Elbow Conditions

We treat the following elbow conditions:

• Cubital Tunnel Syndrome
• Ulnar Nerve Compression
• Arthritis
• Dislocations
• Reflex Sympathetic Dystrophy
• Tendinitis and Tennis Elbow

Cubital Tunnel Syndrome

The cubital tunnel is a narrow tube of tissue at your elbow that contains the ulnar nerve. The ulnar nerve runs from your shoulder down to your wrist and controls movement in your ring and pinky fingers. Cubital Tunnel Syndrome is a type of nerve entrapment that forms when this tunnel swells, putting pressure on the ulnar nerve, causing pain and numbness in the hand and fingers.

Cubital tunnel syndrome can cause the following symptoms:

• Tingling in the ring and pinky fingers, making it more difficult to use them
• Numbness in the ring and pinky fingers
• Weakness in the hands

The cubital tunnel is more likely to swell if

• You sleep or lean on your elbow for too long
• You bend the elbow back and forth repeatedly
• Fluid builds up in the elbow
• You hit or fall on the elbow with force

Other conditions that can contribute to the development of cubital tunnel syndrome include elbow arthritis, fractures, cysts, and bone spurs.

Treatment

Treatment for cubital tunnel syndrome depends on how severely your nerve is compressed and whether you are beginning to develop muscle weakness. Nonsurgical treatment options may include

• Braces
• Splints
• Injections of steroids or anti-inflammatory medications
• Physical therapy

If nonsurgical treatment does not relieve your symptoms, or your muscles are weakening too much, you may need surgery. Surgical options can relieve symptoms by:

• Widening the cubital tunnel to release the pressure on your nerve
• Moving the nerve so it is more protected from injury

 Learn more about MedStar Health’s approach to minimally invasive nerve surgery.

Ulnar Nerve Compression

The ulnar nerve is what people commonly call the funny bone. It fits in a groove in the bottom of the elbow and is very vulnerable to stress, trauma, or overuse. Ulnar nerve compression can cause a lack of sensation, muscular weakness, and shooting pain from the elbow down to the pinkie and ring finger. Numbness and tingling in ring and pinkie fingers are the most common symptoms.

Treatment

Nonsurgical treatments such as splints, oral anti-inflammatory medications, and adjustments in daily activities are typically pursued as the initial course of action. If the swelling around the nerve does not respond to nonsurgical treatments, surgery may be recommended.

Arthritis

Arthritis is an inflammation of the tissues that line your joints. This inflammation can cause pain, swelling, and joint damage. Types of arthritis that most often affect your elbow include:

• Osteoarthritis: The natural aging process can wear away at the protective cartilage that allows the many bones in your elbow to move smoothly, causing inflammation, swelling, and pain.
• Rheumatoid arthritis: This immune system dysfunction attacks and wears away at the cartilage lining between the bones in your elbow. Rheumatoid arthritis generally affects the joints on both hands and is less likely to affect your elbow.

Elbow arthritis symptoms generally include:

• Pain
• Limited ability to move elbow
• Swelling
• Numbness or tingling in ring and pinky fingers

Along with the symptoms above, rheumatoid arthritis can also cause:

• A weak grip
• Difficulty using the hand
• Pain in the knuckles
• Fatigue
• Weight loss
• Fever

The surgeons at MedStar Health have the expertise to help you overcome any challenge your arthritis presents. We treat the entire spectrum of arthritis disorders—from early-stage management to end-stage joint replacement—and offer advanced arthritis treatment options, including the latest arthroscopic and minimally invasive surgical techniques.  We will work with you to develop a treatment plan tailored to your individual needs and the demands of your daily life.

Dislocations

An elbow dislocation occurs when any of the elbow bones are moved out of place. Falling with force onto your hand can push elbow bones out of place; this is the most common cause of cause an elbow dislocation. In some cases, elbow bones may fall back into place on their own, but still cause some pain or bruising.

Dislocating any of the bones of the elbow can cause the following symptoms:

• Pain and swelling
• Bruises
• Inability to bend or move the elbow
• Lack of feeling in the fingers
• Arm looks obviously bent out of shape

To treat an elbow dislocation, our specialists will immediately perform a reduction maneuver.

In some cases, elbow dislocations require surgery. If your injury caused your bones to shift out of place or break through the skin, you may need surgery to restore the proper alignment and avoid infection. If your injury crushed portions of your bone, your surgeon may need to replace the lost bone with bone filler, which is human or artificial bone replacement material.

Reflex Sympathetic Dystrophy

Reflex sympathetic dystrophy (RSD) is a condition of chronic, burning pain; stiffness; swelling; sweating; and discoloration of the hand or arm that may become disabling. It occurs from over-activity in the sympathetic (unconscious) nervous system that controls the blood flow, sweat glands, and other involuntary bodily functions. Additionally, a patient with RSD who sustains an injury usually feels a greater amount of pain than a person without RSD who has sustained the same injury.

RSD has three stages:

• Acute: May last up to three months. Symptoms include pain and swelling, increased warmth and redness in the affected part/limb, and excessive sweating.
• Dystrophic: Can last three to 12 months. Swelling is more constant, skin wrinkles disappear, skin temperature becomes cooler, and fingernails become brittle. Pain is more widespread, stiffness increases, and the affected area becomes sensitive to touch.
• Atrophic: Lasts one year or more. The skin of the affected area is now pale, dry, tightly stretched and shiny. The area is stiff, pain may decrease, and the chance of getting motion back is decreased.

Causes

In some cases, the cause of RSD is unknown. RSD may follow a sprain, fracture, injury to nerves or blood vessels, or the symptoms may appear after a surgery. Other causes include pressure on a nerve, infection, cancer, neck disorders, stroke, or heart attack.

Treatment

The pain of RSD may be severe, resulting in physical and psychological alterations. A coordinated multidisciplinary approach to treatment is best, which may include medication (oral and injections), physical or occupational therapy, and/or surgery.

Tendinitis and Tennis Elbow

The tissues that attach your bones to your muscles are called tendons. When your muscles flex, tendons spring into action, helping to move your bones. It is easy to injure the tendons in the arms and hands, since we use them so often. Tendinitis is an inflammation of a tendon that causes pain near a joint. It generally develops when an accident or injury cuts or damages the tendon.

Tennis elbow is the common term for one of the most common types of tendinitis. It is an overuse injury that causes an inflammation of the tendon fibers that attach the forearm muscles to the outside of the elbow. As the name suggests, tennis players, as well as golfers and other athletes, often suffer from this type of tendinitis. But tennis elbow can also affect you if you twist your wrist repeatedly on a regular basis, or if you type on a computer keyboard without proper support.

Although tendinitis and tennis elbow can be painful, the good news is that it rarely becomes chronic if caught early and treated properly with the following

• Rest
• Ice
• Cortisone injections
• Ceasing or changing your activity
• Elbow supports
• Anti-inflammatory medicines

 

Repetitive strain injuries (non-specific forearm pain, overuse syndrome)

Some conditions may be caused by repeated movement of the elbow. As for any other part of the body, the term repetitive strain injury (RSI) may be used to describe the cause of the condition. RSI is also known as non-specific forearm pain or overuse syndrome. Types of RSI in the elbow include tennis elbow and golfer’s elbow.

Tennis elbow

Tennis elbow is a condition in which the tendons that attach the extensor muscles to the lateral epicondyle become painful. It’s also known medically as lateral epicondylitis (itis = inflammation).

However, this may be misleading as the cause may be tendon degeneration rather than inflammation. Although tennis elbow is painful it shouldn’t cause any lasting damage and doesn’t lead to arthritis. Anybody can develop tennis elbow, but it’s most common between the ages of 40–60.

Despite its name, tennis elbow isn’t just caused by playing tennis. It’s an overuse injury linked with activities that involve repetitive extension of the wrist and hand. People who are continually gripping and twisting – for example carpenters and plasterers, or people who use a computer mouse – are more likely to get it. Almost 80% of people recover with basic treatment.

What are the symptoms?

The main symptoms are:

• pain on the lateral epicondyle (the bony area on the outside of your elbow)
• increased tenderness when pressure is applied on the outside of your elbow
• pain when gripping.

The level of pain can vary from person to person, ranging from a mild discomfort to a severe ache that prevents you from sleeping. Repetitive movements of the wrist will make your symptoms worse, especially if combined with a weight (for example if you’re lifting heavy boxes).

 

Golfer’s elbow

Golfer’s elbow is a similar condition to tennis elbow, but it affects the medial epicondyle on the inside of the elbow. It’s also known as medial epicondylitis, and it doesn’t affect the elbow joint. It’s caused by wear and tear in the tendon that attaches the flexor muscles to the medial epicondyle.

Like tennis elbow, golfer’s elbow isn’t specifically caused by playing golf but certain activities that involve repeatedly flexing and twisting your forearm, wrist and hand and a tight grip can make the condition worse.

What are the main symptoms?

The main symptoms of golfer’s elbow are:

• pain on the medial epicondyle (the bony area on the inside of your elbow)
• pain when gripping. 

 

Olecranon bursitis

Olecranon bursitis occurs when the bursa at the back of the elbow becomes swollen and inflamed. Bursae are normal structures which are found where parts of the body move over one another, for example where tendons or ligaments pass over bones. They help to reduce friction. Normally they don’t swell up, but when they become inflamed or infected they can become swollen and painful.

The olecranon is the bony tip you can feel on your elbow. It has a bursa between the bone and the skin. Olecranon bursitis most commonly occurs in people who get repetitive friction over the back of their elbow, for example if you often lean your elbows on a chair or table. Some people who have gout or rheumatoid arthritis can get inflammation of the bursa without any external pressure.

What are the symptoms?

The main symptoms of olecranon bursitis are:

• swelling, pain and warmth over the bony part at the back of the elbow
• restricted movement of the elbow.

Most cases are caused by inflammation but occasionally bacteria can cause the bursa to become infected. If the condition is caused by an infection, your doctor will prescribe a course of antibiotics for you. 

Compression/entrapment syndromes

If the nerves that travel across your elbow into your forearm (the median, radial and ulnar nerves) are trapped (compressed) it can cause many different symptoms, ranging from pain or pins and needles in your forearm to weakness and wasting of your muscles. These are called compression or entrapment syndromes.

The symptoms produced vary depending on where the nerve is compressed. The median nerve can get trapped near your elbow or, more commonly, your wrist. The ulnar nerve is more commonly trapped around the elbow but can also be trapped at the wrist. 

Cubital tunnel syndrome

Cubital tunnel syndrome is caused by the ulnar nerve being squeezed where it passes around the inside edge of elbow. The compression may be a result of the normal coverings of the tunnel tightening, but rarely it can be due to abnormal bone formation caused by arthritis in the area. Other causes can include a fracture around the nerve which has healed into an abnormal position or excess bone forming when the fracture heals.

What are the symptoms?

The main symptoms of cubital tunnel syndrome are:

• tingling and numbness of your ring and little finger after your elbow has been kept bent (flexed) for long periods or you’ve been resting on the inner edges of your elbows – as the condition progresses the symptoms can come on after shorter periods
• weakness of the small muscles of your hand, causing your ring and little fingers to become claw-like – this only happens if it’s left untreated

Radial tunnel syndrome

Radial tunnel syndrome is similar to cubital tunnel syndrome but is caused by the radial nerve being compressed below the elbow. It is however extremely rare.

Radial tunnel syndrome is normally self-limiting, which means it’ll eventually get better on its own.

What are the symptoms?

The main symptom of radial tunnel syndrome is pain starting from the outside of the elbow and running down to the forearm. Because this type of pain also occurs in tennis elbow the two can be confused, but with radial tunnel syndrome there’s no tenderness on the lateral epicondyle – the problem is further down the arm.

Distal biceps rupture

The biceps is the main muscle on the front of the upper arm. Its upper (proximal) end is attached at the shoulder and its lower (distal) end is attached to the upper part of the radius by a tendon very close to the elbow joint. A distal biceps rupture is caused if this tendon tears, which can happen if you’ve lifted a heavy weight. You may have even heard the tendon snapping.

What are the symptoms?

The symptoms of a distal biceps rupture are:
• pain in the elbow (although this eases)
• bruising around the elbow and forearm within a few hours to days after lifting the weight
• the bicep changing shape and shifting up towards the shoulder – this is commonly called the Popeye sign
• difficulty in twisting the forearm to turn the palm upwards – your arm will feel weak compared to the unaffected arm when doing this.

Distal biceps rupture should be treated as an emergency requiring urgent surgical repair.

A similar condition can occur in the triceps, the muscle at the back of the arm. This is called a distal triceps rupture and it can cause pain and swelling at the back of the elbow, and reduce the movement in your elbow. It’s uncommon, but it can be caused by falling onto an outstretched hand.

 

Athletic Throwing Injuries

Common Throwing Injuries of the Elbow

When athletes throw repeatedly at high speed, the repetitive stresses can lead to a wide range of overuse injuries. Problems most often occur at the inside of the elbow because considerable force is concentrated over the inner elbow during throwing.

Reproduced with permission from Ahmad CS, ElAttrache NS: Elbow valgus instability in throwing athletes. Orthopaedic Knowledge Online Journal 2004. Accessed December 2012.

Flexor Tendinitis

Repetitive throwing can irritate and inflame the flexor/pronator tendons where they attach to the humerus bone on the inner side of the elbow. Athletes will have pain on the inside of the elbow when throwing, and if the tendinitis is severe, pain will also occur during rest.

Ulnar Collateral Ligament (UCL) Injury

The ulnar collateral ligament (UCL) is the most commonly injured ligament in throwers. Injuries of the UCL can range from minor damage and inflammation to a complete tear of the ligament. Athletes will have pain on the inside of the elbow, and frequently notice decreased throwing velocity.

Valgus Extension Overload (VEO)

During the throwing motion, the olecranon and humerus bones are twisted and forced against each other. Over time, this can lead to valgus extension overload (VEO), a condition in which the protective cartilage on the olecranon is worn away and abnormal overgrowth of bone — called bone spurs or osteophytes — develop. Athletes with VEO experience swelling and pain at the site of maximum contact between the bones.

The abnormal bone growth of VEO is apparent in these illustrations of the back of the elbow and inner side of the elbow.

Reproduced with permission from Miller CD, Savoie FH III: Valgus extension injuries of the elbow in the throwing athlete. J Am Acad Orthop Surg 1994; 2:261-269.

Olecranon Stress Fracture

Stress fractures occur when muscles become fatigued and are unable to absorb added shock. Eventually, the fatigued muscle transfers the overload of stress to the bone, causing a tiny crack called a stress fracture.

The olecranon is the most common location for stress fractures in throwers. Athletes will notice aching pain over the surface of the olecranon on the underside of the elbow. This pain is worst during throwing or other strenuous activity, and occasionally occurs during rest.

Ulnar Neuritis

When the elbow is bent, the ulnar nerve stretches around the bony bump at the end of the humerus. In throwing athletes, the ulnar nerve is stretched repeatedly, and can even slip out of place, causing painful snapping. This stretching or snapping leads to irritation of the nerve, a condition called ulnar neuritis.

Throwers with ulnar neuritis will notice pain that resembles electric shocks starting at the inner elbow (often called the "funny bone") and running along the nerve as it passes into the forearm. Numbness, tingling, or pain in the small and ring fingers may occur during or immediately after throwing, and may also persist during periods of rest.

Ulnar neuritis can also occur in non-throwers, who frequently notice these same symptoms when first waking up in the morning, or when holding the elbow in a bent position for prolonged periods.

Cause

Elbow injuries in throwers are usually the result of overuse and repetitive high stresses. In many cases, pain will resolve when the athlete stops throwing. It is uncommon for many of these injuries to occur in non-throwers.

In baseball pitchers, rate of injury is highly related to the number of pitches thrown, the number of innings pitched, and the number of months spent pitching each year. Taller and heavier pitchers, pitchers who throw with higher velocity, and those who participate in showcases are also at higher risk of injury. Pitchers who throw with arm pain or while fatigued have the highest rate of injury.

Symptoms

Most of these conditions initially cause pain during or after throwing. They will often limit the ability to throw or decrease throwing velocity. In the case of ulnar neuritis, the athlete will frequently experience numbness and tingling of the elbow, forearm, or hand as described above.

Biceps Tendon Tear Elbow

Biceps Tendon Tear at the Elbow

The biceps muscle is located in the front of your upper arm. It is attached to the bones of the shoulder and elbow by tendons — strong cords of fibrous tissue that attach muscles to bones.

Tears of the biceps tendon at the elbow are uncommon. They are most often caused by a sudden injury and tend to result in greater arm weakness than injuries to the biceps tendon at the shoulder.

Once torn, the biceps tendon at the elbow will not grow back to the bone and heal. Other arm muscles make it possible to bend the elbow fairly well without the biceps tendon. However, they cannot fulfill all the functions of the elbow, especially the motion of rotating the forearm from palm down to palm up. This motion is called supination.

To return arm strength to near normal levels, surgery to repair the torn tendon is usually recommended. However, nonsurgical treatment is a reasonable option for patients who may not require full arm function.

Anatomy

The biceps muscle has two tendons that attach the muscle to the shoulder and one tendon that attaches at the elbow. The tendon at the elbow is called the distal biceps tendon. It attaches to a part of the radius bone called the radial tuberosity, a small bump on the bone near your elbow joint.

The biceps muscle helps you bend and rotate your arm. It attaches at the elbow to a small bump on the radius bone called the radial tuberosity.

Reproduced and modified from The Body Almanac © American Academy of Orthopaedic Surgeons, 2003.

Description

Biceps tendon tears can be either partial or complete.

Partial tears. These tears damage the soft tissue but do not completely sever the tendon.

Complete tears. A complete tear will detach the tendon completely from its attachment point at the bone.

In most cases, tears of the distal biceps tendon are complete. This means that the entire muscle is detached from the bone and pulled toward the shoulder.

A complete tear of the distal biceps tendon. The tendon has pulled away from where it attached at the radial tuberosity.

Modified from Bernstein J (ed): Musculoskeletal Medicine. © American Academy of Orthopaedic Surgeons, 2003.

Other arm muscles can substitute for the injured tendon, usually resulting in full motion and reasonable function. Left without surgical repair, however, the injured arm will have a 30% to 40% decrease in strength, mainly in twisting the forearm (supination).

Rupture of the biceps tendon at the elbow is uncommon. It occurs in only three to five people per 100,000 each year, and rarely in women.

Cause

The main cause of a distal biceps tendon tear is a sudden injury. These tears are rarely associated with other medical conditions.

Injury

Injuries to the biceps tendon at the elbow usually occur when the elbow is forced straight against resistance. It is less common to injure this tendon when the elbow is forcibly bent against a heavy load.

Lifting a heavy box is a good example. Perhaps you grab it without realizing how much it weighs. You strain your biceps muscles and tendons trying to keep your arms bent, but the weight is too much and forces your arms straight. As you struggle, the stress on your biceps increases and the tendon tears away from the bone.

Risk Factors

Men, age 30 years or older, are most likely to tear the distal biceps tendon.

Additional risk factors for distal biceps tendon tear include:

Smoking. Nicotine use can affect tendon strength and quality.

Corticosteroid medications. Using corticosteroids has been linked to increased muscle and tendon weakness.

Symptoms

A distal biceps tendon tear can cause the muscle to ball up near the shoulder. Bruising at the elbow is also common.

There is often a "pop" at the elbow when the tendon ruptures. Pain is severe at first, but may subside after a week or two. Other symptoms include:

• Swelling in the front of the elbow
• Visible bruising in the elbow and forearm
• Weakness in bending of the elbow
• Weakness in twisting the forearm (supination)
• A bulge in the upper part of the arm created by the recoiled, shortened biceps muscle
• A gap in the front of the elbow created by the absence of the tendon

• Nursemaid's Elbow

Nursemaid's Elbow

Nursemaid's elbow is a common injury of early childhood. It is sometimes referred to as "pulled elbow" because it occurs when a child's elbow is pulled and partially dislocates. The medical term for the injury is "radial head subluxation."

Because a young child's bones and muscles are still developing, it typically takes very little force to pull the bones of the elbow partially out of place, making this injury very common. It occurs most often in children ages 1 to 4, but can happen any time from birth up to age 6 or 7 years old.

Although the injury may cause initial pain, a doctor or other healthcare professional can easily reset the elbow, quickly relieving any discomfort and restoring arm movement.

Anatomy

The elbow is made up of the upper arm bone (humerus) and the two bones in the forearm (radius and ulna).

On the inner and outer sides of the elbow, strong ligaments hold the elbow joint together and work to prevent dislocation.

There are two joints in the elbow:

• The humeroulnar joint between the ulna and humerus allows for bending of the elbow.
• The radiocapitellar joint, made up of the radius and part of the humerus, allows for rotation of the forearm so that the hand can be turned palm up or palm down.

The radiocapitellar joint is involved in nursemaid's elbow.

(Left) The bones of the elbow and forearm shown with the palm facing forward. (Right) The ligaments of the elbow. In young children, the annular ligament may be weak, making it easier for the radius to slip out of place.

Reproduced with permission from J Bernstein, ed: Musculoskeletal Medicine. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2003.

Description

Nursemaid's elbow occurs when there is a partial separation of the radiocapitellar joint. Because a young child's ligaments - the strong tissues that attach bones to each other-are not fully formed, even a mild force on the joint may cause it to shift, or partially dislocate.

The annular ligament surrounds the radius and may be particularly loose in some young children, which may lead to nursemaid's elbow recurring over and over again.

Cause

Nursemaid's elbow often occurs when a caregiver holds a child's hand or wrist and pulls suddenly on the arm to avoid a dangerous situation or to help the child onto a step or curb. The injury may also occur during play when an older friend or family member swings a child around holding just the arms or hands.

Nursemaid's elbow is rarely caused by a fall. If a child injures the elbow when falling onto an outstretched hand or directly onto the elbow, it may be a broken bone rather than nursemaid's elbow.

Symptoms

Because moving the injured arm may be painful, the primary symptom of nursemaid's elbow is that the child will hold the arm still at his or her side, and refuse to bend the elbow or use the arm.