FAQ Category: Elbow

Tennis elbow and golfer’s elbow are similar but not exactly the same. Tennis elbow tends to affect the common extensor tendon along the outside of the elbow. The result is pain and tenderness in that same area along the lateral elbow.

Golfer’s elbow affects the medial or inner aspect of the elbow instead. The muscles of the forearm responsible for bending the fingers and thumb, making the fist and turning the hand palm up are involved. Tendons of the flexor muscles come together to form the common flexor tendon. The tendon inserts into the medial epicondyle of the humerus (upper arm bone) at the elbow joint.

Just like tennis elbow, golfer’s elbow develops as a result of repetitive motions such as the golf swing. It can also occur in response to minor injury, or for no apparent reason at all. At first, there is an inflammatory response. But with chronic golfer’s (or tennis) elbow, there are no inflammatory cells present. When pain and tenderness persist without an underlying inflammatory presence, the condition is referred to as tendinosis.

Steroid injections bathe the disrupted tissue with a numbing agent and an antiinflammatory. The evidence doesn’t support the use of steroid injections for this problem. Injections do provide short-term pain relief. But the effect doesn’t last. When compared with other treatments (including placebo), medium- and long-term results are no different.

And there are some negative effects of steroids to consider. For example, steroid injections may actually delay tissue healing, thus prolonging the course of recovery. Besides the potential for delayed healing with steroids, post-injection pain is reported as worse than preinjection pain for half the patients studied. Until research can show that steroid injections works better than other forms of treatment (or no treatment at all), the cost of intervention may not be justified.

Laser stands for Light Amplification by Stimulated Emission of Radiation. It’s a form of low intensity light treatment that actually uses electromagnetic waves as a source of energy. The theory is that a narrow focused beam of light aimed at disrupted tissue such as occurs with tennis elbow can stimulate blood flow to the area and a healing response.

But studies have only produced contradictory results. It may be safe, but it appears to be ineffective in the treatment of this condition. Much work remains to be done before scientists are satisfied that laser can be used safely and effectively for lateral epicondylitis.

Trials using different doses and wavelengths are needed to compare one to another until the optimal use of laser is determined. It’s possible that only a certain subgroup of patients with tennis elbow respond well to laser. Finding that subgroup is important in directing patients to the right treatment approach for them.

It’s also possible that when combined with another modality or treatment method, laser would yield even better results. But we don’t know that yet.

You should check with your surgeon to find out what, if any, restrictions he or she would like you to follow. Sometimes the follow-up home or rehab program depends on the type of surgery, type of sutures used, placement of sutures, and so on.

Some procedures allow for a more aggressive rehab program. Immobilization is only required for a day or two, whereas in other cases, the elbow remains in a sling much longer. Most rehab protocols require a week or more of immobilization before allowing a gradual increase in active motion. The thinking behind the conservative approach is that the body needs time to allow tendon ingrowth into the bone. Too much stress too soon could disrupt the surgical site.

But surgeons have noticed that patients who don’t follow their instructions and who return to aggressive activities earlier than they should, seem to do just fine. In fact, no matter how the injury is treated in the postoperative rehab program, everyone seems to have the same results. And tendon rerupture is rare. That’s good news for patients like you who have a need to get back into action sooner than later.

Having said that, please be aware that there is a difference between encouraging elbow motion and allowing activities that require strength, such as lifting heavy objects. Even with an aggressive rehab program, lifting is restricted to one-pound for the first six weeks. Then the patient is allowed to increase to two pounds until a gradual increase to full weight at the end of three months.

With a job that requires heavy lifting, following the restrictions placed on you will be extremely important. Playing the violin may have its own challenges. Some patients report difficulty fully supinating (rotating) the forearm (palm up).

Motion and strength of the forearm are both affected and this can interfere with holding the violin. If you work with a physical therapist, he or she can help you regain the motions, strength, and function needed for both your job and your music.

Loss of forearm rotation into the palm up position called supination is common after repair of a distal bicep rupture. But it’s not normal in the sense that you don’t have full motion or strength when you need it.

Surgeons aren’t sure why this happens. When they look at all the various procedures and analyze each variable, they come up with no reason for this loss of strength. It doesn’t happen to everyone, so there may be an anatomical or biomechanical explanation. It seems to occur whether the surgeon uses a one-incision versus a two-incision approach. So it’s not likely caused by that factor.

There was some question about whether or not it occurs because the tendon doesn’t always get reattached at the same place where it pulls away from the bone. That spot is called the footprint. But arthroscopic surgery from the posterior approach (coming in from behind the elbow) allows for complete restoration of the footprint, so that’s not it.

Anything that disrupts the surgical site (e.g., using the arm too much too soon) should affect motion created by the tendon in all directions If forearm supination is affected, then other motions controlled by the biceps tendon (such as elbow flexion) should also be compromised. But that doesn’t seem to be the case.

More study is needed to get to the bottom of this mystery. For now, when this happens, patients are encouraged to see a physical therapist who can help you get your full motion, strength, and function back. It shouldn’t take too long. In addition to some hands on approaches to restore motion, the therapist can give you a home program to round out the rest.

Athletes involved in overhead throwing sports are at risk for this problem at the elbow called osteochondritis dissecans (OCD). Baseball pitchers and racket-sport players are affected most often. Sometimes gymnasts who put weight through the arms develop this condition, too. It can be very disabling. Treatment that enables them to return to full participation in their sport is a challenge.

The forceful and repeated actions of these sports can strain the surface of the elbow. With repetitive shearing and compressive force on the elbow, the bone under the joint surface weakens and becomes injured. This, in turn, damages the blood vessels going to the bone. Without blood flow, a section of bone dies. The injured bone cracks. It may actually break off. The result is osteochondritis dissecans (OCD).

The diagnosis is usually made on the basis of the patient’s history and symptoms. The doctor begins by asking questions about the patient’s age and sports participation. In the physical exam, the sore elbow and healthy elbow will be compared. The doctor checks for tenderness by pressing on and around the elbow. The amount of movement in each elbow is measured. The doctor checks for pain and crepitus when the forearm is rotated and when the elbow is bent and straightened.

X-rays are needed to confirm the diagnosis. A front and a side view of the elbow are generally the most helpful. Early in the course of the problem, the X-rays may appear normal.

As the condition worsens, the X-ray image may show changes in the affected bone. The normal shape of the bone may appear irregular. In bad cases of elbow OCD, the capitellum (affected bone of the elbow) might even look like it has flattened out, suggesting that the bone has collapsed. The X-ray could show a crack in the capitellum or even a loose body.

A magnetic resonance imaging (MRI) scan may show more detail. The MRI can give an idea of the size of the affected area. It can show bone irregularities and also help detect swelling. Doctors may repeat the MRI test at various times to see if the area is healing.

The doctor might order a computed tomography (CT) scan. The CT scan helps confirm the diagnosis. A CT scan clearly shows bone tissue. The doctor can compare CT scans over a period of time to monitor changes in the bones of the elbow.

OCD stands for osteochondritis dissecans. It is a lesion of the bone under the joint that also affects the joint surface. Forceful and repeated actions of the elbow in a young teenager can strain the immature surface of the outer part of the elbow joint.

The bone under the joint surface weakens and becomes injured, which damages the blood vessels going to the bone. Without blood flow, the small section of bone dies. The injured bone cracks. It may actually break off. The result is this condition known as osteochondritis dissecans (OCD).

In the past, this condition was called Little Leaguer’s elbow. It got its name because it was so common in baseball pitchers between the ages of 12 and 20. Now it is known that other sports, primarily gymnastics and racket sports, put similar forces on the elbow. These sports can also lead to elbow OCD in adolescent athletes.

The prognosis is somewhat guarded. Early diagnosis and treatment can help. But even with proper care, some patients end up with permanent disability of the elbow and joint osteoarthritis. A stiff and painful elbow can make activities of daily living difficult.

Current methods of treatment aren’t always able to restore the joint’s ability to handle the shearing and compressive forces and load placed on the joint(s) of active athletes. Conservative (nonoperative) care may involve an extended time of rest and recovery without participation in sports or activities. Getting back to the athlete’s previous level of play can also be a problem.

Some doctors have their patients work with a physical therapist. Treatments such as heat, ice, and ultrasound may be used to ease pain and swelling. Therapists also work with young athletes to help them improve their form and reduce strain on the elbow during sports.

When the elbow starts to feel better, exercises are begun to get the elbow moving. At first, the movements are done passively, meaning that the therapist moves the arm. This is followed with active motion exercise, which means the patient’s muscles help do the work of moving the arm. As elbow motion and strength improve, patients progress in more advanced strengthening exercises.

If pain relief is not obtained with sufficient conservative care, then surgery may be needed. Most patients will need to modify their activities after surgery. In general, most athletes with elbow OCD need to stop playing high-level sports due to lingering elbow pain and reduced elbow motion.

If symptoms come back again, patients must modify their activities until symptoms subside. They’ll need to avoid heavy sports activity until symptoms go away and they are able to safely begin exercising the elbow again.

This is a difficult question to answer because there are too many unknowns. The type of treatment chosen to treat a stiff elbow depends on what has caused the stiffness, how long the stiffness has been present, how stiff the elbow is, and if the person needs full range of motion of the elbow or is ok with a little be less than full range.

In some cases, splints are used with good results, but again, it depends on why the elbow is stiff to begin with.

A stiff elbow can be caused by several things and developing one after an elbow injury isn’t unusual. The injury could have set off a chain of events that resulted in inflammation or perhaps there now are bits of bone or tissue in the joint that can cause pain.

Not all elbow stiffness requires surgery, especially if there is a fairly good range of motion, even if it’s not complete. However, surgery may be done to prevent the elbow from getting stiffer or causing more problems.

The best thing is for you nephew to speak with this doctor to find out why the surgery is needed, what could happen if he doesn’t have the surgery, and what exactly the surgeon plans on doing.

This would be a good question to pose to your orthopedic surgeon. He or she knows the tensile strength of the surgical repair technique used on you. You’ll want to ask for a timeline, too. A timeline gives you some idea of where you should be in rehab three, six, nine, and 12-months after surgery.

A supervised rehab program is always a good idea. It’s very easy to disrupt the healing tendon (or tendon graft if one was used for the repair). Motion is usually restricted with a splint at first and later with a hinged elbow brace. The therapist advances the brace by 10 degrees each week.

Only active-assisted motion is allowed at first. That means the therapist guides your arm through elbow flexion (bending) and extension (straightening) and forearm supination (palm up) and pronation (palm down). You actively try to move your arm at the same time the therapist is moving it.

Resisted motion to regain strength is started around three months after the operation. This is gradually progressed. The therapist will help you learn how to increase the exercises safely and effectively. By the end of six months, you should be back to all of your regular daily activities without restrictions.

Weight-lifting obviously requires more strength than typical daily activities. The therapist will be able to test and measure your strength to give you some idea where you are on the continuum and how close to normal you are. The surgeon usually has criteria for percentage of muscle strength present before weights can be increased.

For the most successful results, follow both your therapist’s and your surgeon’s advice. Don’t push too fast, too far or you may not get the optimal outcome needed to resume your favorite activities.

Rupture of the biceps tendon can be a very disabling injury. Loss of motion and decreased strength can affect function. Pain along the inside of the elbow can hamper daily activities. It’s not a common injury, but one that is seen most often in middle-aged men. The mechanism of injury is usually a violent, eccentric contraction.

An eccentric contraction occurs when an already fully contracted muscle starts to lengthen. With a biceps tendon rupture, this means the biceps tendon was contracted putting the elbow in a position of flexion. Then as the elbow extended, the biceps lengthened. Sudden extension, especially with a weight in the hand can result in this type of biceps rupture.

This type of injury usually requires surgery right away. The surgeon finds the retracted tendon, pulls it back down, and reattaches it to the radial tuberosity. The radial tuberosity is the bony bump on the radius bone of the forearm where it meets the humerus (upper arm bone) to form the elbow. That’s the site of the original distal biceps insertion.

This procedure is considered an anatomical repair because it restores the tendon to its original site. If the surgery is delayed for a long period of time (18 months or more), then an anatomical repair may not be possible. The tendon retracts too far and then gets bound down in scar tissue.

In chronic cases of this type, the surgeon performs reconstructive surgery. A graft is used to make up the distance between the stump (end) of the retracted tendon and the elbow where it is reattached. The surgeon carefully removes scar tissue from around the tendon and nerve in the forearm, and then gently stretches the tendon as far as it will go before attaching the graft. The graft comes from the hamstring or Achilles tendon. It can be an autograft (taken from your own body) or an allograft (someone else’s tissue from a donor bank).

Results can be very satisfactory. Your first step is to have an orthopedic surgeon examine you and determine the best plan of care. There are different surgical techniques used for this type of reconstruction. Each case is decided on an individual basis. The surgeon will take into consideration your age, goals for the surgery, type of injury, and your current level of disability. He or she will be able to advise you according to the results of the evaluation.

It’s not possible to second guess the treatment choices made by a surgeon 10 years ago. There’s a lot of unknowns in the case. Most often, if someone breaks the bones near the elbow and dislocates the elbow as well, surgery is done. The surgery is meant to stabilize the elbow and ensure that there’s no further damage from the fracture.

However, there are situations where this may not be needed. Perhaps the fracture wasn’t near the elbow itself, but further up or down on the arm? Maybe the surgeon felt that the elbow was quite stable after it was put back into place? At this point, we can only guess at what the reasoning was.

Reducing the elbow, putting it back into place, can be very painful so that’s one reason for the anesthetic. The other reason is that when someone is under anesthetic, their muscles relax, allowing the doctor to manipulate the elbow back into place without fighting muscles that are resisting it.

Every time your daughter throws a pitch, she is putting a large amount of sudden and forceful stress on her elbow. Repeated stresses like this can damage her ulnar ligament, a ligament that helps move the elbow.

Studies have shown, as has real life, that athletes who throw things at such a level are at high risk of injuring this ligament. If the ligament is torn, it causes pain and elbow instability and the athlete can no longer play at that sport or in that role without surgery. Even with surgery, 20 percent of the athletes can’t return to their previous level of competition.

Studies have also shown that by limiting the amount of pitching that growing children and teens do also limits the damage they can do to their elbow. This limit of a certain number of pitches per game and a minimum amount of time between games is to protect your daughter from hurting – and perhaps ruining – her elbow.

he ligament in the elbow, the ulnar ligament is usually torn because of sudden and forceful stress on the elbow, like what baseball pitchers and tennis players do. The repeated stress weakens the ligament until it tears.

Partial tears are usually treated with rest, ice, and anti-inflammatories, but complete tears usually do well with surgery. However, if the person who has injured the tendon doesn’t want to go back to the sport or activity that caused the injury, it is possible for the doctor to first try healing the injury with nonsurgical treatment.

Compartment syndrome is a potentially serious condition. Pressure within the compartments of the forearm builds up and cuts off the blood supply to the muscles. Rest and changing the way you do things may help. But activity modification may be difficult in a profession such as bricklaying where you perform the same actions over and over.

In fact, it’s this chronic repetitive overuse of the muscles that eventually leads to compartment syndrome. The primary areas affected are the compartments separating groups of muscles (and the muscles) in the forearm. Fascia (sheaths of connective tissue) separate the compartments. It’s these bands of fibrous tissue that constrict the space. Inflammation in the confined compartment takes up any extra space. Muscles cannot contract and expand. Increasing pressure keeps the cycle of pressure – restriction – blood loss – inflammation – pressure going.

Without prompt treatment, nerve damage and muscle death can occur. If your symptoms are not reduced or eliminated with conservative care, surgery may be needed. Don’t delay treatment at any step in this process. Keep close contact with your physician in order to modify treatment as needed.

In some cases, surgery to release the constricting fascial bands (called a fasciotomy) is a faster way to recovery. The surgery, recovery, and rehab can have you back to work in three to six weeks. Conservative care can take much longer to reduce inflammation and restore the tissues to normal.

Your surgeon can help you make this decision based on your symptoms, work history, and the clinical presentation.

As you have discovered, compartment syndrome is an acute medical problem. Pressure within the compartments of the forearm builds up and cuts off the blood supply to the muscles. The increased pressure occurs as a result of inflammation after an injury, surgery, or in most cases, repetitive overuse of the muscles.

This condition is seen most often in the lower leg, but can affect the arm as well. Most patients with compartment syndrome have been engaged in activities requiring significant demand on the muscles of the forearm. Forearm chronic exertional compartment syndrome has been reported in manual laborers, rock climbers, tennis players, kayakers, and weight lifters.

There are six known compartments in the forearm. Three on the extensor (back) side and three on the volar (flexor or under) side. In the forearm, the volar compartment is affected more often than the extensor compartment.

Fascia (sheaths of connective tissue) separate the compartments. It’s these bands of fibrous tissue that constrict the space. Inflammation in the confined space (fascial compartment) takes up any extra space. Muscles cannot contract and expand. Increasing pressure keeps the cycle of pressure – restriction – blood loss – inflammation – pressure going.

Without prompt treatment, nerve damage and muscle death can occur. Although rest and activity modification may be prescribed for mild cases early on, chronic exertional compartment syndrome usually requires surgery.

Sometimes during the operation, the surgeon can see evidence of a previous injury that may have led to the compartment syndrome. Long-term muscle exertion and chronic overuse combined with the results of a prior injury can eventually create the environment described that leads to compartment syndrome. Although it seems like it came on suddenly, usually, there has been a long period of development.

Bone scintigraphy is a diagnostic study used to look at the distribution of active bone. It helps show blood flow to and through the bone and shows places throughout the skeletal system where the bone is actively metabolizing.

The advantage of bone scintigraphy is that changes in bone metabolism show up on the bone scan long before structural changes would appear on an X-ray. Conditions such as fractures, infections, tumors, and arthritis can be recognized with a bone scan long before they can be seen with plain radiographs.

In the case of epicondylitis, bone scintigraphy can show whether or not there is a reparative process started. The test results don’t explain what is causing the problem. They just show the specific areas of bone where local bone responses are occurring.

Although not routinely ordered, bone scintigraphy has a place in the diagnosis of chronic epicondylitis. It does not replace standard X-rays and medical examination. But it offers additional information about the underlying healing or inflammatory process present. This type of advanced imaging shows when there is a healing response in the bone tissue and may help guide patients in making treatment, rehab, and return-to-work decisions.

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. Reaching across the computer keyboard to use the mouse is one of the more common causes of this problem in patients today.

Your doctor will first take a detailed medical history. You will need to answer questions about your pain, how your pain affects you, your regular activities, and past injuries to your elbow. Many other types of information may be gathered such as treatment tried so far, tobacco use, work history/sick leave, and time spent in leisure or recreational activities.

A detailed physical exam is often most helpful in diagnosing tennis elbow. Height, weight, health status, pain assessment, strength, and motion may be measured and recorded. Your doctor may position your wrist and arm so you feel a stretch on the forearm muscles and tendons. This is usually painful with tennis elbow. There are also other tests for wrist and forearm strength that can be used to detect tennis elbow.

You may need to get X-rays of your elbow. The X-rays mostly help your doctor rule out other problems with the elbow joint. The X-ray may show if there are calcium deposits on the lateral epicondyle at the connection of the extensor tendon.

Other special tests such as magnetic resonance imaging (MRI) aren’t routinely ordered. The doctor may order additional tests of this type when the diagnosis is not clear. MRI scans use magnetic waves to create pictures of the elbow in slices. The MRI scan shows tendons as well as bones.

Ultrasound tests use high-frequency sound waves to generate an image of the tissues below the skin. As the small ultrasound device is rubbed over the sore area, an image appears on a screen. This type of test can sometimes show problems with collagen degeneration.

Doctors are also now looking at bone scanning imaging as a possible diagnostic tool for this type of problem. This technique is called bone scintigraphy. Bone scintigraphy looks at the distribution of blood flow and active bone.

It helps show blood flow to and through the bone and shows places throughout the skeletal system where the bone is actively metabolizing. The advantage of bone scintigraphy is that changes in bone metabolism show up on the bone scan before structural changes would appear on an X-ray. Conditions such as fractures, infections, tumors, and arthritis can be recognized with a bone scan long before they can be seen with plain radiographs.

In the case of epicondylitis, bone scintigraphy can show whether or not there is a reparative process started. The test results don’t explain what is causing the problem. They just show the specific areas of bone where local bone responses are occurring. This is not routinely ordered and would not be part of a standard diagnostic examination.

It could be the way you are sleeping at night. Bending the elbow while sleeping on your side can put a compressive force on the ulnar nerve as it passes through the elbow. Wearing a slip-on elbow support with the pad along the inside of the elbow may help.

If your symptoms are better in the morning, this could mean you have a mild nerve compression. Continuing to wear the elbow protection may be all that’s needed.

If your symptoms are unchanged, then there may be something else going on. If you develop more serious symptoms such as pain, numbness, or weakness, you may be experiencing a condition called cubital tunnel syndrome (CTS).

Cubital tunnel syndrome is the name of the condition that affects the ulnar nerve where it crosses the inside edge of the elbow. If it’s not caused by prolonged elbow flexion while sleeping, it may be caused by an extra slip of muscle that crosses the nerve, a ganglion cyst, or a bone spur.

Any of these extra anatomical structures can cause enough pressure to compress the neural tissue. Sometimes it’s not even possible to tell what’s causing the problem. These cases are called idiopathic, which means unknown.

A careful history and evaluation of your symptoms can help your physician make an accurate diagnosis. A loss of sensation can be measured using special wires called monofilaments. The monofilaments are pressed against the skin with a certain amount of pressure. The patient reports whether or not the pinpoints of pressure are felt.

Muscle and nerve testing are also done. Tapping over the nerve can reproduce the symptoms. This is called the Tinel’s sign. But a more accurate test is the elbow flexion test. The elbow is held in a position of elbow flexion for 60 seconds. This position compresses and irritates the nerve and sets off the symptoms. Applying pressure to the bent elbow increases the sensitivity of this test. Studies show that not pressing long enough or applying pressure for too long can result in false negative or false positive tests.

Imaging studies such as ultrasound or MRIs have their place in the diagnostic process. Ultrasound pictures can show the presence of tumors, extra muscle tissue, or nerve subluxation (nerve slips out of its tunnel). MRIs can show when the nerve (or a section of the nerve) is enlarged. Tumors, cysts, infection, or other lesions are also clearly seen on MRIs.

Once the diagnosis has been made, your physician can advise you as to the best treatment approach.

Cubital tunnel syndrome (CTS) 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. That’s where 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. Pressure on the nerve over time can also lead to muscle weakness and loss of forearm function. I

Pressure or traction on the nerve can come from a variety of places. The prognosis may depend on the underlying cause of the symptoms. Part of the problem may lie in the way the elbow works. The ulnar nerve actually stretches several millimeters when the elbow is bent. Sometimes the nerve will shift or even snap over the bony medial epicondyle. (The medial epicondyle is the bony point on the inside edge of the elbow). Over time, this can cause irritation of the nerve.

Bending the elbow over and over, such as pulling levers, reaching, or lifting can lead to cubital tunnel syndrome. Constant direct pressure on the elbow over time may also contribute to the problem. For example, the nerve can be irritated from leaning on the elbow while you sit at a desk or from using the elbow rest during a long drive.

The ulnar nerve can also be damaged from a blow to the cubital tunnel. Other possible causes include an extra slip of muscle that crosses the nerve, a ganglion cyst, or a bone spur. Any of these extra anatomical structures can cause enough pressure to compress the neural tissue. Sometimes it’s not even possible to tell what’s causing the problem. These cases are called idiopathic, which means unknown.

Nonoperative care can be very successful for mild cases of CTS. This may include antiinflammatory drugs, activity modification, and rest. It is important to stop doing whatever is causing the pain in the first place. Limiting elbow flexion is a key factor.

If the symptoms are worse at night, a lightweight plastic arm splint or athletic elbow pad may be worn while sleeping. This will help limit movement and prolonged periods of time with the elbow bent, thus easing nerve irritation. The elbow pad can be worn during the day to protect the nerve from the direct pressure of leaning.

Doctors commonly have their patients with cubital tunnel syndrome work with a physical or occupational therapist. Therapist gives patients tips on how to rest the elbow and perform activities without putting extra strain on the elbow. Nerve gliding exercises can be done to keep the nerve moving smoothly and reduce pressure from adhesions or soft tissue obstructions. Exercises are used to gradually stretch and strengthen the forearm muscles.

When conservative treatment fails to give patients the relief needed, then surgery may be considered. The results of surgery may vary depending on the severity of the problem, the surgical approach used, and any complications that may occur postoperatively.

Studies over time are showing that less disruption of the nerve is better. Moving the nerve and overlying muscle apart from each other (called submuscular transposition) is successful for moderate nerve compression. But instead of moving the nerve away from the compressing forces, it appears that removing the compression may be a better treatment method.

For example, the surgeon can do a medial epicondylectomy (shaving off the bump of bone along the inside elbow). This procedure has just as good of results as transposition and is recommended instead. The surgeon uses caution to take just the right amount of bone off to avoid elbow instability.

Surgeons have also moved from using an open incision to minimally invasive endoscopic procedures. With a much smaller incision and the use of a scope to see inside the elbow area, surgical techniques are continually refined and improved. The results are better, which means a better overall prognosis.