Elbow

Specialist in upper limb surgery of the elbow

Fellowship at Sydney Shoulder Research Institute & Orthoclinic in elbow surgery

Pain

Elbow pain with movement, at rest or pain while sleeping.

Instability

Acute elbow dislocation or chronic elbow instability.

Stiffness

Reduced elbow movement with locking/catching.

Fracture

Fracture of the elbow – lower end of the arm or upper end of the forearm bones.

Pain

Elbow pain with movement, at rest or pain while sleeping.

Capitellar OCD

Definition: Osteochondritis dissecans (OCD) of the capitellum is a condition affecting the elbow, particularly in adolescents

Symptoms

Lateral elbow pain
Swelling and tenderness

Diagnosis

Physical examination
Imaging studies (e.g., X-rays, MRI

Treatment

Conservative management for stable lesions:
- Elbow rest or activity modification
- Physical therapy
- Cold application
Surgical intervention for:
- Unstable lesions
- Stable lesions not responding to conservative treatment
- Grade III or higher lesions

Prognosis

Varies depending on lesion severity and treatment approach

Overview

A distal biceps rupture is an injury where the biceps tendon, attaching at the elbow, is torn from its insertion point on the radial tuberosity. This injury is often associated with sudden, forceful movements, such as lifting heavy weights or during high-impact activities.

Symptoms

Sudden pain in the elbow.
A noticeable bulge in the upper arm where the biceps muscle retracts.
Weakness in elbow flexion and forearm supination (rotating the palm up)

Treatment

Diagnosis

Physical examination to detect the characteristic "popeye" muscle bulge.
Imaging techniques like ultrasound or MRI to confirm the extent of the rupture.

Non-Surgical: Physical therapy may be recommended for partial tears or in cases where surgery is not feasible.
Surgical: Complete ruptures typically require surgical repair to reattach the tendon to the bone. This involves an outpatient procedure where the tendon is reattached using sutures or anchors

Rehabiilitation

Post-surgery, rehabilitation focuses on restoring range of motion and strength. This includes stretching and strengthening exercises and may last several months.

Overview

Elbow arthritis refers to inflammation of the elbow joint, which can cause pain, stiffness, and difficulty in movement.

Common types include:

Osteoarthritis: A degenerative condition where the cartilage that cushions the joint wears down over time, leading to pain and limited movement. It often affects people who have had previous elbow injuries or repetitive strain on the joint.
Rheumatoid Arthritis: An autoimmune disorder where the immune system attacks the joint lining, leading to inflammation, pain, and deformity. It can affect multiple joints, including the elbow.

Symptoms

Pain in the elbow, especially when bending or straightening the arm
Stiffness or difficulty in fully extending the arm
Swelling or tenderness around the elbow
Clicking or locking sensation in the joint

Treatment

Conservative Treatments: These may include rest, physical therapy, anti-inflammatory medications, and corticosteroid injections to manage pain and inflammation.
Surgical Options: In severe cases, surgery such as joint replacement or arthroscopy may be recommended.

Symptoms

Pain or burning on the outer part of the elbow.
Weak grip strength.
Pain that worsens with forearm activity.

Elbow Epicondylitis: An Overview

Elbow epicondylitis, commonly known as Tennis Elbow or Lateral Epicondylitis, is a condition that involves pain and tenderness on the outside of the elbow. It is caused by the overuse of the muscles and tendons in the forearm, particularly the extensor carpi radialis brevis, which is involved in wrist and finger extension.

Causes

Repetitive Motions: Activities that require repeated wrist extension or gripping, such as tennis, painting, or typing, can lead to the overuse of forearm muscles and tendons, resulting in microscopic tears and inflammation.
Age: It is most common in adults between the ages of 30 and 50, though it can affect people of any age.

Treatment

Conservative Management: Rest, ice, physical therapy, anti-inflammatory medications, and braces are commonly used. Stretching and strengthening exercises are also recommended.
Advanced Treatments: In chronic cases, steroid injections, shock wave therapy, or surgery may be considered

Triceps Rupture / Avulsion

Definition: Triceps rupture or avulsion is an injury to the triceps brachii muscle or its tendon attachment to the olecranon.

Rehabilitation

Postoperative care includes immobilization and gradual return to activity
Specific protocols may vary

Importance of proper treatment

Treatment

Partial tendon avulsions or midsubstance muscle tears:

Nonoperative treatment
- Arm in extension for 3-4 weeks
- Gradual range-of-motion exercises
Complete ruptures:
- Surgical repair
- Reattachment of avulsed tendon to olecranon

Diagnosis

Clinical examination
Imaging studies (e.g., MRI, ultrasound) may be used.

Prevents late disability
Maximizes function

Instability

Acute elbow dislocation or chronic elbow instability.

Overview

Posterior medial rotatory instability (PMRI) of the elbow is a less common type of elbow instability characterized by a combination of posterior and medial instability. It involves the instability of the elbow joint primarily due to injury or damage to the medial collateral ligament (MCL) complex and often accompanied by a posterior dislocation.

Causes

Trauma: Typically results from a high-impact injury, such as a fall onto the elbow or a forceful impact with the arm.
Overuse: Repetitive stress or strain can also contribute to the condition, though it is less common.

Symptoms

Pain: Pain on the medial (inner) aspect of the elbow.
Instability: A feeling of instability or giving way in the elbow joint.
Limited Range of Motion: Difficulty in moving the elbow normally.

Diagnosis

Involves clinical examination and imaging studies like MRI or

X-rays to assess ligament damage and joint instability.

Treatment

Initially managed with conservative treatments such as rest, bracing, and physical therapy. In cases with significant instability or associated fractures, surgical intervention may be necessary.

Anatomy

Posterior lateral rotatory instability (PLRI) of the elbow is a condition that involves the lateral collateral ligament (LCL) complex, specifically the lateral ulnar collateral ligament (LUCL). The LCL complex is crucial for maintaining the stability of the elbow joint, particularly against rotational forces. In PLRI, the LUCL becomes injured or stretched, compromising the stability of the elbow. This allows the radius and ulna (the bones of the forearm) to subluxate or partially dislocate from the humerus (the upper arm bone) in a posterolateral direction, especially during activities that involve pushing off with the arm or bearing weight through the hand with the elbow extended.

Incidence

PLRI is relatively uncommon but can occur following trauma, such as a fall on an outstretched hand (FOOSH), which may cause an elbow dislocation or ligamentous injury. It can also result from repetitive stress, particularly in athletes who participate in sports that involve frequent elbow extension and rotation, such as gymnastics, weightlifting, and throwing sports. Iatrogenic causes, such as surgical procedures around the elbow, may also contribute to PLRI if the LUCL is inadvertently damaged. While the exact incidence is not well-documented, it is recognized as the most common form of chronic elbow instability.

Treatment Options

Treatment for PLRI of the elbow depends on the severity of the instability, the patient's symptoms, and their activity level. Options include:

Conservative Management: Initial treatment may involve non-surgical approaches, especially for mild cases or patients who are not candidates for surgery.
- Bracing: A brace may be used to stabilize the elbow, particularly during activities that provoke symptoms.
- Physical Therapy: Strengthening exercises targeting the muscles around the elbow, especially the extensor-supinator group, can help compensate for the ligamentous insufficiency and improve joint stability.
- Activity Modification: Avoiding activities that exacerbate symptoms, such as pushing off with the hand or weight-bearing on an extended elbow, can reduce the risk of recurrent instability.
Surgical Intervention: Surgery may be necessary for patients with significant instability, persistent symptoms despite conservative treatment, or those with a high demand for elbow stability (e.g., athletes).
- Ligament Reconstruction: The primary surgical treatment for PLRI involves reconstructing the LUCL using a tendon graft, often harvested from the patient’s own tissue (autograft) or from a donor (allograft). The goal is to restore the normal anatomy and function of the LCL complex.
- Arthroscopic Debridement: In some cases, particularly if there is associated cartilage damage, arthroscopic surgery may be performed to clean out loose bodies or damaged tissue from the joint.
Post-Surgical Rehabilitation: Following surgery, a structured rehabilitation program is crucial for a successful outcome. This typically involves a period of immobilization, followed by gradual strengthening exercises and a progressive return to activities.

Stiffness

Reduced elbow movement with locking/catching.

Heterotrophic Ossification

Heterotopic ossification (HO) refers to the abnormal formation of bone in soft tissues, typically around a joint. It can significantly impact joint mobility and function.

Causes

Trauma: Often occurs after severe injury or surgery, particularly around the elbow, hip, or knee joints
Neurological Conditions: Conditions such as spinal cord injury or brain injury can also lead to HO.

Symptoms

Restricted Movement: Stiffness and reduced range of motion in the affected joint.
Pain and Swelling: Discomfort and swelling in the soft tissues surrounding the joint.

Diagnosis

Typically involves imaging techniques such as X-rays or MRI to detect abnormal bone formation

Treatment

May include physical therapy, medications to manage pain and inflammation, and in some cases, surgical excision of the ossified tissue to restore joint function.

Post-Traumatic Elbow Stiffness

Post-traumatic elbow stiffness (PTES) is a condition where the elbow joint becomes stiff and loses its range of motion following an injury or trauma. This stiffness can significantly impair functional use of the arm.

Causes

Trauma: Injuries such as fractures, dislocations, or severe sprains can lead to PTES.
Inflammation: Post-injury inflammation and scar tissue formation can restrict movement.
Joint Contracture: Prolonged immobilization or inadequate rehabilitation may cause contracture, where the joint becomes permanently fixed in a bent position

Symptoms

Limited Range of Motion: Difficulty bending or straightening the elbow fully.
Pain and Discomfort: Especially when attempting to move the joint.
Functional Impairment: Difficulty performing daily activities that involve the arm.

Diagnosis

Clinical Examination: Assessing joint movement and symptoms.
Imaging: X-rays or MRI scans to identify any underlying damage or changes in the joint structure.

Prevention

Early Rehabilitation: Ensuring proper and timely physical therapy after an injury can help prevent stiffness.
Avoid Prolonged Immobilization: Limiting the time the elbow is immobilized post-injury can reduce the risk of stiffness

Treatment

Physical Therapy: Exercises and stretches to improve joint mobility.
Medications: Pain relievers and anti-inflammatory drugs.
Surgical Intervention: In severe cases, procedures like arthroscopic release might be necessary to remove scar tissue and restore movement.

Fracture

Fracture of the elbow – lower end of the arm or upper end of the forearm bones.

Overview

A capitellar fracture is a rare but significant injury to the elbow, involving the capitellum, a small rounded part of the distal humerus. This type of fracture can be challenging due to its potential association with other elbow injuries and its impact on joint function.

Associated Injuries

Radial Head Fractures: Often occur simultaneously with capitellar fractures.
Posterior Dislocations: Can be associated with capitellar fractures.

Diagnosis

Causes

Trauma: Typically results from high-energy trauma such as a fall on an outstretched arm or a direct blow to the elbow.

Imaging: X-rays and sometimes CT scans are used to assess the extent of the fracture and any associated injuries.

Treatment

Surgical Fixation: Often required to stabilize the fracture, typically using screws or plates. This helps restore the joint's function and prevent long-term complications
Rehabilitation: Post-surgery, physical therapy is crucial for regaining range of motion and strength.

Overview

A radial head fracture is a common injury that affects the radial head, a part of the radius bone located at the elbow. It often results from trauma, such as a fall onto an outstretched hand or direct impact to the elbow.

Diagnosis

Imaging: X-rays and sometimes CT scans are used to determine the fracture's severity and check for associated injuries.

Treatment

Non-Surgical: For minor fractures, treatment may include rest, ice, and physical therapy. A brace or sling might be used to immobilize the elbow.
Surgical: Severe fractures or those with complications may require surgery to repair or replace the radial head. This may involve plates, screws, or radial head replacement.

Causes

Trauma: Typically caused by a fall with the arm extended or direct blows to the elbow

Symptoms

Pain: Localized around the elbow.
Swelling and Bruising: Common near the fracture site.
Limited Range of Motion: Difficulty moving the elbow and forearm.

Recovery

Timeframe: Recovery can take from 3 to 6 weeks, depending on the severity of the fracture and the treatment approach.

Overview

A coronoid fracture involves a break in the coronoid process, a bony projection on the ulna bone of the forearm that contributes to elbow stability. This type of fracture is less common but significant due to its potential impact on elbow function and stability.

Diagnosis

Imaging: X-rays and CT scans are used to evaluate the extent of the fracture and associated injuries. Proper assessment is crucial to determine the appropriate treatment.

Treatment

Causes

Trauma: Often results from high-energy trauma, such as a fall on an outstretched arm or severe elbow injury.

Associated Injuries

Surgical Intervention: Repair typically involves surgical fixation of the fracture to restore stability. The treatment approach may vary based on the fracture's complexity and associated injuries.
Rehabilitation: Post-surgery, rehabilitation focuses on regaining range of motion and strength to ensure proper recovery.

Elbow Instability: Coronoid fractures are frequently associated with other elbow injuries like radial head fractures and posterior dislocations.