FAQ Category: Elbow

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.

It’s true that making an incision through the soft tissues on the outside of the elbow changes the support for the elbow. This is usually a temporary situation. Unless there is a need to cut through all the major ligaments, your elbow should remain stable after surgery.

You will be immobilized for a period of time in a cast. When the cast is removed, there may be a rehabilitation phase with exercises prescribed by your doctor or physical therapist. It usually takes six to eight weeks to regain strength equal to that of the other arm. You can return to your weight-lifting program gradually, according to your doctor’s recommendations.

It’s a good idea to let your doctor know of your interest in weight training. This may influence the surgical method used and enable you to safely resume your program more quickly.

When it comes to joint motion, there is a wide range of what is considered “normal.” Some people notice their elbows don’t straighten all the way, while others have extra motion that allows the elbows to go beyond straight. This is all genetically determined, or based on inherited traits from your parents.

The structures around the elbow, such as ligaments, tendons, and attaching muscles, determine flexibility and motion. How the fibers stretch across and around the joint and how tight or loose the fibers are contribute to the final amount of joint motion.

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.

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.

Elbow arthritis may be surgically treated with a procedure called interposition arthroplasty. The term “interposition” means that new tissue is placed between the damaged surfaces of the elbow joint. In this surgery, the surgeon takes tissue from another source to fill in the space in the elbow joint. The soft tissue forms a false joint. This surgery has best results in younger people with healthy tissue around the elbow joint.

After surgery, you will either wear an external fixator for up to twelve weeks or a long-arm cast for about six weeks. Both devices hold the elbow still while the ends of the bones fuse together. Your surgeon will want to check your elbow within five to seven days. Stitches will be removed after ten to fourteen days, although most of them will have been absorbed by your body. You may have some discomfort after surgery. Your doctor can give you pain medicine to control the discomfort.

You should keep your arm elevated above the level of your heart for several days to avoid swelling and throbbing. Keep it propped up on a stack of pillows when sleeping or sitting.

If you keep having pain or find that you have stiffness in the shoulder, wrist, or finger joints, you may need a physical or occupational therapist to direct your recovery program.

Any joint that has been severely injured could eventually develop osteoarthritis. The original injury may change the way the joint works just enough to cause extra wear and tear to the surfaces of the joint. Over time, the joint degenerates, causing pain and difficulty with daily activities. This condition is post-traumatic arthritis.

A fusion of any joint eliminates pain by making the bones of the joint grow together, or fuse, into one solid bone. Fusions are used in many joints. They were very common before the invention of artificial joints. Fusions are still performed fairly often to treat arthritis pain. An elbow fusion gets rid of pain because the bones of the joint no longer rub together.

Advanced arthritis can change the alignment of the elbow, leading to deformity. Fusing the bones together improves the alignment and prevents further deformation. Fusion may also be needed to align the elbow after a severe injury.

You will not be able to bend your elbow after fusion surgery. An elbow fusion is a tradeoff. You will lose the hinge motion in your elbow, but you will regain a strong, pain-free elbow joint. Regaining strength is especially important to laborers who work with their arms and hands. Some patients may need range of motion more than strength. In these cases, doctors usually recommend surgeries such as interposition arthroplasty or elbow joint replacement.

The radius bone of the forearm is usually not part of the elbow fusion. The end of the radius forms a joint with the ulna. This joint allows you to pronate and supinate (rotate) your forearm and hand. When this joint is a source of pain, the surgeon may remove the round end of the radius near the elbow. This still allows the forearm to rotate.

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.