ELBOW

Anatomy

The elbow and forearm form a functional unit whose primary role is to accurately position the hand in space. view 

Elbow Contusion

An elbow contusion results from blunt direct trauma and produces muscle strains and ligament sprains. view 

Ligament Tears and Elbow Fractures

Fractures about the elbow are the result of high energy injuries. view 

Forearm Compartment Syndrome

Compartment syndrome in all extremities is an orthopedic emergency. view

Elbow/Forearm Wounds/Amputations

Wounds occurring in the forearm and elbow must be treated as an emergency because the risk of infection if left open increases about 7 hours after an injury has occurred. view

Elbow Arthritis

Arthritis in the elbow can occur after an injury (post-traumatic arthritis), congenital lack of blood supply to the bone causing flaking off of the cartilage called Osteochondritis Dessicans. view

Cubital Tunnel Syndrome

Cubital tunnel syndrome is the compression of the ulnar nerve at the level of the elbow. view

Pronator Syndrome

Pronator syndrome is the compression of the median nerve around the elbow and palmar side of the forearm. Because it is the same nerve that causes carpal tunnel syndrome, there is overlap in the symptoms making the diagnosis difficult, at times. view

RTS & PIN Palsy

Radial tunnel syndrome and posterior Interosseous Nerve palsy are both a result of compression of the Posterior interosseous nerve with a more severe compression occurring in posterior interosseous nerve palsy. view

Lateral Epicondylitis, Medial epicondylitis, Distal Biceps Tendon Rupture

Lateral epicondyltis also called tennis elbow and medial epicondylitis called golfers elbow is a condition affecting the forearm muscles’ on the humeral bone at the elbow called the lateral and medial epicondylitis respectively. view

Elbow Stiffness

The cause of a stiff elbow is either at the bony level or the collagen capsule/ligament level or both. view

Elbow and Forearm Infections

The elbow, like the shoulder is well perfused with ample blood supply allowing for circulating white blood cells to offer excellent protection against infection and, consequently an elbow infection is uncommon. view

Elbow Tumors

Tumors are divided into benign and malignant types. A benign tumor is an abnormal growth of a particular cell type presenting as a mass. view

ELBOW CONTUSION

Pathology

An elbow contusion results from blunt direct trauma and produces muscle strains and ligament sprains.

Symptoms

  • Pain with muscle use
  • Bruising
  • Muscle spasms
  • Loss of elbow motion, particularly elbow extension.

Causes of Loss of Elbow Extension:

  • The mobile wad and brachialis muscle crossing the elbow joint feels more comfortable when strained if the length of the muscle is shortened, making elbow flexion the preferred position for the patient.
  • The elbow joint capsule can hold a maximum of 25 ccs of fluid. This maximal capacity is allowed with the elbow in the flexed (bent) position. Consequently, if active elbow extension is avoided, an elbow contracture will develop.

Treatment

Treatment of elbow contusions is symptomatic, similar to the treatment of contusions elsewhere in the body:

  • R.I.C.E. treatment (Rest, Ice, Compression, Elevation)
  • Anti-inflammatory treatment
  • Controlled early motion
  • Therapy

The stages of R.I.C.E. are used to treat injuries such as a strain (muscle injury) and a spring (a ligament stretch injury).

The Rest stage is usually done for 24-48 hours and can include the use of slings, splints or other types of immobilizers unless otherwise advised by a physician.

The Ice stage is used for no more than 20-30 minutes, three to four times per day. Icing treatment functions by causing the arteries to narrow the size of their lumen, which in turn decreases swelling and the pain from the subsequent increased pressure. Ice treatment is best applied by using an ice slush. Ice slush is made by mixing crushed ice with water in a bag. This The ice bag should not be placed in direct contact with the skin but instead use a buffer layer between the skin and ice bag like a towel to prevent skin freezing.

The Compression stage is the wrapping of a body part to further assist in minimizing swelling and is used in conjunction with elevation. The best compressive wrapping has multiple layers providing a cushion effect. The compression wrapping should not cause constriction of the blood supply. Constriction is recognized by increasing pain to the body part wrapped. Other signs of a tight compressive dressing are:

  • A cold sensation in the wrapped limb
  • Blue discoloration of the body part
  • Any change in color from the natural skin color of the body part

The Elevation stage of treatment is best done by elevating the limb to the level of the heart. If elevation is lower than this, the effects of gravity on the veins will increase vein pressure and cause the blood to have difficulty traveling back to the heart. This can result in limb swelling.

The use of anti-inflammatory medication helps treat the pain, swelling, and inflammation occurring after injury.

Examples of anti-inflammatories include:

  • Aspirin products
  • Naprosyn
  • Mobic
  • Indocin
  • Arthrotec
  • Celebrex
  • Ibuprofen: Motrin/Advil

All of these medications have side effects and should be taken with this knowledge in mind. Prescriptions should be discussed with your pharmacist and physician.

Controlled early motion and therapy to the involved limb decreases the effects of prolonged immobilization.

Effects of Prolonged Immobilization

  • Stiffness
  • Muscle atrophy
  • Weakness
  • Longer return to pre-injury state

The type of therapy recommended will depend on the tissue type injured and the severity of the injury. Consult your surgeon for the best advice.

The home exercise program for the elbow focuses on avoiding an elbow contracture with the occasional use of splints, called static progressive splints, to assist in progressively regaining elbow motion.