Elbow
Elbow (olecranon) Fracture
Description
The Olecranon is the tip of the elbow and is a bony prominence that extends from the ulna. Fractures of the olecranon can result from a direct blow to the elbow or landing directly on a bent elbow. Sometimes it is caused by a fall on an outstretched arm with the elbow locked, in these instances the triceps muscle pulls the olecranon off of the ulna.
Symptoms
Sudden, intense pain and swelling over the bony part of the elbow. An inability to straighten the elbow and numbness in one or more fingers. There may be bruising around the elbow and pain with any movement.
Surgical: Surgery is usually necessary if the bone fragments are out of place or if the fracture has broken the skin. The surgeon may need to use pins/wire, plates, screws or sutures (stitches) in the bone or tendons. Following surgery a splint or sling may be applied to the arm to help keep it in place while it is healing.
Treatment
Non-surgical: If the bone fragments are in a good alignment it may only require a splint or sling to hold the elbow in place while it heals. After this period of immobility treatment with a physiotherapist will help regain movement and strength in the elbow joint.
Surgical: Surgery is usually necessary if the bone fragments are out of place or if the fracture has broken the skin. The surgeon may need to use pins/wire, plates, screws or sutures (stitches) in the bone or tendons. Following surgery a splint or sling may be applied to the arm to help keep it in place while it is healing. Physiotherapy will help regain the movement and strength following surgery.
Recovery
Exercises are started following surgery although there are usually restrictions placed on lifting objects with the injured arm for at least six weeks. Recovering full strength can take up to 6 months with rehabilitation therapy.
Radial Head Fracture
Description
The radius is the smaller bone in the forearm that runs from the thumb side of the wrist to the elbow. The end of the bone near the elbow is called the radial head and is a common site of fracture when arms are used to break a fall.
Symptoms
Pain on the outside of the elbow, swelling in the elbow joint and difficulty bending or straightening the arm or turning the palm face up or face down.
Treatment
There are three types of fractures of the radial head:
- Small crack like fracture with the bone pieces still fitted together. Treatment is non-surgical and usually involves use of a splint or sling to support the bone while it heals. Movement exercises are introduced slowly as to not move the bone out of alignment.
- These fractures involve pieces of bone which are slightly displaced. Treatment may require a splint or sling if the displacement is only minor. Otherwise Dr Marchant could recommend surgery if there are small fragments of bone that need to be removed or larger fragments that require plates and/or screws to hold them together. Any ligament damage may also require surgical repair.
- These fractures have multiple broken pieces of bone and there is also significant damage to the elbow joint and surrounding ligaments. Surgery is required to either fix or remove the broken pieces and repair the damage to the soft tissues. In some cases the radial head may need to be removed and in some cases replaced with an artificial one. Dr Marchant will carefully explain the options you have to treat this fracture.
Recovery
Recovery times will vary dependent upon the extent of damage to the radial head. In all cases splints and slings may be used followed by physical therapy to restore movement and strength.
Biceps Tendon Tear at the Elbow
Description
The biceps muscle is located at the front of the upper arm and is attached to the elbow and the shoulder with tendons. Tears to the tendons can be either partial which is more common or complete. A complete tear will split the tendon into two pieces meaning that the entire muscle is detached from the bone and pulled toward the shoulder. Injury can occur when the elbow is forced straight against resistance for example lifting a heavy box with straight arms.
Symptoms
There is often a pop at the elbow, with severe pain, swelling and bruising around the elbow and upper arm. There may be a bulge in the upper part of the arm (the biceps muscle) and a gap in the front of the elbow created by the absence of the tendon. Weakness in bending of the elbow and in rotating the palm face down or face up.
Treatment
Non-surgical:Dr Marchant may recommend non-surgical management in some patients, particularly the elderly.
Surgical: Surgery to repair the tendon should be performed in the first 2-3 weeks following injury to get the best results and ensure restoration of arm function. The tendon can be reattached to the bone with sutures (stitches) or small metal implants.
Recovery
Following surgery the arm will be immobilised in a splint or cast. Once rehabilitation exercises have begun a brace may be used to protect certain movements while healing takes place. It takes approximately two to three months for the tendon to fully heal and it is important to protect the repair by restricting certain activities. The rehabilitation therapy is important to help regain strength and range of motion in the joint.
Ulna Nerve Entrapment at the Elbow
Description
Ulnar nerve entrapment at the elbow occurs when the ulnar nerve which runs from the neck down into the hand becomes compressed or irritated. The most common place for compression is behind the inside part of the elbow.
Symptoms
Aching pain on the inside of the elbow, numbness and tingling in the little finger, half of the ring finger and that edge of the hand. Your grip may be weakened and there may be difficulty coordinating finger movements (e.g., typing or playing an instrument). If the compression has been going on for a long period of time, there may be some muscle wasting in the hand which may be irreversible.
Treatment
Non-surgical: avoiding activities which irritate or compress the nerve such as keeping the arm bent or leaning on the elbow especially the inside of the elbow for long periods of time. Other treatments include anti-inflammatory medications to reduce swelling around the nerve, bracing or splinting the keep the elbow straight or certain exercises that can help the nerve movement and prevent stiffness in the arm and wrist.
Surgical: If non-surgical methods have not been successful or if the compression is severe or causing muscle weakness or damage, surgical management may be recommended by Dr Marchant to relieve the pressure on the nerve. There are a few surgical procedures that may help including cutting the ligament to increase the size of the tunnel through which the nerve travels. Another technique is to move the nerve from the behind the medial epicondyle to in front of the bone to prevent it getting caught. A third option is to remove part of the medial epicondyle which may be irritating the nerve. Dr Marchant will discuss the best option for your specific case.
Recovery
Depending on the type of surgery a splint may be needed for a few weeks after the operation. Physical rehabilitation may be recommended to help regain strength and motion in the arm.
Olecranon Bursitis
Description
Bursa are thin, slippery sacs of fluid that act as cushions between bones and soft tissue. Normally the olecranon bursa, which is located between the loose skin and the pointy bone at the back of the elbow is flat. If it becomes irritated or inflamed then more fluid will accumulate in the bursa and bursitis will develop. Bursitis can occur because of a direct trauma or prolonged pressure to the area, infection inside the bursa or medical conditions such as rheumatoid arthritis or gout.
Symptoms
Swelling is usually the first symptom, followed by pain as the bursa gets larger. Pain can be worse with direct pressure or attempting to bend the elbow. If infection is present the skin may be red and warm and can spread causing serious illness if not treated.
Treatment
Non-surgical: Aspiration (draining of the fluid using a needle) may be used to remove the fluid to relieve symptoms or in the case of a suspected infection the fluid can be sent for testing – which may require antibiotics. Restricting aggravating activities, the use of elbow pads or anti-inflammatory medications may also be recommended to relieve symptoms. If these methods are not successful a steroid injection may be put into the bursa (after aspiration) to relieve pain and swelling, this may only provide temporary relief.
Surgical: If non-surgical management is unsuccessful then Dr Marchant may recommend surgery to remove the bursa may be recommended. Surgery does not affect any surrounding soft tissues and the bursa usually grows back as a non-inflamed, normally functioning bursa over a period of several months.
Recovery
A splint will usually be applied after the procedure to protect the skin.If you require surgery you will be given some general exercises to improve range of motion and advised to use padding to protect your elbow for several months.
Tennis Elbow (Lateral Epicondylitis)
Description
A painful condition of the elbow caused by overuse leading to inflammation of the tendons that join the forearm muscles to the outside of the elbow.
Symptoms
Symptoms usually develop gradually with pain and tenderness on the outside of the elbow that worsens over weeks and months. There may be pain and burning in this region or weakened grip strength.
Treatment
Non-surgical: Avoiding aggravating activities and resting the arm can relieve symptoms, this may be achieved with a forearm brace to take the stress off the tendons. Other treatment includes physical therapy to strengthen the forearm muscles or steroid injections into the muscle.
Surgical: If symptoms do not respond to non-surgical methods after 6-12 months, surgery may be recommended by Dr Marchant. Surgery involves removing the damaged muscle and reattaching healthy muscle back to bone.
Recovery
Following surgery the arm may be immobilised temporarily with a splint, once the splint is removed physiotherapy is recommended to strengthen the elbow and restore flexibility. Athletic activity can usually be resumed four to six months following surgery.