We can help you overcome elbow pain and injury
The elbow is an integral part of the arm and allows us to flex, bend, and twist our arm. Due to simple and complex daily tasks, the elbow gets a lot of use. It's no surprise the bones, muscles, and ligaments at and near the elbow are prone to injury and overuse.
The elbow joint is a hinge joint that connects the forearm to the upper arm. It allows for two main motions – flexion (bending) and extension (straightening) of the arm. It is made up of three smaller joints: 1) where the arm bone (humerus) meets the forearm bone (olecranon of ulna). The end of the ulna is called the olecranon process which is the bony prominence you feel on the back of your elbow; 2) where the arm bone (humerus) meets the forearm bone (radius); and 3) where the ulna and radius meet. The joint is susceptible to different injuries that fall in the categories of bone, muscle, tendon, ligament, and nerve.
VSMD Approach
At VSMD, we diagnose elbow pain and injuries by analyzing medical history, conducting a physical exam, and using imaging such as ultrasound and x-ray. Based on the findings, the doctor may recommend a conservative treatment to reduce pain and swelling and allow the elbow to heal properly. In case of more severe injury, like a ligament tear, tendon rupture, or fracture, the doctor may prescribe a more involved approach to initiate the healing process.
For most elbow issues, a non-surgical regiment with frequent evaluation by the doctor is the best course. At VSMD, we treat each patient through a holisitic lens. Our doctors not only evaluate the ebow but also the accompanying area to maximize healing and function.
Causes of Elbow Pain and Injury
There are many conditions that can occur at and near the elbow joint in sports and everyday tasks. All athletes are subject to elbow injury whether from contact, impact, hyper-extension, or overuse. Below are some common injuries and conditions that affect the elbow.
Common problems include:
Tennis Elbow & Golfer Elbow
“Tennis Elbow” (also called lateral epicondylitis) and “Golfer’s Elbow” (also called medial epicondylitis) are common overuse injuries of the elbow that cause pain with many daily activities. Injury and pain occur when the tendon that attaches to bone at these locations becomes inflamed. In the acute setting it is called tendonitis and when it lasts longer, it is called tendinopathy. Activities that involve flexing and extending the wrist, hand grip, and repetitive motions with the hand and wrist can cause pain when you have Tennis or Golfers elbow.
Symptoms of tennis elbow: Tennis elbow typically presents as pain on the outside (lateral) aspect of the elbow that is made worse by gripping objects and/or extending the wrist. The pain may be constant or only occur with activity. It may have a sudden or gradual onset and continued repetitive motions cause it to be more painful. You are at higher risk for developing this condition if you smoke, perform repetitive movements for at least 2 hours daily, regularly lift heavy weights, and are between the ages of 45-54. Common aggravating activities include tennis, squash, carpentry, sewing and computer keyboarding.
Symptoms of golfer’s elbow: Golfers elbow typically presents as pain on the inside (medial) aspect of the elbow that is made worse by flexing the wrist. The pain may be constant or only occur with activity. It may have sudden or gradual onset and continued repetitive motions cause it to be more painful. You are at higher risk for developing this condition if you smoke, perform repetitive movements for at least 2 hours daily, regularly lift heavy weights, and are between the ages of 45-54.
Tennis and Golfer’s elbow can both be diagnosed by a sports medicine physician in office with or without imaging. It is important to tell your doctor if you have neck pain, radiating pain, shoulder pain, numbness or tingling as these may lead to other diagnoses. A physical exam may include range of motion testing, palpating the bones and tendons that are painful, and functional testing. Ultrasound examination can be helpful in determining the diagnosis.
Bursitis
Bursitis is a musculoskeletal condition that can occur in different areas of the body and is characterized by pain and swelling. A bursa is a fluid filled sac that cushions and protects bony prominences. Bursitis occurs when the bursa, or lining of the fluid-filled sac, becomes inflamed. When the bursa is inflamed, it can accumulate fluid which results in a lump that you can feel and even see over a bony prominence.
Common bursitis areas are: trochanteric (hip) bursitis, olecranon (elbow) bursitis, pre-patellar (knee) bursitis, pre-anserine (below the knee) bursitis, and retrocalcaneal (heel) bursitis.
Bursitis can be diagnosed in office by a sports medicine physician with or without imaging. The physician will obtain history information from the patient about how the painful area started, location, and activities. A physical exam may include range of motion testing, palpation of the painful and swollen area, and functional testing. Ultrasound evaluation may be useful to evaluate the surrounding area, joint, and bursa itself. You should tell your doctor if you have severe pain, fever, red or hot to touch skin as these may indicate a different diagnosis.
Ulnar Collateral Ligament Injuries
Ulnar collateral ligament (UCL) injuries may occur in athletes that place a lot of stress on the elbow joint, commonly seen in throwing sports. A ligament is a fibrous band that provides support between two bones and helps to stabilize the joint and create smooth motion of the joint. The ulnar collateral ligament is a ligament that is located on the inside (medial side) of the elbow (the side of the arm that is on the same side as the small finger).
The ulnar collateral ligament of the elbow can get stretched, frayed, or torn from repetitive stress or by a direct blow from the outside of the elbow joint. Athletes at higher risk of an UCL injury are baseball pitchers, javelin throwers, and athletes of racquet sports. It may also occur as a result of falling on an outstretched hand (common with elbow dislocation).
Elbow Strain or Sprain
A strain or sprain is an injury to a muscle or ligament. The elbow joint is supported by multiple ligaments and muscles that could be damaged by injury to the elbow. Injury may occur suddenly from a fall or if it is twisted too hard. These injuries are common in football, wrestling, gymnastics, skiing, and many other sports. An injury could also occur from overuse or repetitive motions that involve the muscles or ligaments of the elbow. The muscles that are attached to the elbow help control motions of the wrist. These injuries might occur in throwing sports, such as baseball, softball, and field sports (javelin, shot put, discus).
Pain may start suddenly and be sharp or occur with a popping sensation or increase over a couple of days. Pain may be constant or occur only during specific movements of the elbow or wrist. The elbow joint may feel unstable or the athlete may feel weakness when there is injury to a muscle or ligament.
Distal Biceps Tendon Rupture
The biceps muscle runs from the shoulder down through the elbow. It is connected to the shoulder joint and elbow by tendons. The biceps works to flex (bend) the elbow and rotate the hand palm up. When the tendon connection just past the elbow tears, it is called a distal biceps tendon tear or rupture. The tear may be partial where part of the tendon is still attached or complete where the whole tendon is torn from its attachment. This injury may occur in weight lifters, someone trying to pick up a heavy object, or when a ball is forcibly pulled from an athletes hand (common in football and rugby).
Symptoms of a distal biceps tendon rupture may include a sharp pain, tearing sensation, weakness of elbow flexion or opening door knobs, a defect in the arm where the muscle used to be, a bulge in the upper arm where the muscle is pulled towards, and swelling and bruising around the elbow.
Ulnar neuritis or neuropathy
Inflammation and irritation of the ulnar nerve is called neuritis. When this condition goes on for a long time, it is called neuropathy. The ulnar nerve is located on the medial (inside) part of the elbow just around the elbow bone (medial epicondyle or funny bone). Ulnar neuritis causes elbow pain, numbness and tingling in the hand, and sometimes weakness in the hand. When the elbow flexes (bends), the ulnar nerve is stretched over the medial epicondyle. The nerve can become inflamed due to repetitive bending motions of the elbow, sustained pressure like leaning on the elbow, or bending the elbow for long periods of time. Ulnar neuritis is commonly seen with fractures or dislocations of the elbow, arthritis, and swelling of the elbow.
Elbow Arthritis
Arthritis, osteoarthritis, or degenerative change is a common condition that causes pain, swelling, and reduced motion of the elbow. There is not one single cause of arthritis but the joint changes caused by arthritis can increase over time. These changes can be seen as early as the 30s and are much more common with each decade one ages over 50 years old. Arthritis may or may not be painful. When the arthritis gets irritated or inflamed is typically when pain starts. Depending on the severity of the arthritis and pain, there are various treatment options but there is no cure for this disease.
Little League Elbow
Little League Elbow is an injury to the inside (medial side) of the elbow that occurs in young athletes. As its name implies, it is associated with throwing and pitching sports. The injury is caused by repeated throwing motions that put stress on the growth plate causing inflammation and sometimes disruption (separation of the growth plate from the bone) of the growth plate. Risk factors for developing Little League Elbow include pitching (however, other positions can develop it), improper throwing technique, high pitch count, playing in multiple leagues, and not allowing enough rest between seasons.