FAQ Category: Elbow

The pivot shift test is used by doctors to see how stable or steady a joint is. This test is usually applied to the knee or elbow. To carry out the test on the elbow, the doctor bends the elbow with the palm facing up while putting pressure against the joint from the inside (pushing toward the outside). A slip or click in the joint suggests that the ligaments on the outside of the elbow have been torn or damaged.

There are two particular ligaments that help give the elbow strength and support. Without their full strength, the elbow will show a positive “shift.”  This is an indication that surgery is needed to repair the injured ligaments.

Tingling sensation from tapping, bumping, or putting pressure on a nerve is called Tinel’s sign. This may be a sign that the nerve is continuing to heal after surgery. It happens in about a quarter of all patients who have the surgery you describe. It can also be a sign that the nerve is permanently irritated or partially damaged. You can expect to see continued improvement for up to 18 months after this type of surgery.

Cubital tunnel syndrome is when pressure on the ulnar nerve–the nerve along the inner side of the elbow–causes symptoms. The person may have numbness and tingling of the ring and little fingers. There may be elbow pain and loss of grip strength.

Early treatment may include holding the elbow in a straight position with a splint (especially at night), anti-inflammatory medications, and treatment with a physical therapist. Ask your doctor to help you find a therapist who is trained in a technique called neural mobilization. This technique gently releases the nerve in its pathway, restores its natural movement, and increases its circulation.

If the symptoms do not improve after four to six weeks, surgery may be necessary. A recent study showed that early surgery to take the pressure off the nerve has a better result than waiting until the nerve tests positive for injury. By that time, permanent damage may develop, and surgery may be less successful.

There is a wide range of possible causes for these symptoms. Sometimes loss of circulation or pressure on the ulnar nerve as it travels down the arm from the elbow can cause the numbness, tingling, and weakness you’ve described. There may be a problem higher up in the neck. For example, pressure on a spinal nerve from a bulging disc can cause these symptoms. Likewise, pressure on the nerves where they travel under the collarbone or by the shoulder can result in numbness and tingling in the hands.

There may be some changes in anatomy causing this type of pressure on the nerves. Activities that repeat the same motions can lead to these symptoms. Even diabetes can affect the nerves and cause symptoms. It is best to have a doctor examine you, especially since it has been six months since the symptoms started. Early treatment may prevent long-term problems.

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.

Anytime a person does the same activity over and over, there is a risk of developing pain and problems. You may have developed a condition called tennis elbow, known to doctors as lateral epicondylitis. With this condition, overuse causes damage to one tendon/muscle unit in particular.

A doctor can determine the exact cause of your painful symptoms. In the case of lateral epicondylitis, most patients become symptom-free with the use of medications. Sometimes other kinds of treatment are necessary, such as physical therapy, injections, or surgery.

Most people do respond to the treatments you have described. However, when severe and chronic pain persists with little or no response to conservative care, surgery may be needed.

There are many different surgical methods to help with tennis elbow. For example, the surgeon may release the tension on the outside of the elbow by cutting the tendon that attaches there. This lets the tendon slide down the forearm about half an inch. The soft tissues are sewn together to allow the muscles to function. Sometimes the bone underneath is shaved or smoothed off at the same time.

Make an appointment to see an orthopedic doctor. Your need for surgery can be decided. Then you and the doctor can discuss which operation is best for you.

Each doctor has a plan for when and how to use devices such as splints and slings. It is important to follow the specific recommendations made by your doctor for the splint. In the early days and weeks after surgery, there is a chance for overuse of the elbow and damage to the area that was operated on. The splint provides necessary protection and is required.

Doing the exercises prescribed by your doctor or physical therapist can help keep your motion and avoid swelling. Wearing the splint protects the surgical site and increases the chances of quicker wound healing. Follow your doctor’s advice carefully, and avoid taking shortcuts without your doctor’s approval. When in doubt, call the doctor’s office and ask questions. This may save you additional problems in the long run and help you understand the day-to-day healing process.

At the present time, there are no Little League (or other baseball organization) rules about pitching. Young pitchers who have not completed their bone growth are especially at risk for elbow and shoulder injuries. Most coaches are aware of this problem but may not be aware of how much children are actually pitching.

Keep a pitch-count book on your child for a week (or longer). Keep track of the number of pitches in practice and in games. Record the kinds of pitches he’s throwing. Keep track of how often he has pain, where it is located (elbow, shoulder), and how long it lasts after pitching. Show this to the coach along with the magazine article.

Becoming an educated parent and passing that knowledge on to coaches takes time. Check with the coach in a week and ask what he or she thought about the materials. Don’t be discouraged if the coach doesn’t seem interested in the information. Making the information available is the first and most important step.

Most of the time, pain over a particular area of the elbow is caused by injury to the muscles, tendons, or ligaments in that area. Using the arm over and over in the same way can cause small tears to these structures. Sometimes a nerve can get trapped between the bone and the tendon or muscle, and this can also cause painful symptoms.

The first step is to get a medical evaluation. The doctor will take a careful history and examine the arm. X-rays or other scanning technology may be used to look inside the elbow. This will help determine the cause of the elbow problem. Treatment is decided by what causes the problem. If there are no broken bones or torn tendons, the physician will most likely send your son to a physical therapist.

The physical therapist will use various treatments to reduce the painful symptoms. Once the painful symptoms are gone, a program of specific exercises will be prescribed. The therapist can also work with your son and his coach to identify any factors causing this problem. In this way, future injuries can be avoided.

Not necessarily. A recent study examined the elbow joints of 136 male college athletes. Over one-third played sports that required overhand actions, such as baseball and tennis.

Participants had both elbows tested in a device that pushed against the forearm, angling the elbow outward. An X-ray showed how far the joint separated, suggesting how well the ulnar collateral ligament on the inside edge of the elbow held under pressure. This is the ligament mainly responsible for securing the elbow so it isn’t easily strained into this outward position.

To visualize this angle, straighten your arm with your palm up. Now try to make your forearm angle out to the side where it meets the elbow joint. In a healthy elbow, the ulnar collateral ligament makes this action nearly impossible.

There were no major differences between players, even the ones doing overhand sports and those who had been playing for many years. These findings led the authors of the study to conclude that extra laxity of the elbow doesn’t occur in athletes who participate in such sports but are free of elbow pain.

The ulnar collateral ligament (UCL) is the strongest and stiffest ligament crossing the elbow joint. It is located on the inside edge of the elbow.

Ligaments connect one bone to another. They are designed to keep the two bones from moving too far in one or more directions. Connecting the upper arm bone (humerus) to the inside bone of the forearm (ulna), the UCL is the main ligament protecting the elbow from angling too far out to the side.

Compared to players in other positions and other types of sports, baseball pitchers have a greater chance for an elbow injury. This relates to the remarkably high forces on the elbow joint during the pitch. The primary diagnosis in pitchers is bone spurs along the inside edge of the olecranon bone, the main bump on bottom of the elbow. Forceful straightening of the elbow during the pitch sometimes brings the bones of the elbow into contact. Repeated contact eventually causes bone spurs to develop where this contact occurs.

The second most common condition affects the ulnar collateral ligament. This ligament crosses the inside edge of the elbow. It normally keeps the elbow from bending out to the side. Pitching puts tremendous strain on the elbow in this awkward angle. To visualize this angle, straighten your arm with your palm up. Now try to make your forearm angle sideways where it meets the elbow joint. In a healthy elbow, the ulnar collateral ligament makes this action nearly impossible.

However, the repetition of pitching compounds the strain on this ligament. This can lead to problems of overuse, eventually allowing the elbow to be strained into this awkward outward position. Talk to your trainer or coach to learn ways to prevent, recognize, and treat these conditions.

Golfer’s aren’t the only athletes subject to pain on the inside bump of the elbow, the medial epicondyle. Any activity that puts repeated strain on the forearm tendons attaching to the medial epicondyle can produce similar symptoms. The medical term for golfer’s elbow is medial epicondylitis.

Swimmers are particularly at risk for this problem. Repeating swim strokes over and over can begin to put a strain on the flexor tendons of the forearm. And swimmers who power their arms through the water to gain speed can end up straining the tendon where it attaches on the medial epicondyle. Eventually, these strains can begin producing symptoms of medial epicondylitis.

The golf swing is a common source of pain on the inside bump of the elbow, the medial epicondyle. Repeating the golf swing over and over can begin to put a strain on the flexor tendons of the forearm where they attach to the medial epicondyle. Eventually, these repeated strains can produce pain on the inside edge of the elbow. Commonly called “golfer’s elbow,” the medical term for this condition is medial epicondylitis.

However, any activity that puts a similar strain on the forearm flexor tendons can produce symptoms. For example, shoveling, gardening, and hammering nails can all cause medial epicondylitis.

Tennis elbow is not always due to inflammation. Pain that first strikes the outside bump of the elbow (the lateral epicondyle) is likely due to inflammation. However, symptoms that are chronic and unchanged after taking anti-inflammatory medications may not be tendonitis.

Conditions that involve inflammation are indicated by “-itis” on the end of the word. For example, inflammation in a tendon is called tendonitis. When tennis elbow is from inflammation around the lateral epicondyle, the medical term is lateral epicondylitis.

Rather than a problem with inflammation, you may have symptoms of tendinosis. This is a condition where the body keeps trying to repair the injured tendon. About the time healing gets underway, the tendon becomes strained again. Eventually, the body stops trying to heal the area and instead replaces normal tissue with scar tissue. This leads to degeneration where the forearm extensor tendons attach to the lateral epicondyle. Treatment generally takes longer when the problem involves tendinosis. Talk to your doctor and physical therapist to see what other treatment options can help your condition.

When you bend your wrist back or grip with your hand, the wrist extensor muscles contract. The contracting muscles pull on the extensor tendon where it attaches on the outside bump of the elbow, the lateral epicondyle. The forces that pull on these tendons build when you hit a tennis ball in a backhand swing in tennis.

Overuse of the muscles and tendons of the forearm and elbow are the most common reason people develop tennis elbow. Repeating the same action of the backhand swing in tennis over and over again can put too much strain on the elbow tendons.

The repeated actions of the tennis swing may eventually cause the body to undergo an inflammatory response. Special inflammatory cells make their way to the injured tissues to help them heal. Elbow pain and swelling result.

In tendinosis, wear and tear is thought to lead to tissue degeneration. A degenerated tendon usually has an abnormal arrangement of collagen fibers.

Instead of inflammatory cells, the body produces a type of cells called fibroblasts. When this happens, the collagen loses its strength. It becomes fragile and can break or be easily injured. Each time the collagen breaks down, the body responds by forming scar tissue in the tendon. Eventually, the tendon becomes thickened from extra scar tissue.

No one really knows exactly what causes tendinosis. Some doctors think that the forearm tendon develops small tears with too much activity. The tears try to heal, but constant strain and overuse keep re-injuring the tendon. After a while, the tendons stop trying to heal. The scar tissue never has a chance to fully heal, leaving the injured areas weakened and painful.

The main symptom of tennis elbow is tenderness and pain that starts at the lateral epicondyle of the elbow. The pain may spread down the forearm. It may go as far as the back of the middle and ring fingers. The forearm muscles may also feel tight and sore.

The pain usually gets worse when you bend your wrist backward, turn your palm upward, or hold something with a stiff wrist or straightened elbow. Grasping items also makes the pain worse. Just reaching into the refrigerator to get a carton of milk can cause pain. Sometimes the elbow feels stiff and won’t straighten out completely.