Image by Dan Gold
Man_swimming_front_crawl_landscape_1024_edited.jpg

Elbow

Causes of pain & recommended treatments

Cubital tunnel syndrome

Cubital tunnel syndrome

What is it? 

The ulnar nerve runs in a tunnel on the inner side of the elbow. Pressure on the nerve cuts off its blood supply and changes the way it works, causing unpleasant numbness, tingling and pain in the ring and little fingers. In severe or established cases there may be weakness of grip and pinch. The problem is most noticeable when the elbow is flexed – for example when driving, holding a telephone, reading or sleeping.

Lateral epicondylitis

Lateral epicondylitis

Tennis elbow

What is it? 

Muscle and tendon units at the back of the forearm are responsible for finger and wrist extension. These tendons arise largely from the lateral epicondylar area – the outer side of elbow. One in particular, the extensor carpi radialis brevis, is prone to degeneration and mechanical overload. The frayed tendon can result in a healing response, which is painful. This may interfere with gripping and holding objects.

Medial epicondylitis

Medial epicondylitis

Golfer’s elbow.

What is it? 

Muscle and tendon units at the front of the forearm are responsible for finger and wrist flexion as well as forearm rotation. Many of these tendons arise from the medial epicondyle – the inner side of the elbow. One of these tendons is prone to degeneration and mechanical overload. The frayed tendon can result in a healing response, which is painful. This may interfere with gripping and holding objects. Medial epicondylitis is diagnosed on the basis of the history described above, and by clinical examination for tenderness over the inner aspect of the elbow. Resisted contraction of the affected muscle and tendons can reproduce the pain. The diagnosis can be confirmed with an ultrasound or MRI scan. Persistent cases that do not respond to rest or physiotherapy can be treated with shockwave therapy, stem cell or a single steroid injection locally, with a 60-70% success rate. Surgical release may be required if these treatments fail.

Biceps tendon problems at the elbow

Biceps tendon problems at the elbow

What is it? 

The biceps tendon can be pulled away from its main bony insertion just below the elbow as a result of a single powerful muscle contraction, for example while undertaking intense weight training or lifting a heavy object. There is usually immediate pain and an obvious deformity of the arm, known as the ‘Popeye sign’. The long term result can be weakness of elbow flexion and forearm rotation. In order to achieve maximal recovery, surgical reconstruction is required but must be undertaken within 3 weeks. Surgery is not appropriate for all patients. With recent advances in surgical technique, the rehabilitation period has been considerably reduced. This has helped to achieve excellent outcomes in most cases. The biceps tendon can sometimes be subject to partial tears, strain or bursitis – inflammation of a fluid-filled sac next to the tendon. In most cases what may be required is rest, alteration of activities, non-steroidal anti-inflammatory tablets or gel, physiotherapy and occasionally stem cell injection. For some cases of partial biceps tendon injury, surgical reconstruction is advisable. A full explanation can be provided at the time of your consultation.

Osteoarthritis of the elbow

Osteoarthritis of the elbow

What is it? 

In a normal joint the articulating bone ends are covered with a smooth layer of cartilage which allows free and painless movement. In osteoarthritis (degenerative arthritis) the cartilage thins and eventually the bone ends articulate against each other. The joint capsule may also thicken and there may be additional bone formation. The result is pain, stiffness, loss of movement and maybe catching or grinding of the joint.

Rheumatoid arthritis of the elbow

Rheumatoid arthritis of the elbow

What is it? 

In rheumatoid arthritis the synovium which lines joints and tendons becomes swollen and inflamed. In some individuals the disease progresses with destruction of joint cartilage. Pain, stiffness, loss of movement and deformity of the joint may ensue.

Elbow arthroscopy

Elbow arthroscopy

What is it? 

This technique is rapidly evolving to the point where it is now possible to carry out many elbow procedures using this form of keyhole surgery, including: Lateral epicondylar release (tennis elbow), Capsular release (soft tissue contracture), Osteocapsular release (osteoarthritis), Removal of loose bodies, Debridement of defects (osteochondritis), Excision of radial head, Assessment of an unstable elbow, Synovectomy (rheumatoid arthritis), Synovial biopsy (for diagnostic purposes).

Cubital tunnel syndrome

Lateral epicondylitis

Medial epicondylitis

Biceps tendon problems at the elbow

Osteoarthritis of the elbow

Rheumatoid arthritis of the elbow

Elbow arthroscopy