FAQ Category: Elbow

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.

Overuse of the muscles and tendons of the forearm and elbow are the most common reason people develop tennis elbow. Repeating some types of activities over and over again can put too much strain on the elbow tendons. These activities are not necessarily high-level sports competition. Hammering nails, picking up heavy buckets, or pruning shrubs can all cause the pain of tennis elbow.

Lateral epicondylitis, commonly known as tennis elbow, is not limited to tennis players. The backhand swing in tennis can strain the muscles and tendons of the elbow in a way that leads to tennis elbow. But many other types of repetitive activities can also lead to tennis elbow–painting with a brush or roller, running a chain saw, and using many types of hand tools. Any activities that repeatedly stress the same forearm muscles can cause symptoms of tennis elbow.

The main goal of interposition surgery is to ease pain where the surfaces of the elbow joint are rubbing together. A piece of tendon or other soft tissue forms a “spacer” that separates the surfaces of the joint. Interposition arthroplasty is different than a fusion surgery. Fusion simply binds the joint together, and the elbow loses much movement. Interposition arthroplasty can help take away pain while allowing the elbow joint to retain some movement.

On the outside part of the elbow, the radial nerve enters a tunnel formed by muscles and bone. This is called the radial tunnel. Passing through the radial tunnel, the radial nerve runs below the supinator muscle. The supinator muscle lets you twist your hand clockwise. This is the motion of using a screwdriver to tighten a screw.

The goal of conservative treatment is to help you manage your pain and use your elbow without causing more harm. Your doctor may recommend nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen, to help control swelling and pain. Other treatments, such as heat, may also be used to control your pain.

Rehabilitation services, such as physical and occupational therapy, have a critical role in the treatment plan for elbow osteoarthritis. The main goal of therapy is to help you learn how to control symptoms and maximize the health of your elbow. You’ll learn ways to calm your pain and symptoms. You may use rest, heat, or topical rubs.

You may be issued a special elbow splint to immobilize and protect the elbow. Resting the joint can help ease pain and inflammation. Range-of-motion and stretching exercises can improve your elbow motion. Strengthening exercises for the arm help steady the elbow and protect the joint from shock and stress. Your therapist will give you tips on how to get your tasks done with less strain on the joint.

To get rid of your pain, you may also need to limit your activities. You may even need to change jobs, if your work requires heavy, repetitive motions with the hand and wrist.

An injection of cortisone into the joint can give temporary relief. Cortisone is a powerful anti-inflammatory medication. It can very effectively relieve pain and swelling. Its effects are temporary, usually lasting several weeks to months. There is a small risk of infection with any injection into the joint, and cortisone injections are no exception.

Pain is usually the first sign of elbow osteoarthritis. At first, the pain gets worse when using the elbow. Once it gets warmed up, though, the pain usually eases. Pain and stiffness commonly occur after resting the joint, such as when waking up after a night’s sleep. Again, these symptoms usually subside as you get moving. Eventually, you may have pain when resting the joint, and the pain may interfere with sleep.

Swelling around the elbow may cause the joint to feel tight, especially after using it. When the surfaces of the joint have worn off, moving the elbow may cause you to hear and feel a squeak or creak in the joint. This is called crepitus.

Osteoarthritis eventually affects the elbow’s motion. The elbow joint is one of the most sensitive to injury. It quickly becomes stiff and loses motion. The first thing most people notice is that it becomes hard to completely straighten the arm. Later it may also become hard to bend it.

An elbow fusion will greatly decrease the motion in your arm. However, it does leave you with a strong and pain-free elbow. If you need a good range of motion in your elbow, you should consider another type of operation, such as an elbow joint replacement.

A small bursa sac on the point of the elbow can become tender and inflamed from repeated pressure on the elbow. This condition, called olecranon bursitis, causes pain and swelling in the area at the tip of the elbow. It may be very difficult to put the elbow down on a surface due to the tenderness and swelling.

Arrange your desk to avoid direct pressure on your elbow. While doing work tasks, pull items toward you, keeping your elbow off the desk. If this is not possible, you may want to consider wearing an elbow pad, such as the type used in sports, on the sore area. The pad will help protect the elbow from direct pressure.

The olecranon bursa can become irritated and inflamed in a number of ways. Direct impact on the elbow can cause bleeding in the bursa. This can cause the bursa to become swollen and tender. Repeated strains on the elbow, such as resting your elbows on a hard surface, can also cause the bursa to become inflamed.

The olecranon bursa can also become infected. This may occur without any warning, or it may be caused by a small injury and infection of the skin over the bursa that spreads down into the bursa. In this the sack fills with pus, and the area around the bursa becomes hot, red, and very tender.

The olecranon bursa is located between the tip, or point, of the elbow (called the olecranon) and the overlying skin. This bursa allows the elbow to bend and straighten freely underneath the skin as we use our arm.

One difference between radial tunnel syndrome and tennis elbow is the exact location of the pain. In tennis elbow, the pain starts where the tendon attaches to the lateral epicondyle. In radial tunnel syndrome, the pain is centered about two inches further down the arm, over the spot where the radial nerve goes under the supinator muscle. Radial tunnel syndrome may also cause a more achy type of pain or fatigue in the muscles of the forearm.

Radial tunnel syndrome happens when the radial nerve is squeezed where it passes through a tunnel near the elbow. The symptoms of radial tunnel syndrome are very similar to the symptoms of tennis elbow. There are very few helpful tests for radial tunnel syndrome, which can make it hard to diagnose.

Pain is caused by pressure on the radial nerve. There are several spots along the radial tunnel that can pinch the nerve. If the tunnel is too small, it can squeeze the nerve and cause pain. Repetitive, forceful pushing and pulling, bending of the wrist, gripping, and pinching can also stretch and irritate the nerve.

Sometimes a direct blow to the outside of the elbow can injure the radial nerve. Constant twisting movements of the arm, common in assembly work, can also pinch the radial nerve and lead to radial tunnel syndrome.

Most doctors prefer to try conservative (nonsurgical) treatments for patients before going ahead with surgery. The symptoms you describe are common with a condition called medial epicondylitis, better known as golfer’s elbow.

Surgery for this condition is technically easy. It involves severing the sore elbow tendon from the bone. However, before going forward  with an aggressive procedure like this, most doctors will try physical therapy and medication. If these measures don’t resolve the problem, a cortisone injection may be tried. Then, after trying all these other options, your doctor may recommend surgery.

Repairing a broken elbow is difficult even in the best of circumstances. Fixing a fracture in a person with osteoporosis is even more challenging. Bones affected by osteoporosis have less density and are softer than normal bones. Metal plates and screws used to fix the broken elbow can’t hold as well in bones that are softened by osteoporosis. Thus, doctors may recommend removing the broken pieces of bone and replacing the elbow joint with a new joint.
 

Yes, in most cases. A study of 97 patients with tennis elbow showed that these kinds of treatments often have good results. Patients in this study rested and iced their elbows. They also wore braces and did physical therapy. Some of them took anti-inflammatory drugs. Some also had steroid injections if their pain was severe.

After this treatment, only 25 percent of patients went on to have surgery. What distinguished patients who had surgery from those who did not? Patients who had already tried conservative treatment for sore elbows were twice as likely to have surgery as those who hadn’t. Also, patients who still had pain after getting more than one steroid injection were much more likely to have surgery.

Conservative treatment can be helpful, up to a point. If patients don’t get some relief early on, they may not be the best candidates for continuing to use this approach.