Overview
Elbow Injuries
The elbow is a complex joint formed by the upper arm (the humerus), the forearm (the radius and ulna) and an intricate system of ligaments and muscles, which connect the bones. The elbow is the joint that connects the shoulder to the hand. Elbow injuries are common and can be extremely painful for both adults and children. Dr. Nasef specializes in degenerative conditions of the elbow such as arthritis, as well as common elbow injuries associated with sports, overhead and throwing athletes, and everyday activities. He offers several surgical options for elbow conditions such as tennis elbow, elbow arthritis, biceps and triceps tendon injuries, ligament tears in throwers, and arthroscopic elbow surgery.
| Arthritis of the Elbow |
| Elbow arthritis occurs when there is an inflammation in the joint of the elbow caused when the cartilage surface of the elbow becomes damaged or worn. Similar to arthritis in other areas of the body, elbow arthritis can be the result of a degenerative disease, aging, general wear and tear, trauma or a prior injury that existed in the area. |
| Symptoms |
| Elbow arthritis symptoms range from mild to severe. In most cases, the symptoms will begin gradually and become worse over time. Elbow joint pain, swelling in the elbow area, stiffness, joint locking, redness and warmth as well as an overall difficulty in movement of the elbow area are all common symptoms associated with elbow arthritis. |
| Treatment : |
| – Non-Surgical There are treatment options for arthritis of the elbow. Many patients can live with the symptoms for years and will only need to take pain medications such as anti-inflammatory drugs and receive cortisone shots to help relieve elbow arthritis symptoms. Physical therapy exercises also help. In addition, rest is the most important recommendation. For individuals suffering from elbow arthritis, over-use of the joint almost always worsens the symptoms. For those who experience chronic elbow arthritis symptoms and whose arthritis continues to worsen, surgery is available. |
| – Surgical Arthritis in the very early stages can be controlled and treated with arthroscopic techniques. During this procedure, Dr. Nasef will trim out and remove the inflamed and degenerative tissue and loose bodies within the joint. Arthroscopic treatment for elbow arthritis will not cure the arthritic condition, but it will prolong more drastic measures and relieve many of the symptoms for a while. |
| In more severe elbow arthritis conditions where elbow arthroscopic surgery may not be effective, joint supplementation or joint replacement may be recommended. These procedures have a very good reputation for offering pain relief, and often will restore motion. During these procedures, the joint surfaces are surgically replaced through a 2-5 incision and hardware is used to take the place of the joint. |
| Before a treatment plan can be put into place, Dr. Nasef will need to examine the elbow and determine the cause of the elbow arthritis, the stage it is in and then develop a course of treatment that works best for the patient. |
| Lateral Epicondylitis (Tennis Elbow) |
| The term lateral epicondylitis-often referred to as “tennis elbow” is a condition marked by small tears in the tendons that surround the elbow area. These tears occur on the outside of the elbow and do so because of cumulative and on-going trauma that is caused by repeated use of the arm and forearm muscles. Athletes and sports enthusiasts who play tennis are at a higher risk for developing lateral epicondylitis. |
| For individuals that play tennis or similar activities every day, bone strength, the right technique and decreasing the intensity of play can oftentimes help keep tennis elbow at bay. |
| Symptoms : |
| Tennis elbow can create a great deal of pain for those suffering from the condition. Pain on the outside of the elbow is usually the first sign. Lifting objects, gripping and turning the arm will be difficult to do. For some, the pain will radiate up and down the arm while for others the pain will stay primarily in the elbow itself. |
| Treatment : |
| – Non-Surgical As with many sports-related injuries, RICE is typically the first form of treatment Dr. Nasef will recommend. If the injury is related to overuse of the wrist, eliminating the activity all together for a duration of time will often heel the injury. RICE stands for: rest, ice, compression and elevation. Over time, physical therapy might also be required to help strengthen the elbow. In some cases, a splint or brace will be recommended. |
| – Surgical If left untreated, tennis elbow may require surgical intervention. Dr. Nasef will likely perform arthroscopic elbow surgery to repair the torn tendons. The procedure is a minimally-invasive, out-patient surgery that is most often a successful course of treatment for the patient. |
| Stiff Elbow (Frozen Elbow) |
| The elbow joint is one that is referred to as a “hinge” joint. It bends, straightens, extends-and offers a range of flexion up to 145 degrees. Stiff elbow refers to those individuals who experience pain or problems when extending their elbow greater than 30 degrees. There are many factors that may cause stiff elbow including arthritis, post-traumatic injury, joint infection, congenital and degenerative conditions and infection. |
| Symptoms : |
| The major symptoms of stiff elbow are pain and loss of motion. The onset of symptoms may be gradual or sudden, depending on the cause of the condition. In most cases, the elbow will become inflamed and produce pain upon movement which gradually will worsen over time and produce stiffness. When this occurs, the pain in the region will actually become less, however, movement will be very difficult. |
| Treatment : |
| – Non-Surgical There are several treatment options for people experiencing stiff elbow. The goal in treatment is to provide the patient with a pain-free, functional and stable elbow. This means gaining flexion and a degree of motion. Physical therapy is usually the best course of treatment. Working with a physical therapist, the patient will perform exercises and strengthen techniques to gain flexion, control and motion. Rest, anti-inflammatory medications and at times, splinting, may also be used to help treat the condition. |
| – Surgical Surgery is recommended when other stiff elbow treatment alternatives are no longer working. Elbow arthroscopic surgery is usually the best option. During this procedure, Dr. Nasef will make several small incisions and insert an arthroscope into the elbow joint. This will allow him to identify loose bodies, fragments and damaged cartilage. Once removed, recovery is usually about 3 months. |
| Ulnar Nerve Entrapment (Carpal Tunnel Syndrome) |
| There are several nerves that are located and travel through the arm-one nerve in particular is called the ulnar nerve. This long nerve travels from the collarbone through the inside of the upper arm and passes through the elbow (through a grouping of tissue known as the cubital tunnel-also known as the “funny bone”). From this point, just beyond the elbow, the nerve continues to travel down through the muscle of the arm and into the hand where it resides in the area of the little finger. |
| It is this specific nerve that allows the pinky finger to move all the way and the ring finger partially. It is a huge controller of the little muscles in the hand that help make fine movements. |
| Ulnar nerve entrapment occurs when the ulnar nerve becomes compressed or entrapped. When this occurs, pain and the inability to move the little finger will be present. It is not known what exactly causes the compression that entraps the ulnar nerve, but prior fractures of the elbow, cysts, swelling of the elbow joint and bone spurs are likely reasons. |
| Symptoms: |
| In addition to pain in the hand, pinky finger and ring finger, ulnar nerve entrapment can give symptoms of tingling, numbness and a “falling asleep” feeling in the ring finger and little finger, especially when the elbow is bent. There may be an aching pain on the inside of the elbow. Oftentimes, it may be hard to move the fingers in and out or hold or grip objects. Finger coordination will also become difficult (for example, typing or playing the piano). |
| Many times, patients will confuse ulnar nerve entrapment with carpal tunnel syndrome because they have similar symptoms. However, these two conditions involve different nerves (in the case of carpal tunnel, the median nerve is affected). Carpal tunnel syndrome typically causes tingling in the thumb, index finger, and long finger. |
| If the nerve is very compressed or has been compressed for a long time, muscle wasting in the hand can occur. Once this happens, muscle wasting cannot be reversed. For this reason, it is important to see the doctor as soon as any of the symptoms are noticed. |
| Treatment : |
| – Non-Surgical Occupational and physical therapy is often a good starting place to strengthen the ligaments and tendons in the ands and elbows. Depending on the severity of the entrapment, nonsteroidal anti-inflammatory drugs and pain relievers can be taken to help reduce pain and inflammation. Wearing splints to help immobilize the elbow may also be recommended. Dr. Nasef might also recommend surgery to treat your ulnar nerve neuropathy. |
| – Surgical There are two surgical approaches to treat ulnar nerve entrapment: one is at the elbow and the other is at the wrist. Arthroscopically, Dr. Nasef will make an incision at the elbow and perform a nerve decompression. During this time, the nerve is moved from its place behind the elbow to a new place in front of the elbow. This is the most common procedure to treat an ulnar nerve entrapment. If he performs the surgery at the wrist, the incision is made there and the decompression is performed. Both out-patient procedures use a minimally-invasive technique and in most cases, patients are able to resume their normal activities in about 6 weeks. |
| Biceps Tendon Tear or Rupture (Elbow) |
| The biceps muscle plays a crucial role in the ability to help lift, rotate and move your upper arm. Located on the front of the upper arm just under the shoulder, the muscles are attached to the elbow and shoulder with biceps tendons. If these tendons become torn, either through a fall, a sports related injury or from extreme wear and tear, strength in the upper arm can become lost and movement in the upper arm painful. |
| There are a couple of varieties of a biceps tendon tear: – A partial tear is a tear that does not completely sever the tendon – A complete tear will fully split the tendon into separate pieces |
| Most tears are the result of on-going, continuous strain and wear and tear on the biceps muscle. This is most commonly seen in weight and strength training and usually starts with just a simple fraying of the tendon. As the injured tendon progresses, it will eventually tear. These tears can occur in two distinct ways: |
| – At the shoulder joint: A proximal biceps tendon rupture is an injury to the biceps tendon at the shoulder joint. This is the most common biceps tendon tear and typically occurs in patients 60 years of age or older. This injury creates minimal symptoms and usually will heal on its own. – At the elbow joint: A distal biceps tendon rupture is an injury at the elbow joint. It most commonly affects middle-aged men and is caused by heavy lifting or sports. Most people who suffer from this injury will need to have surgery in order to correct the problem. |
| Symptoms : |
| Symptoms associated with a torn biceps tendon include sudden, sharp upper arm pain-sometimes with a noticeable snap or popping sound. Cramping, bruising, pain and tenderness of the shoulder, biceps and elbow are common. In addition, it will most likely be difficult to turn the palm up or down. |
| Treatment: |
| It is important to note that the biceps have two attachments at the shoulder: a long head and a short head. These heads will affect the injury and treatment differently. The long head is the part that is more likely to be injured whereas the short head rarely tears. Because of this second attachment, many people can still function and use their biceps even with the long head of the biceps damaged. With that said, many people can still function with a biceps tendon tear, and only need simple treatments to relieve symptoms. |
| – Non-Surgical Treating a torn biceps tendon non-surgically will include resting the arm that is injured and avoiding any heavy lifting or the activity that may have caused the injury (i.e. weight training). Applying cold packs and ice will help with swelling and overall pain. You can also take anti-inflammatory medications and non-steroid drugs for pain relief. We will consult with you on various at-home physical therapy exercises you can do in order to help with flexibility and strength. |
| – Surgical Several new torn biceps tendon procedures are available to repair the injured tendon with minimal incisions using arthroscopic surgery. The goal of the surgery is to re-anchor the torn tendon back to the bone. Each case will vary slightly and they usually have a good prognosis. |
| Medical Epicondylitis (Golfer’s Elbow) |
| Medical epicondylitis-often referred to as “golfers elbow” is a condition marked by small tears in the tendons of the elbow area. These tears on the inside of the elbow rather than on the outside, which occurs with “tennis elbow” Golfers elbow occurs with cumulative and on-going trauma that is caused by repeated use of the arm and forearm muscles and most commonly affects men ages 20-49. Athletes and sports enthusiasts who play golf are at a higher risk for developing medical epicondylitis. |
| For golfers who take part in the sport every day or on a very regular basis, bone strength, the right technique and decreasing the intensity of play can often help keep golfers elbow at bay. |
| Symptoms : |
| Golfers elbow can make the elbow feel very stiff. The pain and tenderness associated with medical epicondylitis or golfers elbow will occur on the inside of the elbow and will intensify if lifting, extending or making a fist occurs. For some, the pain will radiate up and down the arm while for others the pain will stay primarily in the elbow itself. Numbness or tingling will often occur making the elbow area weak and stiff. |
| Treatment : |
| – Non-Surgical As with many sports-related injuries, RICE is typically the first form of treatment Dr. Nasef will recommend. If the injury is related to overuse of the wrist, eliminating the activity all together for a duration of time will often heel the injury. RICE stands for: rest, ice, compression and elevation. Over time, physical therapy might also be required to help strengthen the elbow. In some cases, a splint or brace will be recommended. |
| – Surgical If left untreated, tennis elbow may require surgical intervention. Dr. Nasef will likely perform arthroscopic elbow surgery to repair the torn tendons. The procedure is a minimally-invasive, out-patient surgery that is most often a successful course of treatment for the patient. |
| Ulnar Collateral Ligament Injury (Skier’s Thumb) |
| If you attempt to stretch out your thumb until it can’t reach any further, then you are moving the ulnar collateral ligament. This band of tough, fibrous tissue, connects the bones at the base of the thumb. Athletes often hear the term “skier’s thumb” and “gamekeeper’s thumb” Although they are similar conditions, they occur from different injuries. |
| In skiing accidents, when a skier falls while gripping the ski pole, the thumb can be jerked and pulled away from the hand. This places significant trauma and stress on the ulnar collateral ligament leading to an acute injury of the thumb. If the ulnar collateral ligament is pulled far enough, it will create a torn thumb ligament. This injury is also prevalent among baseball players who throw and catch at high speeds as well can occur with a variety of other sporting activities where the hand is being used in a forceful manner. |
| Symptoms : |
| Patients who sustain an acute tear of the ulnar collateral ligament will experience thumb pain, numbness, swelling and possibly, bruising at the base of the thumb. Grasping objects, holding things firmly and throwing items will be very hard to do if not impossible in some severe cases. |
| Treatment : |
| – Non-Surgical Treatment depends on many factors associated with the ulnar collateral ligament injury. Dr. Nasef will examine the injury and will research how long ago it occurred, the age of the patient and review the daily lifestyle of the patient. If surgery is not required-meaning, if the tear is a partial one-then Dr. Nasef will most likely place the hand in a cast or wrist splint for about 6 weeks. Rest, anti-inflammatory medication and ice will help modify the pain and treat the injury. |
| – Surgical If severe instability in the thumb area exists, or if the tear is complete, then ulnar collateral ligament reconstruction surgery will be required. In injuries concerning the ulnar collateral ligament, the sooner the surgery can be performed, the better the healing process will be overall. Dr. Nasef will repair the torn ligament ends back together. If the ligament is torn from the bone itself, it will be sutured back to the bone. If the thumb injury to the ulnar collateral ligament is older, then this surgical procedure, most likely, will not be possible. In this case, a tendon transfer will be performed to compensate for the torn ligament. |
| Following surgery, patients are required to wear a cast for about 6 weeks. Moderate exercises and movements of the thumb can then occur. Most patients are able to return to their sporting activities in roughly 3-4 months following surgery. |