Elbow Conditions
About the Elbow
The elbow is a complex joint, that works as both a hinge (for flexing and extending of the arm) as well as a rotator of the forearm. Even subtle injuries can lead to misalignment of the elbow biomechanics, and symptoms like pain and stiffness. There are number of key structures in the elbow, which can be affected in this way.
The Cartilage – Osteoarthritis
In order for the elbow joint to move freely, the bony components of hinge (humerus above, radius and ulna below) and the rotator (humerus above, radius below) must have smooth movement. This friction free gliding is facilitated by cartilage – which covers the bone. Unfortunately, cartilage does not regenerate very well, and over time natural wear and tear results in thinning, and eventual loss of the cartilage in your elbow. This leads to bone on bone articulation, and is known as osteoarthritis. It can result in both pain and stiffness in the elbow. Sometimes, with severe osteoarthritis, small fragments of bone can become loose within the elbow joint, and these can lead to locking, catching and clicking. There are non-operative ways to treat this arthritis such as steroid injections and physiotherapy, as well as surgical treatments like joint replacement – either a hemi or total elbow replacement. Sometimes for loose bodies, a small keyhole (arthroscopic) procedure can be performed to remove the floating bits of bone as well.
The Nerve – Cubital Tunnel Syndrome
The nerve which controls most of the muscle function of the hand, as well as the sensation to the ring and little finger runs around the inside of the elbow. It is commonly compressed, and if left untreated can result in numbness or tingling, weakness and clumsiness of the hand and wasting. A decompression of this nerve (the ulnar nerve) via an open incision will help improve these symptoms of numbness and weakness, as well as prevent further irreversible loss of function.
Lateral Epicondylitis or Tennis Elbow
This is a very painful condition of the outside of the elbow. If often occurs from overuse, and is the result of excessive force travelling up the back half of the forearm, and coalescing into a single point at the lateral epicondyle of the elbow. It is named “Tennis Elbow” as it was seen in tennis players who employed a single handed backhand - the last flick of the wrist in extension would over-exert the forearm extensors, leading to recurrent swelling, inflammation and eventual tearing of the muscles at the elbow.
Treatment of lateral epicondylitis is very challenging. Non operative treatment includes use of a counterforce brace, non steroidal anti-inflammatories and hand therapy/physiotherapy.
In refractory cases, after appropriate work up, there is some newer literature which would support the use of PRP injections into the lateral epicondyle. Not all conditions in the upper limb will benefit from PRP - but lateral epicondylitis is one of the few conditions where there is the literature to support its use. Studies suggest that improvement in symptoms is variable - it is not a magic cure, but an option which may help! PRP injection is treatment which Mr Lau is happy to offer at the Fitzroy campus of VBJS - see attached link for further information. PRP Injection Protocol
Lastly, in a small minority of patients, surgery including common extensor debridement and reattachment may be considered, but is rarely offered.