FAQ Category: Elbow

Carpal tunnel and cubital tunnel syndrome are very similar problems. They both involve pressure, traction, or loss of blood flow to a nerve in the forearm. In the case of carpal tunnel syndrome, the median nerve is affected as it travels through the carpal (wrist) bones. Those carpal bones are lined up to form a tunnel through which the nerve passes. Anything that alters the alignment or shape of that tunnel can put pressure on the nerve causing carpal tunnel syndrome.

The cubital tunnel is also an anatomic location only this time in the elbow. A natural groove in the bone keeps the ulnar nerve along the inside of the elbow on track as it travels from the upper arm through the elbow area and down to the hand. Symptoms of finger numbness and tingling develop but affect different fingers depending on which nerve is compresses or pinched.

Symptoms affecting the ring and little fingers point to the ulnar nerve as the problem. That leads the physician to examine the cubital tunnel for any signs of nerve impairment. For example, palpation while moving the elbow is performed. This technique may show that the nerve moves in and out of the natural groove (cubital tunnel) in the bone where it should remain all the time. This type of nerve subluxation (partial movement out of the groove) or dislocation (nerve displaced out of the groove completely) can contribute to the problem.

Although physicians rely on these tests to diagnose cubital tunnel syndrome, studies show they aren’t all that reliable or dependable. One of the biggest problems in coming to any conclusions about testing for cubital tunnel syndrome is how much variation there is in conducting the tests. Judging the results (called interrater reliability) is another important factor. The lack of interrater reliability is one reason why these tests can’t be used alone to make the diagnosis.

There are electrodiagnostic tests that can be done. Nerve conduction studies check the speed at which the nerve transmits signals. Damaged, compressed, or irritated nerves may have abnormal conduction times. But studies of the validity and reliability of nerve conduction tests show limited sensitivity for these tests.

What about imaging studies such as ultrasound, MRI or CT scans? There haven’t been a lot of studies in this area. So far, it looks like MRIs show nerve compression before it is evident using electrodiagnostic testing.

The best imaging choice may be ultrasound. Bouncing sound waves off the tissues creates a picture on a computer screen. It allows the surgeon to see any changes in the cubital tunnel. Ultrasound images reveal bone spurs or ganglions that are pressing on the nerve. Ultrasound also provides a view of the nerve to see if it is subluxed or dislocated from the cubital tunnel.

You can always get a second opinion but first you may want to ask your surgeon to reconfirm her diagnosis with an ultrasound scan. It can’t hurt and it may help offer some additional information. Unless a tumor or other unusual mass is found in the area, it’s likely that the initial treatment will be the same: conservative (nonoperative) care. Conservative care usually consists of antiinflammatory medications, an elbow splint at night to keep the elbow straight, and modifications to your daily activities to give the elow (and the ulnar nerve) a rest. If your symptoms do not improve with this approach, then further diagnostic testing may be ordered.

You may be experiencing a problem called cubital tunnel syndrome or CubTS. Cubital tunnel syndrome is a condition that affects the ulnar nerve where it crosses the inside edge of the elbow.

The symptoms are very similar to the pain that comes from hitting your funny bone. When you hit your funny bone, you are actually hitting the ulnar nerve on the inside of the elbow. There, the nerve runs through a passage called the cubital tunnel. When this area becomes irritated from injury or pressure, it can lead to cubital tunnel syndrome.

Numbness and tingling of the ring and little fingers are the most common symptoms associated with cubital tunnel syndrome. At first, the symptoms may be intermittent or transient (on and off or come and go).

Sometimes there was also pain along the medial (inside next to the body) border of the elbow. Gradually, the symptoms may become constant and weakness of the hand muscles can develop. Decreased dexterity and grip strength along with increased clumsiness when using that hand would be a definite problem in your line of work.

The best thing to do is get a medical evaluation and diagnosis. See a hand specialist who will most likely check your past medical history first. Has there anything that could contribute to these symptoms (e.g., previous elbow fracture, fall on the elbow, sleeping on that arm, repetitive elbow flexion)?

Several clinical tests to check for possible mechanical irritation, friction, or compression on the ulnar nerve. These tests are referred to as provocative maneuvers. For example, gentle tapping over and around the nerve were positive for causing the symptoms to get worse. Putting the elbow in a fully flexed (bent) position for three minutes is positive if again the position causes the ring and small fingers to go numb. The anesthesiologist/patient had a positive flexion test.

Other typical clinical testing includes pressing on the nerve (called palpation) to see if it is tender. Palpation while moving the elbow may also show that the nerve moves in and out of the natural groove (cubital tunnel) in the bone where it should remain all the time. This type of nerve subluxation (partial movement out of the groove) or dislocation (nerve displaced out of the groove completely) can contribute to the problem.

Early diagnosis and treatment may be your saving grace. It could be as simple as a short course of antiinflammatories or using an elbow extension splint at night. Don’t wait. Avoiding permanent nerve damage is important for you.

Surgeons from the Mayo Clinic recently reported on the results of surgical treatment for patients who had a bone fracture around the ulnar side of an elbow joint replacement. The ulna is the larger of two bones in the forearm.

The elbow implant inserts up into the humerus (upper arm) and down into the ulna. It’s not exactly that the bone has come loose around the implant. But there may be some bone thinning or bone loss around the implant. Without a firm circle of bone around the implant, it will loosen. Movement of the implant combined with the bone loss can result in bone fractures around the implant called periprosthetic fractures.

The fractures occur in one of three places: at the olecranon, around the stem, and below the stem. The olecranon is a large, thick, curved part of the ulnar bone that forms what you feel as the back of the elbow.

This type of periprosthetic fracture is fairly uncommon and studies are few and far between. So this study was important in giving surgeons (and patients) an idea of what to expect in terms of managing the problem and results of surgery to correct the problem.

There are several surgical options to choose from including strut allografts, allograft-prosthetic composites, and impaction grafting. These are all ways to augment (build up) the areas of weak, thin, or absent bone.

The specific method of surgical reconstruction used is based on the severity of bone loss. The surgeon will likely remove the loose component, found the fracture site, and cleaned out any debris or loose fragments in the area.

Then bone graft material (struts or impaction grafting) are used to support the fracture until it can heal. Metal plates or wires may be used to hold the graft in place. In the case of a prosthetic composite, a replacement implant is partially cemented into a bone graft. This unit is then placed inside the patient’s remaining ulna.

These are just examples of the types of surgery available for this type of problem. Your surgeon may have a different idea in mind for you. Your age, bone density, and activity level will all be taken into consideration when planning treatment. The location, type, and severity of fracture will be factored in as well.

Even though it has been two years since you had the elbow joint replacement and all has been well — a sudden symptom like this should be examined by your physician. It may be nothing more than a shift of muscle over bone but it’s important to rule out other potential problems.

You may need an X-ray to see how the implant is doing. An X-ray will show the placement of the implant and the condition of the bone. The X-ray will give some indication if there has been any bone loss around the implant with subsequent loosening of the implant.

And not to alarm you unnecessarily but there have been reports of bone fracture during normal activities in patients with elbow joint replacements. Usually there has been some severe bone loss around the implant leading up to this complication.

It’s not clear why this type of problem (bone loss around the implant and bone fracture) develops. It is currently being studied. One suggestion is that the problem comes from the type of implant used and in particular, the type of finish placed around the prostheses.

Some have a sprayed on layer of titanium plasma. Others have a beaded surface or precoat with a thin layer of polymethylmethacrylate (PMMA). It’s possible that these surface finishes (designed to help bone fill in around the implant) actually cause bone loss.

In any case, don’t put off notifying your surgeon of this symptom and requesting an immediate appointment. Let the scheduling staff who take your call know this isn’t a routine follow-up visit but something that needs to be looked at right away.

It sounds like you might have had what orthopedic surgeons refer to as a simple elbow dislocation. By simple, we mean a dislocated joint that can be set back into its proper place. There’s no fracture and surgery isn’t needed to relocate the joint. The joint is stable.

Elbow dislocations occur most often as a result of falls, assault, car accidents, and sports-related trauma. At the time of the injury after reduction, X-rays are taken to make sure everything is in order. Reduction for a simple elbow dislocation is usually followed by immobilization in a splint (for no more than three weeks) and then early range-of-motion and movement.

Patients are advised to avoid certain movements (e.g., supination or a palm up position with the elbow fully extended) during the healing phase. Heavy lifting is not allowed for six weeks. Physical therapy is prescribed if stiffness is a problem.

The real concern about motion too early is a recurrence of the dislocation. But typically, repeated elbow dislocations and subsequent instability are not linked resuming elbow motion early on after the first episode.

Those guidelines will change if the surgeon has done any kind of ligament reconstruction or applied external fixation to hold the elbow in place for any length of time. It’s best to follow your surgeon’s advice and check in with him or her for further clarification.

This is a very good question that has not been heavily researched. But according to one study from England, you can run into a few problems along the way. At least half of the patients they surveyed reported loss of elbow motion, some elbow stiffness, and reduced grip strength. These symptoms did affect elbow/arm function.

The good news is that despite these long-term symptoms, the majority of patients involved still rated themselves as satisfied with the results. That may be because even with loss of motion and strength, the elbow wasn’t unstable.

Women seemed to have slightly different results when compared with men. The women tended to be older than the men and more likely to have a fall contributing to the injury (men had high-impact traumatic injuries). But even controlling for these factors, women still reported poorer function after treatment. Surprisingly, the women’s satisfaction wasn’t lowered by the physical limitations.

Not all patients have problems after elbow dislocation. Some come through just fine with no sense that there ever was a problem. We hope that describes your situation in the years to come!

For a long time, steroid injections were the gold standard for lateral epicondylitis (tennis elbow). But studies have shown that this approach may not be as helpful as we once thought.

For one thing, the steroid is always injected in combination with a numbing agent. Patients experience pain relief for the first time and then overuse the arm. The effect of steroids on collagen tissue has also been studied. It looks like steroid injections can actually make permanent changes in the tendon — changes that do not promote healing.

That’s where platelet-rich plasma comes in. Using the patient’s own blood, the plasma with its supply of platelets is injected into the painful tendon. The growth factors in the platelet-rich plasma go right to work creating a healing response within the tendon. The result is a significant relief of pain and improved function.

There is a high rate of recurrence of the painful symptoms associated with tennis elbow after steroid injection. Platelet-rich plasma injection has no similar recurrence rate. Studies from the Netherlands show that the application of platelet-rich plasma is easy, safe, and effective. The only downside is the cost. It is definitely less expensive than surgery but more costly than other conservative approaches.

Tennis elbow causes pain that starts on the outside bump of the elbow, the lateral epicondyle. When you bend your wrist back or grip with your hand, the wrist extensor muscles contract. The contracting muscles pull on the extensor tendon. The forces that pull on these tendons can build when you grip things, hit a tennis ball in a backhand swing in tennis, or do other similar actions.

Tennis elbow (also known by its medical term: lateral epicondylitis) 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 require a strong grip and repeatedly stress the same forearm muscles can cause symptoms of tennis elbow.

Treatment is broken down into two phases: acute and chronic. If this is your first bout with tennis elbow, then you may be in the acute phase. Rest, activity modification, and possibly bracing to protect the healing tendons are usually advised.

Pain relievers may be recommended but the use of anti-inflammatories has come under question. Letting the body mount an inflammatory healing phase without interfering is advised by some experts. Physical therapy combined with bracing has been shown to benefit the majority of patients treated this way.

For those individuals who have had tennis elbow before without improvement using these treatment principles, steroid injections was once the next step. But studies have repeatedly shown that this type of injection therapy only provides temporary pain relief. Symptoms return and patients experience a recurrence of the problem.

That’s where the plasma injections come in. Platelet-rich plasma (PRP) injections may be recommended for someone who has chronic tennis elbow that has not responded to conservative care but who does not want to have surgery.

The platelet-rich plasma (PRP) releases growth factors into the soft tissues. The result is a faster, more effective healing response. Studies have shown this treatment is safe, easy, and effective. Reduced pain and improved function last for months up to two years or more.

To find out what’s best for you, see a medical doctor. A sports medicine physician or orthopedic surgeon will be able to evaluate you and make a recommendation as to the best treatment for your particular problem.

Elbow joint replacement isn’t nearly as common as a hip or knee replacement. But when there’s a severe fracture or painful arthritis limiting function, it can be a life-saver.

As with any joint replacement procedure, there can be complications. In fact, the risk of problems following elbow replacement is far greater than with a hip or knee replacement. The risk of complications and the surgical expertise required for elbow replacements may help explain why not all surgeons perform this procedure.

The six most recognized post-operative problems associated with elbow replacement include loosening of the implant, fracture of the bone around the implant, implant failure, infection causing loosening of the implant, weakness of the triceps muscle, and nerve palsy. Here’s a quick look at each one starting with the most common cause of implant failure: loosening.

Loosening of the implant can occur even when there hasn’t been an infection or fracture of the bone around the implant. It’s a complicated problem. Normal elbow function requires slight side-to-side motion with a little rotation even as the joint is bending and straightening.

Reproducing all of that with a metal implant is a challenge. The implant has to be placed in the right position with the correct angle and just the right amount of soft tissue tension. The alignment of the implant stem (placed down into the bone to anchor the implant) is another key feature that can affect elbow function.

The capsule and ligaments around the elbow along with the muscles and their tendon attachments contribute to elbow stability and function. Keeping all of this balanced after removing the diseased elbow and putting an implant in place requires considerable surgical technical expertise.

There are different types of implants that seem to work better with the soft tissues than others. Research efforts are being directed toward improving the implant design in order to reduce the number of complications from loosening.

Then there’s periprosthetic fractures another possible complication in up to 29 per cent of cases. Periprosthetic fracture refers to cracks in the bone around the implant or fracture lines down the shaft of the bone.

These can develop as a result of trauma, poor implant alignment, or as a direct consequence of the patient’s activities. Patients are given guidelines for what they can and can’t do until full healing takes place but they don’t always follow those guidelines. Doing too much too soon can be very detrimental.

Implant failure refers to some aspect of the implant wearing out causing squeaking, pain, and poor elbow movement. Increased stress on the implant from poor alignment can cause what’s called fatigue fracture. The implant itself breaks. Elbow deformity may be occur as a result of any of these problems.

Infection after total elbow arthroplasty develops in a fair number of patients. Studies report a three to eight per cent rate of infection. Detected and treated early with antibiotics, this complication is more manageable than some of the other problems that require additional surgery. In extreme cases, surgery to remove and replace the implant may be needed.

The patient who can’t reach overhead or push a door open may have weakness of the triceps muscle referred to as triceps insufficiency. The triceps muscle located along the back of the upper arm helps extend (straighten) the elbow.

In order to get to the joint, the triceps muscle may be cut and moved out of the way. Of course, it is reattached but cutting it at all can lead to problems. Newer surgical techniques have been developed to spare this muscle and prevent postoperative weakness (and the need for another surgery to fix the problem).

One last problem to consider: nerve palsy. There are two important nerves to the hand that are located on either side of the elbow: the radial and ulnar nerves. The ulnar nerve is at greatest risk when putting an implant in while the radial nerve is at risk when taking the implant out.

The nerves aren’t deliberately cut during the procedure, so that’s not the issue. Pulling on the nerve and exposure to heat from the cement used to hold the implant in place are two factors in nerve irritation or damage. Fortunately, the problem is transient or temporary. It takes a couple of weeks, but the symptoms usually go away.

Problems may persist even after corrective surgery. The final outcome can be very disappointing for both the surgeon and the patient. Considerable training and experience are required before a surgeon adds this particular procedure to his or her schedule.

Newer implants with improved designs have reduced implant-related complications. Future advancements in implant design and/or surgical technique may bring more surgeons to the table for this procedure.

As with any joint replacement procedure, there can be problems or complications. Loosening of the implant is probably the most common post-operative problem. Deep infection (inside the joint) is a major concern and can lead to implant loosening.

Loosening of the implant can occur even when there hasn’t been an infection. If it occurs in the absence of an infection, it is referred to as an asceptic loosening. Fracture of the bone around the implant can also cause the implant to give.

It’s a complicated problem. Normal elbow function requires slight side-to-side motion with a little rotation even as the joint is bending and straightening. Reproducing all of that with a metal implant is a challenge.

The implant has to be placed in the right position with the correct angle and just the right amount of soft tissue tension. The alignment of the implant stem (placed down into the bone to anchor the implant) is another key feature that can affect elbow function.

The capsule and ligaments around the elbow along with the muscles and their tendon attachments contribute to elbow stability and function. Keeping all of this balanced after removing the diseased elbow and putting an implant in place requires considerable surgical technical expertise.

Once loosening has been diagnosed, the treatment can vary. If you aren’t having any painful symptoms, altered motion, or loss of function, then a wait-and-see period of observation may be advised. Rehab to strengthen the muscles on either side of the elbow may be a good idea.

Once your surgeon is able to take a closer look, then an appropriate plan of follow-up care can be determined. If you are having pain and other symptoms, then it may be necessary to perform a second surgery.

The procedure doesn’t have to be extreme — the surgeon may just remove (and replace) the part that is loose. If the joint is unstable, then it may have to be completely taken out and a new implant put back in.

The surgeon will evaluate you carefully in order to determine the best way to conduct the arthroscopic surgery. The surgeon can enter the joint from the front (anterior approach) or from the back of the elbow (posterior). Swelling in the joint and/or scar tissue from previous surgeries can dictate which way the surgeon will begin.

When entering from the front, special care must be taken to avoid injury to any of the nerves in that area. Before beginning the operation, the surgeon may mark the skin of the patient. A black marker is used to identify all of the important soft tissues. During the procedure, fluid may be injected into the joint. This step helps increase the distance between nerves and other soft tissues.

Entering the joint from the back (posterior approach) gives the surgeon an entirely different view compared with an anterior approach. A different part of the capsule can be released from this direction.

The capsule around the joint has to be released to allow the surgeon access into the joint. Special surgical tools called retractors are used to pull the capsule away from the bone and allow the surgeon a better view inside the joint.

Whichever approach is used (and sometimes both anterior and posterior approaches are required), once inside, the surgeon gets busy. Any areas of debris, loose fragments of tissue, or scar tissue are cleaned up. Bone spurs are shaved off. This part of the procedure is called debridement.

Scar tissue from around the nerve is carefully scraped or cut away. This portion of the operation is the decompression. The surgeon will move the arm through its full motion while the patient is under anesthesia (manipulation). Anything that keeps the elbow from moving normally and fully is addressed.

You will probably leave the operating area with a soft dressing and a splint on the arm. Early movement is advised and hand therapy to reduce pain and swelling while maintaining and possibly improving motion begins immediately. It’s likely you will continue in physical therapy for four to six weeks with a very active home program of exercise as well.

What kind of results can you expect? Experts agree that treating the stiff elbow (for whatever reason it develops) can be difficult with a high risk of complications. For example, infection and damage to the nerves and blood vessels are not uncommon problems. It seems the patients who have the best results start out with mild-to-moderate elbow stiffness and without heterotopic ossification (bone fragments that grow inside the muscle).

For carefully selected patients, arthroscopic treatment of the stiff elbow can be very effective. You may not get a perfectly normal elbow after surgery. But you can expect an elbow that moves enough to restore basic function.

You will be facing some hard work everyday to get smooth motion back and to keep it. Let your therapist know your daily activities and needs (e.g., lifting and carrying hay bales) so that you have a treatment plan that will help you reach those goals.

Stiffness of the elbow following trauma or injury can be a very difficult problem to solve. Starting with conservative care as you have done is the first step. But, if after three to six months of concentrated, daily work on it, you haven’t progressed, then it may be time to check in with a surgeon.

Many times, these complex injuries also have nerve damage, muscle tears, and/or ligament ruptures. Sometimes a condition called heterotopic ossification (HO) develops and further complicates matters. HO is the formation of bone in soft tissues where it doesn’t belong (e.g., inside the muscle).

A surgeon will take a detailed history and evaluate you clinically. Your motion, strength, and condition of the blood and nerve supply will be checked. Imaging studies with X-rays, CT scans, MRIs and sometimes ultrasound help the surgeon identify just what’s going on insider there to cause the problem.

Arthroscopic exam is the final, most accurate diagnostic test. During the procedure, the surgeon may be able to clean out the joint (remove debris, bone fragments, bone spurs, scar tissue) — a procedure called debridement. Motion is restored through a process called manipulation as the surgeon gently and carefully moves the joint through its full motion.

Surgery isn’t the end as you will likely be sent back to the therapist for follow-up treatment. Daily, consistent effort on your part is required to recover motion, strength, and function.

You raise a good question and one that has been debated by other interested parties as well. Throwing the ball while on flat ground is often used to warm-up for mound pitching. But there’s some concern that flat-toss throwing requires different shoulder and elbow biomechanics that may actually harm the pitcher.

A recent study at the American Sports Medicine Institute in Birmingham, Alabama might offer some helpful information to answer your question. Seventeen (17) healthy college athletes participated. No one in the study had any previous shoulder or elbow pitching injuries or problems. Information on pitching was collected using a three-dimensional (3-D) motion analysis system.

Measurements of shoulder rotation, trunk position, and elbow motion and velocity were compared for two different pitches: from the pitcher’s mound and on the flat surface. Comparison of joint forces and torques for pitches from these two locations were made. Measurements were taken with the arm in a cocked position (ready to throw) and at the point of ball release.

Understanding the forces on a pitcher’s shoulder and elbow with different types of baseball throws may be an important key in not only preventing injuries but also improving performance. This study was meant to see if there is a difference in force, load, and stress from one style of pitching to the other.

The results of this study support the continued use of flat-ground (long toss) throwing as a safe and effective rehabilitation exercise. But caution is advised when throwing as far as possible during the early phases of rehab and recovery after injury.

Throwing for distance requires the pitcher to lean forward much farther. This position increases the amount of force placed on the arm and may not be tolerated by injured tissue that is still on the mend. Further study is needed to determine how soon and how often greater distance throws can be used in training exercises for pitchers recovering from an arm injury.

Throwing programs are needed to help players gain greater arm strength, flexibility, and pitch speed. The goal is to help athletes prevent injuries, boost performance, and when injured, recovery quickly and completely.

The use of proper throwing mechanics is essential in training programs for baseball pitchers. This is especially true for the recovering player who is in rehabilitation for a shoulder or elbow injury. The results of a recent study from the American Sports Medicine Institute in Birmingham, Alabama support the use of flat-ground (long toss) throwing as a safe and effective rehabilitation exercise.

Here’s what they found: 1) pitchers leaned farther forward when trying to pitch to a maximum distance, 2) maximum-distance throws also required greater elbow flexion and shoulder external rotation, 3) elbow extension velocity (speed of elbow moving from flexion to extension) was greater for maximum-distance throwing, and 4) long distance throwing changed foot mechanics.

Using the flat ground long toss as a warm-up exercise is okay. But caution is advised when throwing as far as possible during the early phases of rehab and recovery after injury. Throwing for distance requires the pitcher to lean forward much farther. This position increases the amount of force placed on the arm and may not be tolerated by injured tissue that is still on the mend.

It may help if we explain a bit about elbow bursitis (also known as olecranon bursitis). A bursa is a sac made of thin, slippery tissue. Bursae (plural) occur in the body wherever skin, muscles, or tendons need to slide over bone. Bursae are lubricated with a small amount of fluid inside that helps reduce friction from the sliding parts.

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. Treatment may depend on what is causing the bursitis.

In some cases, a direct blow or a fall onto the elbow can damage the bursa. This usually causes bleeding into the bursa sac, because the blood vessels in the tissues that make up the bursa are damaged and torn. In the skin this would simply form a bruise, but in a bursa blood may actually fill the bursa sac. This causes the bursa to swell up like a rubber balloon filled with water.

The blood in the bursa is thought to cause an inflammatory reaction. The walls of the bursa may thicken and remain thickened and tender even after the blood has been absorbed by the body. This thickening and swelling of the bursa is referred to as (acute) olecranon bursitis.

Chronic olecranon bursitis can also occur over a longer period of time. If you have had this problem for months to years, then it’s likely you have chronic elbow bursitis. People who constantly put their elbows on a hard surface as part of their activities or job can repeatedly injure the bursa.

This repeated injury can lead to irritation and thickening of the bursa over time. The chronic irritation leads to the same condition in the end: olecranon bursitis but there may no longer be an active inflammatory process going on.

Surgeons don’t rush in to treat chronic bursitis with aggressive treatment such as steroid injections or surgery. The risk of infection, skin problems, or creating a chronic draining opening outweighs the benefit of the treatment.

Aspirating (withdrawing fluid from) the joint can cause similar problems. Aspiration reduces the swelling and improves motion and function but the fluid may build up again, so it’s often a temporary solution.

Most patients are given advice about how to manage the problem with conservative (nonoperative) measures. It’s not likely you will hear anything different from another source. But seeking a second opinion often helps patients feel confident that everything possible is being done for their problem.

Swelling or a boggy lump around the point of the elbow is often caused by a condition known as chronic olecranon bursitis. The swelling might increase and decrease but it never goes away fully. Some people have elbow pain or tenderness (especially if there is an infection) but many do not. Elbow range-of-motion may be limited but full motion is often present.

Treatment for idiopathic (unknown cause) bursitis may be slightly different than the type caused by another condition. Treating the arthritis, gout, or lupus resulting in elbow bursitis may help resolve the problem. But with idiopathic bursitis, there’s no known cause to address. Instead, conservative (nonoperative) care is the first step in treatment.

The surgeon may advise patients with this problem how to treat just the symptoms. If it is painful or tender, use cold. If it is actively swelling, apply a compressive wrap. If work or daily activities require pressure on the elbow, then a protective pad can be applied over the tip of the elbow.

Steroid injections are not a proven method of treatment. But acupuncture has become increasingly popular for problems like this as evidence for its effectiveness for a variety of problems is published.

If nonoperative care doesn’t work and the symptoms are interfering with daily function, then the surgeon might consider aspirating (withdrawing fluid from) the joint. Aspiration reduces the swelling and improves motion and function. But the fluid may build up again, so it’s often a temporary solution.

Surgery is an option when conservative care has been applied diligently and the symptoms (especially swelling) are still present three (or more) months later. Any more specific recommendations for treatment beyond this are not possible. The lack of evidence supporting (or disproving) treatments and combinations of treatments just isn’t available.

It’s always good to be on the look out for potential problems. Once recognized, early intervention and treatment can minimize the effects of something that might otherwise be a serious problem. In the case of joint replacements (or any major orthopedic surgery for that matter), the first 90-days are crucial for problems like blood clots and skin, joint, or wound infection.

Any of these problems can require hospital readmission. By nature of the thin soft tissues around the elbow, the rate of infection tends to be a problem no matter how careful the surgeon is. Most of these problems occur early and mean the patient has to go back to the hospital for further care.

Fortunately, deaths (usually from blood clots) in the first three months following an elbow joint replacement procedure are reported at a low rate of 0.62 per cent. But blood clots can develop later, so careful observation of any new or disturbing signs and symptoms is important.

There are other complications that can be disabling such as nerve injuries, implant loosening, and fractures. Amputation and conversion to joint fusion are among the more serious problems later on. On the positive side, 92 per cent of elbow implants do just fine and are still working quite well years after being put in.

Elbow joint replacement is still a fairly uncommon procedure. Surgeons are keeping an eye on their own rate of complications as well as reading the literature for any information that can help them improve results. There’s plenty of room for further studies to fill in and round out what we know about short- and long-term results of total elbow arthroplasty (TEA). The conclusion of studies so far is that complications are higher than expected or desired.

Patient results may be improved and costs decreased with further studies to find out why rates of failure, revision, and reoperation are so high. A closer look at patient characteristics may also be helpful in reducing mortality and rates of other serious short- and long-term complications.

Any surgical procedure (elbow joint replacement included) can have small and/or large complications. The goal of any joint replacement surgery is to reduce pain, increase joint motion, and improve function. According to many studies, short- and long-term results for joint replacement (including rates of implant failure and post-operative complications) are best when the procedure is done in a high-volume hospital or clinic. High-volume means many of the same surgeries are performed there. Likewise, high-volume surgeons (those who do the same procedure hundreds of times) have the best results.

Elbow joint replacement (called Total Elbow Arthroplasty or TEA) is possible but not a common procedure. Getting data on results of the TEA procedure to share with patients like yourself looking for information can be difficult.

In a recent study from California, surgeons used information from the California Discharge Database to get a picture of short- and long-term outcomes for patients of all ages, race/ethnicity, and diagnosis (e.g., rheumatoid arthritis, osteoarthritis, traumatic arthritis). They found an overall complication rate of around 10.5 per cent. That means about one in 10 patients developed some kind of problem.

Type of measures used to gauge success versus failure of the total elbow arthroplasty (TEA) included rates of infection, delayed wound healing, and need for revision surgeries or reoperations. Deaths (usually from blood clots) in the first three months were reported at a rate of 0.62 per cent. Other serious complications such as amputation and conversion to joint fusion were also included.

Infections, wound complications, and blood clots headed the list of serious complications requiring hospital readmission. By nature of the thin soft tissues around the elbow, the rate of infection tends to be a problem no matter how careful the surgeon is. Most of these problems occurred early and meant the patient had to go back to the hospital for further care. On the positive side, 92 per cent of the implants did just fine and were still working well four years after being put in.

You can ask your surgeon for a list of possible problems and the likelihood of those problems happening. Not everyone considers the different adverse outcomes as equal in severity. Whether death versus amputation are rated as “worse” than elbow fusion or continued pain is a matter of personal opinion. Knowing what to expect from good to bad is always a good idea in preparing for any surgery. We hope this information is helpful in your discovery and preparations.

The Tommy John procedure is designed to reconstruct (not just repair) the ulnar collateral ligament (UCL). The ulnar collateral ligament is located at the elbow. It supports the humerus-to-radius connection and helps stabilize the elbow. The humerus is the upper arm bone. The radius is one of the bones in the forearm. Without this ligament, the force generated by the throwing motion on the medial side of the elbow (side closest to the body) is enough to potentially dislocate the joint.

In the Tommy John operation, the ulnar nerve is moved away from the bone. A piece of fascia (connective tissue) is used like a sling to hold the nerve in its new place. During the same procedure, the damaged ulnar collateral ligament (UCL) is replaced with a piece of graft tendon tissue.

The Tommy John procedure is used when the loss of an intact ulnar collateral ligament results in an unstable elbow joint. Overhead throwing athletes must have a stable, intact elbow in order to have the speed and accuracy needed for the wind up, cocking, acceleration, deceleration, and follow-through phases of overhead pitching.

In a recent study from the American Sports Medicine Institute in Birmingham, Alabama, an 83 per cent success rate was reported for the 942 patients who had this procedure. Most of the patients in this study were baseball pitchers. Success was defined as return-to-sport at the preinjury level of participation.

Besides baseball pitchers, a smaller number of other athletes were included. There were baseball catchers, outfielders, and infielders. Athletes involved in other sports included football players, javelin throwers, tennis players, wrestlers, soccer players, gymnasts, cheerleaders, and pole vaulters.

Not only was there an 83 per cent success rate (athletes returning to pre-injury level of play), almost half of the patients (41 per cent) advanced to a higher level of play. Some of the athletes were able to move from a minor league to major league; others moved up from amateur to professional baseball.

Only a small number of patients (11 per cent) did not return to sports participation at all.

The time from surgery to throwing was about four and a half months. Some patients advanced to throwing skills as early as the third month. Others took up to a full year to achieve this milestone. Full participation at a competitive level was longer in coming (ranging from three to 72 months).

The ulnar collateral ligament (UCL) is located at the elbow. It supports the humerus-to-radius connection and helps stabilize the elbow. The humerus is the upper arm bone. The radius is one of the bones in the forearm. Without this ligament, the force generated by a throwing motion or weight supported on the medial side of the elbow (side closest to the body) is enough to potentially dislocate the joint.

Overhead throwing athletes (especially baseball pitchers) are at greatest risk of UCL injuries. Besides baseball pitchers, a smaller number of athletes were included. There were baseball catchers, outfielders, and infielders. Athletes involved in other sports included football players, javelin throwers, tennis players, wrestlers, soccer players, gymnasts, cheerleaders, and pole vaulters.

The orthopedic surgeon will complete a patient history and examination to confirm the diagnosis. Imaging studies starting with X-Rays may be taken. A special MRI called magnetic resonance arthrogram (MRA). This type of MRI uses a contrast dye injected into the area to show the presence of bone spurs or other damage. The surgeon could address any of these additional problems if it turns out surgery is needed. Arthroscopic exam may also be done before surgery to confirm elbow instability.

The first line of treatment for injuries of this type is really conservative (nonoperative) care under the supervision of both the orthpedic surgeon and a physical therapist. Treatment begins with rest from throwing or weight-bearing activities. Medications to relieve pain and swelling may be prescribed for a short time.

Once the painful symptoms are gone, exercises to restore strength and stability are done for a minimum of three months. No stress across the elbow joint is allowed until the patient’s elbow is stable again. Then sports-specific exercises can begin. Return-to-sport (in this case, wrestling) is allowed when the patient passes a biomechanical (throwing or weight-bearing) evaluation.

If the elbow remains unstable then surgery may be needed. The ligament may be repaired or if there’s too much damage, then reconstructive surgery may be necessary. But that’s a long way down the road from where you are at the beginning of an acute injury. Your orthopedic surgeon will walk you through the evaluation and treatment process. Each treatment is individual to the athlete’s age, severity of injury, and goals.