splints are used to reduce pain, cushion the area, and support the weak muscles. Patients most likely to get splints for tennis elbow are women in moderate to severe pain during the early phase of the condition.

Studies don’t support the use of splints. Researchers report worse results with splints. The inactivity leads to worse deconditioning. The rate of return to previous activities is the same with or without splints. The cost of treating patients wearing splints is higher, and the final outcome is no better than without splints.

Splints may help a patient remember to use the hand and forearm correctly to avoid further problems. But a splint sends the message that the arm is injured and needs to be rested. It looks like normal movement may help more to heal the injury.

Most people with tennis (tuba) elbow are treated by their doctors. Rest, ice, and medications are the first line of treatment. Nonsteroidal anti-inflammatory drugs and steroid injections are the drugs used most often. Physical therapy for exercises, stretching, and splinting may be advised.

Studies are starting to show results aren’t better after splinting. In fact, patients who are splinted have higher rates of limited duty and more medical costs.

Though it may seem like lifting and carrying your tuba is what brings on the symptoms, it may be that pain occurs with the activity only after the condition got started. Some doctors think using the arm will actually lead to a more rapid recovery.

If you have to transport the tuba around a lot, you may want to think about getting a wheeled cart for it. Tuba cases with wheels can also be purchased.

You’re very observant. A recent study showed that the patients most likely to get a splint for tennis elbow are women with moderate to severe lateral epicondylitis. Lateral refers to the outside of the elbow. Epicondylitis is the medical word for tennis elbow.

It’s not clear if this is because women have more pain than men or are more likely to have lateral epicondylitis. Perhaps there’s some other factor involved. More study is needed to sort these things out.

It may not matter since several new studies have shown that splinting actually keeps a patient from recovering sooner. Patients wearing splints have more time off work and a longer recovery. They also have higher medical costs. It seems elbow pain (like back pain) gets better faster with movement and activity.

What you are seeing is what is commonly referred to as “within normal limits.” The range of “normal” joint motion is on a slight continuum. When the joint forms a straight we say it’s at zero degrees of motion. Slightly more than that in an extended position or slightly less in a flexed position might still be called “normal.”

Normal variations in anatomic structure account for these differences. It could be the shape of the bone forming the joint. Or it could be how tight or loose the soft tissue structures are around the joint. The soft tissue includes ligaments, muscles, connective tissue, cartilage, and the joint capsule that surrounds the entire joint.

Your shortened elbow range is most likely normal, especially if your elbow position doesn’t keep you from doing things and there’s no pain.

Radiofrequency (RF) is a heat treatment applied to the tendon during arthroscopic surgery. It requires a special RF-based device used to generate the energy waves. A needle-like wand is used to apply the energy to the tendon. The tip of the wand is touched to the surface of the tendon.

Many tiny holes are “burned” into the tendon. The new wound sets up an inflammatory response to begin the healing process. New blood flow to the area helps restore tissue to normal.

Surgeons may not be familiar with the use of this treatment method. They may not have the equipment or training. On the other hand some surgeons may be concerned about the amount of tissue damage that can occur with this treatment. Damage can occur to nearby tissues. Holes can be burned too deep, going into the cartilage or joint.

More studies are needed to show long-term results before RF tenotomy is adopted as a standard treatment for tendon problems.

Patients often get pain relief and improved function with surgery. This is possible even after years of elbow pain and problems. Methods vary but include release of the tendon or the nerve. Any extra tissue in the area can be removed to take pressure off the nerve and allow the muscle to move normally.

Part or all of the tendon may be removed. Or the surgeon may just cut the tendon and let it reattach farther down away from the bone. This takes the tension off the tendon. The result is less pain and more function.

Surgery used to be done with an open incision but now arthroscopy is possible. Recovery is faster with fewer problems. Rehab can begin sooner because of the rapid pain relief.

Biceps tendon rupture isn’t rare but it is uncommon. The dominant arm is usually injured. Men in construction or heavy manual labor are affected most often. They are often in their 40’s and smokers. Nicotine has a known effect on bones and muscles.

It sounds like you have two of the three most common risk factors for this type of injury (age and manual labor). If you are a smoker or use tobacco in any other form, your risk goes up even higher.

Soft tissue healing of this kind depends on several factors. Your age, your general health, and whether or not you smoke, drink, or use other substances all make a difference. Health conditions such as diabetes, anemia, liver or heart disease can slow down healing. The use of tobacco, alcohol, and other drugs will also delay wound healing.

The type of injury is also a factor. A small tear will heal on its own but scar tissue may make the tendon less flexible. A large tear will heal with the tendon retracted from its original position. Your elbow motion and strength may be affected.

If you depend on full motion and full strength for your job, you are best advised to have the surgery. There are some risks involved with any surgery, including tendon repair. Your surgeon will go over these with you. Make sure the surgeon knows the type of work you do. Discuss your expectations for return to work after surgery.

You didn’t mention how long ago you had the injury and surgery. Most soft tissue healing takes place in six to eight weeks. The swelling may be causing the numbness and tingling as the fluid takes up space and puts pressure on the nerve.

You have probably been given suggestions to reduce swelling in the arm. Follow your doctor or therapist’s advice carefully.

Have someone help you measure your arm in several places above, below, and at the level of the swelling. Wrap a plastic tape measure around the arm against the skin for the measurement. Don’t apply any pressure or pull the tape tight.

Compare these measurements to the other arm. Your dominant arm is usually slightly larger than the nondominant side. Swelling, of course, will increase the circumference. The idea is to compare the measures over time and see if the swelling is going down. You should see your doctor if there’s any sign that the swelling is getting worse instead of better.

Most people with epicondylitis or “tennis elbow” report symptoms for an average of six months up to two years. This depends on a number of different factors. Patients in good health and fitness level may recovery more quickly.

Anyone continuing with work activities or sports that put a strain on the tendons at the elbow may have more problems. Healing is delayed when tendons of the forearm muscles tear from overuse. These tiny tears cause microtrauma and a cycle of bleeding, inflammation, scarring, and tearing. Stopping this cycle is the goal of treatment.

A study from the University of Tennessee reports the use of blood injections for tennis elbow. The idea is to stimulate healing at the cell level. The blood contains chemicals to help the immune system start the healing process.

Most patients report complete relief of painful symptoms within three weeks of the first injection. This matches the time period for tissue healing. A few patients need a second injection. This is given two weeks after the first injection. A positive effect is noted one to two weeks later.

Tennis elbow or epicondylitis can cause painful symptoms on the inside or outside of the elbow. Lateral epicondylitis along the outer border of the elbow is the most common form. It’s always been assumed that this condition occurs as a result of tendonitis.

However, scientists studying cells from muscles and tendons around the elbow don’t find any sign of inflammation. Instead, chronic overuse of the muscles results in damage to the tendon cells that don’t heal.

Using a microscope, researchers find large numbers of fibroblasts. These are the “baby” cells of soft tissues. They don’t seem to “grow up” or mature after injury. A loss of blood supply may also add to the problem.

These findings have changed the way doctors treat epicondylitis. Instead of ice or drugs to calm the inflammation, the elbow is injected with the patient’s own blood. Special chemicals in the blood start the healing process.

The answer to this question isn’t certain yet. In the early 1990s, researchers found that tennis elbow isn’t an inflammatory condition after all. Scientists looked at the tendon tissue under a microscope. Instead of inflammatory cells, they found damaged tendon cells that just couldn’t finish the healing process.

Steroids work to reduce inflammation, but they can also weaken the collagen structure of the tissue. Blood injections have been shown to heal, not weaken, areas of tendon damage. Chemicals in the blood set up a series of healing steps. Injecting the blood directly to the area is a new treatment idea.

Iontophoresis is a way to use an electric current to send drugs into an area of tissue. Electrodes are used over the skin and the current “pushes” the ions through the skin. Ions are charged particles that can be moved one way or another using electricity.

A steroid injection into the elbow area has many possible problems. It can cause tendon rupture, nerve injury, infection, damage to the joint, and skin changes. Iontophoresis brings the drug to the elbow area in smaller doses over time. Usually, three to six treatments are given over a period of seven to 10 days. Each session takes 30 to 40 minutes.

Iontophoresis can reduce pain and increase motion with fewer local side effects. Some patients get a rash from the electrodes. Treatment is stopped or a different electrode is used.

In a growing child, there is a flat piece of cartilage near the end of long bones (like the forearm) called the growth plate. Eventually, when the child stops growing, these plates will form into bone. Until then, any damage to a growth plate can cause abnormal growth in the injured bone. This can lead to other problems by changing the way the bone lines up at the joint.

Your doctor is right to suggest your son not play the rest of the season. The injury must be treated until the symptoms are gone and full forearm and wrist motion is possible. Anything that causes pain and swelling worsen should be avoided.

There are adaptive aids that can help you with a variety of tasks, from picking up socks off the floor to holding a cup or toothbrush. Also, you’d probably benefit from the services of a physical or occupational therapist. These health care professionals can assess your work or home for ways to help you complete tasks more easily. Ask your doctor for a recommendation, or call a local clinic or hospital for the name of a licensed therapist.

Arthrodesis is a surgical procedure that will fuse your elbow joint in one position. There are a variety of ways to accomplish this. The procedure may involve a bone graft and/or wires to hold the bones together. In the case of a graft, the bone may come from a bone bank, or the doctor may shave pieces of bone from your pelvic bone.

The most important decision about elbow arthrodesis is the final position of the elbow. Once fused, the elbow will not bend or straighten out of that position. The position of the elbow is very important since the arm does tasks with the elbow bent (wash the face, comb the hair) and straightened (reach for objects, tie shoes). Be sure to discuss this important decision with your doctor.

Until recently, it was recommended that the elbow be placed in 90 degrees of flexion. Since there were no data to prove this was the best position, a group of researchers decided to investigate. After studying a group of healthy adults, it seems that a position of 110 degrees of flexion is best (slightly more than a right angle). This position allows for the most arm function.

Before you have this surgery, ask your doctor about a trial period with an adjustable brace. Try five or six different settings, and keep track of which activities you can and can’t do in each. A physical or occupational therapist can help you with this. Other factors to consider include your occupation and work-related tasks, your personal preferences, and whether you are right- or left-handed.