Elbow

The elbow is subjected to daily use through normal, everyday activities as well as during participation in sports activities. It’s not surprising that problems can develop in the elbow over time. Trauma, overuse, aging, and degenerative disorders, such as arthritis, can affect your elbows.

The elbow is a hinge joint where three long bones meet in the middle portion of the arm. The bone of the upper arm (humerus) meets the inner bone of the forearm (ulna) and the outer bone of the forearm (radius). The bicep muscle is the major muscle that flexes the elbow hinge. The tricep muscle is the major muscle that extends the elbow hinge. A fluid-filled sac (bursa) that serves to reduce friction overlies the tip of the elbow. The elbow can be affected by inflammation of the tendons or the bursa, or conditions that affect the bones and joints, such as fractures, arthritis, or nerve irritation.

Many conditions that cause elbow pain can be managed without surgery through a treatment plan prepared by your orthopaedic doctor. Some of the more common problems are:

• Tendinitis: Sometimes referred to as “tennis elbow,” tendinitis occurs when the tendons attached to the elbow from the muscles of the forearm become injured, resulting in inflammation.
• Sprains
• Injury to the “Funny Bone” (Ulnar Nerve)
• Golfer's Elbow: Inflammation at the point where the tendons of the forearm are attached to the bony prominence of the inner elbow
• Bursitis: Inflammation of the bursa at the tip of the elbow

Most often these problems can be treated non-surgically. However, there are some conditions that may cause you to explore surgical options if you are experiencing elbow pain.

Elbow Conditions

Fractures: The bones of the elbow can break (fracture) into the elbow joint or adjacent to the elbow joint. Fractures generally require immobilization and casts, pinning, or open joint surgery.

Arthritis of the Elbow: Inflammation of the elbow joint (arthritis) can occur as a result of many systemic forms of arthritis, including rheumatoid arthritis, gouty arthritis, psoriatic arthritis, and reactive arthritis. Range of motion is decreased with arthritis of the elbow because the swollen joint impedes the range of motion. Generally, this is associated with signs of inflammation of the elbow joint, including heat, warmth, swelling, pain, tenderness, and decreased range of motion.

Elbow Spurs: Elbow spurs are usually precipitated by years of overhead activities (pitching, tennis, etc.) that produced swollen bone linings that develop spurs.

Bone Fragments: Fragments or loose “bodies” are usually caused by a trauma-related condition that results in decreased blood supply, bone collapse, and cracking. “Bodies” already broken free from a cracked surface can be arthroscopically removed; however, the resulting pre-arthritic condition may leave the elbow unable to tolerate the stress of high-impact activities like gymnastics or baseball.

When possible, arthroscopic surgery is preferred by surgeons for spur removal and removal of bone fragments because traditional inpatient surgical techniques tend to produce significant loss of motion after the recovery period. In contrast, arthroscopic surgery is usually successful in restoring almost all motion and allowing a return to activities after the recovery period.

Recovery

The type of surgery you have and your doctor’s recommendations will determine how soon you can begin using your arm again after elbow surgery. If you have arthroscopic surgery, you may go home in a few hours after surgery, but you will need to arrange to have someone drive you home because the pain medications and anesthesia are likely to make you sleepy. If you have a total elbow replacement, you could remain in the hospital for one to three days.

Physical therapy is an extremely important part of the success of elbow surgery and your full participation is necessary for an optimal outcome. Some degree of pain, discomfort, and stiffness can be expected during the early days of physical therapy.

The medical staff and therapist will teach you proper movements and exercises to do so that you can regain your strength and mobility in your elbow. Continue to move the way you were taught by the physical therapist and return to activity slowly. Don’t be surprised if you feel a little stiff at first; it may take a few months to achieve a complete recovery. It is very important to keep all your scheduled follow-up visits with your surgeon.