Written by Keith Glowacki, M.D.
The common pain can be the result of overuse, trauma or pressure—all of which can be fixed by a visit to your orthopaedic surgeon
Does your elbow hurt? Do you experience
numbness, swelling or pain with everyday activities? The three most common elbow disorders are lateral epicondylitis, better known as “tennis elbow,” olecranon bursitis and cubital tunnel syndrome. Chances are your elbow pain is because of one of these three problems.
A little understanding of the anatomy of the elbow will help in understanding these common problems. The elbow joint is formed by three bones: the radial head, the humerus (upper arm) and the ulna (with its olecranon process forming the pointed end). The muscles on the outside of the elbow are called the extensors and will bring your wrist up and off the table when flat. The flexors are on the inside of the elbow and will bend the wrist down and make a fist. The biceps muscle bends the elbow, and the triceps muscle straightens it. There are three nerves traveling through the elbow: the median, radial and ulnar nerves. The ulnar nerve travels through the cubital tunnel. Blood vessels, skin and a small bursa (a fluid-filled sac) make up the rest of the elbow’s anatomy.
Lateral Epicondylitis, or “Tennis Elbow”
Lateral epicondylitis is a disorder caused by overuse. The muscle tissue becomes inflamed and painful in the outside of the elbow. It is common among carpenters, musicians and racquet sport athletes. Micro-trauma accumulates in the elbow extensor tendons on the outside of the elbow. The pain occurs most often when the elbow is extended straight and the person is gripping an object in the hand. Treatment includes activity modification, braces, non-steroidal anti-inflammatory drugs (NSAIDs), stretching exercises, therapy and occasional cortisone injections. In the majority of cases, lateral epicondylitis is treated conservatively. For those who continue to have pain, there is a surgical option: excising the torn scar tissue and repairing the remaining tendon.
Olecranon Bursitis
The olecranon is the name for the end of the ulnar bone in the back of your elbow. This is the site of the most common form of bursitis. The bursa can become inflamed and filled with fluid, creating a large bump on the back of the elbow. In about 20 percent of cases the bursa will become infected. Bursitis can be caused by direct impact or repetitive trauma, or by resting your elbow on a hard surface for hours, giving it the nickname “student’s elbow.” Inflammatory disorders like gout and rheumatoid arthritis can also cause bursitis. Treatment with elbow pads, compression, NSAIDs and aspiration of the fluid is used to relieve the bursitis. When infected, antibiotics and occasionally a surgical procedure to remove the bursa may be necessary. An orthopaedic surgeon can remove the bursa, typically without any detrimental effects on the patient.
Cubital Tunnel Syndrome
Cubital tunnel syndrome should not be confused with carpal tunnel syndrome. This disorder occurs from pressure over the inside of the elbow. The “funny bone,” or ulnar nerve, passes through a groove in the bone on the inside of the elbow. Excessive pressure or prolonged bending can cause numbness to occur in the ring and pinky fingers. Conservative treatment involves splinting and avoiding pressure on the inside of the elbow for four to six weeks. A nerve test can determine if surgery is necessary; if it is, cubital tunnel release surgery can release the pressure on the nerve and relieve numbness.
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Elbow pain is a common problem. An orthopaedic doctor can diagnose the condition based on which part of your elbow feels sore. Pain, repetitive use, trauma and nerve symptoms can all be involved, so consult an orthopaedic doctor if pain or soreness persists.