Elbow

The tip of the elbow is formally called the olecranon. It forms the hinge part of the elbow joint and rotates around the end of the humerus. The triceps muscle also inserts on the olecranon and powers extension of the arm. Occasionally the olecranon can break with either a fall onto an out-stretched or flexed arm. We typically recommend surgery for these fractures to realign the joint surface of the elbow and to restore the triceps mechanism.

The olecranon is one of three bones in the elbow joint. The olecranon does not have much soft tissue (ie-fat muscle) surrounding it unlike a joint like the hip. The skin overlying the olecranon is dragged over the bone as we take the elbow thru a range of motion. The olecranon bursa is a pad of grease that sits between the skin and bone. Its role is to minimize friction between the skin and bone. This bursa can become inflamed - thus the term bursitis.

Infected olecranon bursitis occurs when bacteria penetrate the skin and grow in the bursa. If caught early this may be treated successfully with antibiotics alone. In some cases antibiotics alone are not sufficient and surgical cleaning of the bursa is need.

Non-infected olecranon bursitis represent swelling and inflammation in bursa without the presence of bacteria. This can be treated with simple observation allowing the fluid to self resorb or needle aspiration to remove the fluid. Surgical excision of non-infected olecranon bursitis is uncommon.

The radial head is one of three bones in the elbow joint. It is fractured by trauma - most commonly landing on one's outstretched hand to brace a fall. Radial head fractures can occur in isolation or as part of fractures of the other elbow bones or elbow dislocations.

The radial head is part of a joint and therefore the severity of the fracture determines how it is treated.

Non-operative treatment is possible if the radial head fractures in a way where the shape of the elbow joint is not significantly affected. Thankfully the majority of radial head fractures are treated non-operatively. Immobilization of the fracture is discontinued quickly and motion of the joint is encouraged. Physical therapy is often necessary.

Surgery is indicated when the radial head fracture significantly alters the shape of the elbow joint. There are three different types of surgery performed depending on the type of fracture. 1) Removal of the radial head 2) Replacing the radial head with a metal prosthesis and 3) Putting the pieces of the radial head back together and holding them with screws and/or plate. Physical therapy is necessary after any of these surgeries.

What is it?

Cubital Tunnel Syndrome is caused by pressure on the ULNAR NERVE at the elbow. Common complaints of people with cubital tunnel are of NUMBNESS of the ring and small fingers of the hand, ACHING PAIN on the MEDIAL ELBOW (inside of the elbow) and WEAKNESS of the hand. In severe cases the small muscles of the hand atrophy and the hand has a hollow look.

The most common place for compression of the ulnar nerve is at the elbow where the nerve can be compressed by a variety of structures, the most common being Osborne’s Ligament. Symptoms can also occur if the nerve is too loose and slips back and forth over the bone (subluxation) at the elbow.

How is it treated?

The best test to confirm the diagnosis is the EMG/NCV (electromyelogram/nerve conduction study) which tests the nerves ability to carry a standardized electrical impulse. The EMG/NCV is very good for detecting compression of the nerve but may not detect irritation of the nerve caused by subluxation.

Options for treatment include night splinting, anti-inflammatories, therapy, cortisone injections and surgery. As with carpal tunnel syndrome many of the conservative treatments seem to be of temporary benefit. Surgery is performed on an outpatient basis.

The condition is usually seen in older athletes that do repetitive gripping with the palm of their hand. These patients will develop pain on the inside part of the elbow, and this pain can radiate down the inner forearm. Treatment usually consists of relative rest, anti-inflammatory medication, physical therapy, bracing, and a possible cortisone injection. Refractory cases of this may require surgical intervention.

This is the most common tendonitis of the elbow. This is seen in athletes who do repetitive activities, such as racquet sports. Symptoms are pain and tenderness at the outside of the elbow. This pain may radiate through the lateral or outside aspect of the forearm. Treatment consists of relative rest, bracing, anti-inflammatory medication, physical therapy, and occasionally a cortisone injection. Refractory cases may require surgical intervention.