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  • Biceps Tendonitis

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    Biceps Tendonitis

    The biceps muscle at the front of the upper arm, used to raise the arm and bend the elbow, is attached to both the shoulder and the elbow by means of tendons, tough cords of a connective tissue called collagen. Tendons pull on bones when muscles are contracted, causing movement of the bone. If the tendon is injured it can cause pain or inflammation. This condition is called biceps tendonitis, although it may also be known as tendinopathy if there is pain but no inflammation.

    The proximal (nearest the trunk of the body) end of the biceps muscle has two tendons, one that attaches the muscle to the upper side of the shoulder socket, and another that attaches to a bony protuberance on the shoulder blade called the coracoid process.

    At the distal (furthest from the trunk of the body) end of the biceps, the biceps tendon attaches to the radius, one of the two bones in the forearm.

    The proximal biceps tendons are more likely to be injured than the distal tendon.

    Biceps tendonitis occurs when some or all of the fibers that make up the tendon become frayed or broken. This leads to pain, weakness, and impaired function of the biceps muscle. Tendon strands can heal themselves with time, but if the muscle is not rested the tendon fiber cells do not have time to regenerate and tendonitis can develop.

    Causes:
    The two main causes of biceps tendonitis are overuse and injury. The natural aging process weakens tendons and makes them more vulnerable to injury, as does smoking or taking corticosteroid medication. If your occupation requires much lifting or raising your arms above your head you may also be at increased risk of developing tendonitis. Athletes such as swimmers or tennis players may damage their biceps tendons due to repetitive and excessive overhead motions.

    Traumatic tearing of the tendons may happen during a fall or lifting too heavy a weight, or it may be a symptom of another underlying problem such as a rotator cuff injury or a torn ligament that usually holds the tendon in position.

    Symptoms:
    • Sharp pain at the moment of injury
    • Possible ‘popping’ sound at the moment of injury
    • Aching pain as the tendonitis gradually worsens
    • Pain may become worse at night, and with certain movements
    • Tenderness to touch at the site of injury
    • Muscle weakness in the shoulder or elbow
    • Decreased ability to turn the palm up or down
    • Possible bruising in the upper arm
    • Possible bulge in the arm above the elbow if the tendon is completely ruptured, known as a ‘Popeye Muscle’
    Diagnosis:
    Your doctor will ask you about your medical history, including any previous injuries to your shoulder or arm. Your general lifestyle, activities, and participation in sport will be discussed. You will be asked about the circumstances of your current injury and the onset, duration, and severity of your symptoms.

    Your shoulder and arm will be physically examined. A complete tendon rupture is often easily diagnosed, as the arm will exhibit the characteristic ‘Popeye Muscle’ bulge. You may be asked to move your arm in certain ways as pain caused by such movements can indicate a partial tendon tear.

    X-rays may be taken because although they do not show tendons, they can reveal other conditions that may be causing your symptoms. Ultrasound can assist with diagnosis. It is possible that you will have an MRI (magnetic resonance imaging) scan as these create clear images of soft tissues such as tendons, and will show any damage.

    If treatment has not alleviated your symptoms, a surgical technique called arthroscopy may be used to assess your condition. In such cases any surgical repair necessary might be performed at the same time.

    Treatment:
    Most biceps tendon tears will recover in time, without surgery. In rare cases conventional treatment will not relieve symptoms, and for some people such as athletes or those whose occupations require repeated lifting or overhead movements, surgery may be necessary.

    Conservative (non-surgical) treatment of biceps tendonitis consists of:

    Rest:
    Avoid any activities that make your symptoms worse, particularly raising your arm overhead or lifting heavy objects. You may want to wear a sling temporarily to support your arm.
    Ice:
    Applying ice, crushed in a bag and wrapped in a towel, to the damaged area for as long as is comfortable, several times a day, will help to reduce swelling and inflammation.
    NSAIDs:
    Non-steroidal anti-inflammatory drugs such as ibuprofen (Advil), naproxen (Aleve) or aspirin can be taken to relieve pain and inflammation.
    Physical therapy:
    After the acute stage of the injury you can begin a graduated program of exercises to restore flexibility and improve strength in your arm.

    If surgery is considered necessary, the best procedure for your particular injury would be discussed with you. Surgical repair of a partially or completely torn tendon is performed arthroscopically whenever possible, using narrow instruments inserted through small incisions around the site of damage. This is a minimally invasive technique and results in a shorter recovery time than conventional surgery. Surgically reattaching a biceps tendon is usually a very successful operation. You would need to gradually rehabilitate your arm using exercises and other techniques, as recommended by your physical therapist.

    Exercises:
    When doing these exercises you should feel nothing more than a very mild pain. If you feel a sharp pain you must stop immediately. It is helpful to warm the shoulder before beginning by either taking a shower or using a heat pack.
    Pendulum:
    Standing or sitting, let your arm hang down at your side. Allow your arm to swing from side to side and back and forth, then in small circles. Keep the distances short. Repeat this exercise for 3-7 days then add a small weight (1-2 lbs). Gradually increase the range of motion.
    Wall walking:
    Standing and facing a wall that is about three-quarters of your arm’s length away, walk your fingers up the wall. Do not use your shoulder muscles to achieve this - just your fingers. You should be able to gradually increase the height that your fingers reach.

  • Cubital Tunnel Syndrome Braces?

    Cubital Tunnel Syndrome Braces?

    Cubital Tunnel Syndrome is the name given to a condition where the ulnar nerve that travels down the arm becomes irritated by being compressed or stretched.

    The ulnar nerve begins in the neck and ends at the little finger side of the hand. As it passes through the elbow joint it travels through a narrow tunnel (the cubital tunnel) under the bo ny bump on the inside of the elbow. The bump is the medial epicondyle, otherwise known as the funny bone. At this point the nerve, in the cubital tunnel, is very close to the skin and has little soft tissue for protection. Although the nerve can become compressed or irritated at any point along its length, it is most likely to happen as it passes through the cubital tunnel at the elbow, and is often caused by a prolonged stretching of the nerve (when the elbow is fully bent) or pressure on the nerve.

    Symptoms of cubital tunnel syndrome include pain, swelling, tingling or numbness in the ring and little fingers, and weakness of the hand. Bending the elbow exacerbates the symptoms, and people who sleep with their elbows bent or their arms up by their head can find that the problem persists or worsens.

    Wearing a brace that restricts movement of the elbow while the nerve heals can be extremely beneficial. For severe cases, the brace can initially be worn at all times, and as painful symptoms lessen, just at night. Please follow your medical practitioner’s advice on when to use the brace. The purpose of the brace is to prevent full extension and flexion (stretching and bending) of the elbow so as to decrease irritation of the nerve and allow it to heal, thereby reducing pain. It is, however, desirable to allow for some movement of the elbow during the night.

    There are several cubital tunnel syndrome braces on the market. The brace can be a rigid, thermoplastic splint molded to provide an optimum degree of flexion to the elbow. The correct amount of flexion (30–45 degrees, similar to a ‘handshake’ position) minimizes pressure on the ulnar nerve. Another option is a soft elbow splint that has an aluminum or thermoplastic stay. The advantage of thermoplastic is that it can be heated and molded to the desired degree of flexion. For comfort and the best fit, braces for cubital tunnel syndrome should have a soft, padded liner next to the skin, and be held in place by adjustable straps that can be tightened if the brace begins to slip. Try to avoid a brace that has a compression strap running over the elbow itself, as this will put pressure on the nerve. Many models are available in a short or long length. Be aware that the longer length may also be wider in diameter.

    Ask your medical practitioner about a brace for cubital tunnel syndrome, and speak with a qualified salesperson who will help you choose the best one.

  • Elbow Arthritis

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    Elbow Arthritis

    Arthritis is chronic (long lasting) inflammation of a joint. There are several forms of the disease, but all are characterized by the progressive loss of cartilage in a joint.

    The elbow is a hinged joint formed by the articulation of three bones, the humerus of the upper arm and the radius and ulna of the forearm. Each articulating surface is covered with protective smooth cartilage that cushions the bones and enables them to slide across each other without friction. The conformation of the bone ends that form the elbow, and the strength of the supporting ligaments result in a joint that usually articulates evenly. With age and use this articular cartilage deteriorates, leaving bone surfaces exposed. Bones often respond by growing more bone, decreasing the distance between them. Eventually movement of the elbow joint causes the bones to rub directly against each other, triggering inflammation, pain and deformity, the condition known as osteoarthritis. Osteoarthritis is a progressive condition also known as degenerative joint disease and is more likely to develop when a person is aged 50 or over.

    Rheumatoid arthritis is an autoimmune condition that results in inflammation of the synovial membrane, a tissue that lines the joints. The term autoimmune means that for unknown reasons the body attacks its own healthy tissues. With rheumatoid arthritis the synovial membrane becomes thickened, and the synovial fluid (a nourishing substance that lubricates the joint) increases, leading to pressure within the elbow. The membrane then begins to produce pannus, an abnormal, gritty tissue that destroys the cartilage. Without treatment, exposed bone ends eventually become fused and the joint ceases to function. Rheumatoid arthritis is the most commonly diagnosed arthritis in the elbow, and is likely to affect both arms.

    Juvenile rheumatoid arthritis (JRA) is an autoimmune disease that begins when a child is under the age of 16. It commonly affects the elbows, destroying articular cartilage in the manner described above.

    Gouty arthritis is caused by the accumulation of urate crystals in the elbow joint. Symptoms normally develop in the toes first, but subsequent attacks may produce symptoms in the elbows.

    Pseudogout arthritis is similar to gouty arthritis, but is caused by the accumulation of calcium deposits.

    Causes:
    Arthritis is caused by the loss of articular cartilage that leads to bones having direct contact with each other as they move.

    A previous injury to the elbow, such as a dislocation or fracture, is the most likely cause of osteoarthritis later in life. This is particularly so if the elbow needed surgical repair, or some of the cartilage was lost.

    Other risk factors are:
    Age: Cartilage degenerates over time and with use, becoming thinner and more brittle, and therefore more vulnerable.
    Infection or illness: Inflammation caused by an infection can result in arthritis.
    Occupation: Some occupations or sports that involve repetitive movements of the elbow are more likely to cause stress or overuse injuries that may lead to osteoarthritis.
    Heredity: A family history of arthritis increases the risk of developing the disease.

    Symptoms:
    Arthritis is a progressive disease, and symptoms usually appear gradually. The most common symptoms are:
    • Pain felt in the elbow joint, worse as the disease progresses
    • Stiffness, particularly with arthritis developed after injury
    • Loss of full range of motion
    • Instability, making normal activities more difficult
    • Grating sensation on bending or straightening the elbow
    • Possible ‘locking’ of the joint at a certain angle
    • Swelling of the elbow, more likely with rheumatoid arthritis
    • Numbness felt in the little and ring fingers, if the arthritis is severe
    Symptoms tend to be worse in the morning, or after not moving the elbow for a length of time. Any activity that involves bending the elbow is likely to increase the pain, and there may be a feeling of weakness in the joint. The weather can also affect the level of pain for some people, with cold and damp weather making it worse.

    Diagnosis:
    After your doctor has asked about your medical history, including the details of any previous injury to your elbow, he or she will discuss your current symptoms. The elbow will then be physically examined. Stability and range of motion will be evaluated, and any swelling or numbness noted.

    X-rays will reveal the presence of arthritis. Other diagnostic tests such as CT (computed tomography) or MRI (magnetic resonance imaging) scans are usually not necessary.

    Treatment:
    Treatment for arthritis of the elbow is primarily aimed at relieving symptoms and increasing function. The precise plan of treatment will depend on your medical history, your overall health, your desired level of future activity, and the severity of your arthritis.

    The use of Tylenol (acetaminophen) and NSAIDs (non-steroidal anti-inflammatory drugs) can be helpful, as can cortisone injections, although the cumulative side effects of the corticosteroids mean that only a few injections may be given each year. Your doctor may prescribe stronger drugs for rheumatoid arthritis. Some research has shown that taking supplements such as glucosamine and chondroitin, and receiving saline injections into the elbow are not effective treatments. That being said, if these measures provide relief and if your doctor agrees, you should use them.

    Applying heat or cold to the elbow may help with your symptoms, and using an elbow splint can provide support. If the arthritis is severe enough to limit normal movements, special devices can be obtained that reduce the stress placed on the joint.

    If conservative treatment for arthritis fails, surgery might be indicated. Surgery can be used to repair torn cartilage, remove loose fragments of cartilage in the joint, graft new cartilage onto the bones, replace severely damaged cartilage with other materials such as metal and plastic, smooth rough areas of cartilage, or trim part of the bones to improve joint alignment. With a case of rheumatoid arthritis, the synovium can be surgically removed. Arthroscopy (camera-guided knee surgery) is the preferred technique as it minimizes trauma to the elbow. Arthroscopy uses narrow instruments inserted through very small incisions around the joint to carry out the necessary repairs. Recovery times from an arthroscopic procedure, which is typically done on an outpatient basis, are much faster than with traditional open surgery.

    Your doctor or physiotherapist will develop an exercise program specifically for you, tailored to increase flexibility and mobility of your elbow. It is important to keep moving your elbow in order to minimize stiffness. With medical approval, you can perform the following exercises:

    Exercises:
    Sit at a table with your forearm resting on it. Ten repetitions make 1 set. Build up to 3 sets.
    1. Hold a can in your hand with your palm down. Keeping your forearm on the table, slowly bend the wrist backwards towards you. Hold for 5 seconds.
    2. Hold a can in your hand with your palm up. Keeping your forearm on the table, slowly bend the wrist towards you. Hold for 5 seconds.
    3. Hold the can upright with your thumb pointing up and slowly move your wrist up and down.
    4. Hold the can upright with your thumb pointing up. Slowly curl your wrist towards you as far as you can without forcing, hold for 5 seconds then slowly curl the wrist away from you as far as you can and hold for 5 seconds.

  • Elbow Bursitis

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    Elbow Bursitis

    Elbow bursitis, also known as olecranon bursitis, is a term used to describe the inflammation of a bursa that is found between the skin of the elbow and the olecranon, which is the bony tip of the elbow. A normal bursa is a flat, fluid-filled sac that lies between various tissues and structures such as tendons and bones to cushion them and allow them to glide smoothly over each other. There are many bursae in the body, the major ones found at the large joints. If a bursa is injured or inflamed it swells with extra fluid, creating pressure that can lead to irritation and pain.

    Causes:
    Swelling of the bursa may be caused by a trauma to the elbow, or it may develop gradually as a result of habitually leaning on the elbows. People whose occupations require them to spend extended periods leaning on their elbows, for example plumbers, heating engineers or even students, are at increased risk of developing bursitis.

    Some medical conditions, such as gout or rheumatoid arthritis, tend to produce elbow bursitis.

    An infection of the bursa, whether from an injury to the elbow or not, can cause swelling. Because the bursa lies just under the skin of the elbow and is not protected by fat, muscle or other tissue, the risk of puncture wounds is greater than for bursae elsewhere in the body. A puncture wound to the elbow bursa can provide an entry for infectious microbes.

    Symptoms:
    • Pain and tenderness at the elbow, made worse with pressure or bending the elbow
    • A swollen lump at the tip of the elbow that may restrict elbow range of motion
    • Possible heat and redness of the skin around the elbow, if infected
    Diagnosis:
    Your doctor will ask you for your medical history, particularly any previous injuries to your elbow. Your lifestyle, occupation, and recreational activities will be discussed. Your elbow and arm will then be physically examined, with the location and amount of swelling noted, along with areas of tenderness. You will be asked to bend your elbow so the doctor can check if the swelling is preventing the full range of motion of the joint.

    If an infection is suspected, your doctor may aspirate some fluid from the bursa. This is done in the office and is a simple procedure that removes, via a needle, some of the fluid. This fluid can then be sent to a laboratory for analysis.

    An X-ray may be ordered to look for any other reason for the bursa swelling, such as a bone spur or foreign object. Bone spurs tend to be found in patients with a history of repeated elbow bursitis. Occasionally, if the diagnosis is unclear, a bone scan or MRI (magnetic resonance imaging) scan can be a useful test.

    Treatment:
    Treatment for elbow bursitis is initially conservative (non-surgical). Most cases resolve within a couple of weeks with such measures and surgery is only necessary if conservative treatment fails to provide relief.

    Non-surgical treatment for uninfected bursitis may include:
    Ice: Applying ice, crushed in a bag and wrapped in a towel, to the elbow for as long as is comfortable, several times a day, will help reduce swelling.
    NSAIDs: Non-steroidal anti-inflammatory medication such as ibuprofen (Advil), naproxen (Aleve) or aspirin, taken according to directions, can reduce swelling and alleviate pain.
    Rest: Avoiding the sorts of activities or movements that press directly on the olecranon will allow the swelling to subside.
    Compression: Wearing a compression bandage will make you feel more comfortable. It should feel snug, but be sure not to wrap it so tightly that you feel tingling in your fingers or notice that your fingers are turning blue.
    Elevation: Raising your elbow above the level of your heart will help any swelling to go down. Do not hold your elbow over your head, but instead rest it on a couple of pillows.
    Needle aspiration: As well as providing fluid for analysis, by removing fluid from the swollen bursa this procedure will relieve pressure and pain.
    Injection: Your doctor may administer a corticosteroid injection directly into the bursa, often at the same time as aspirating the site. The corticosteroid is an anti-inflammatory and can provide immediate relief, although such relief may be only temporary. There is a limit to the number of times a corticosteroid can be given.
    Protection: A pad worn over the elbow will provide protection from further pressure.
    Physical therapy: Although physical therapy is not often needed for elbow bursitis, your doctor may suggest that you practice some stretching and strengthening exercises, after the bursitis has eased. Sometimes applying ultrasound to the elbow can promote healing.

    Fluid from an infected bursa will need analysis to identify the cause of infection, followed by a course of antibiotics. Occasionally the medicine may need to be administered intravenously (into a vein), and the aspiration repeated.

    A bursa may need to be surgically removed if conservative treatment, or antibiotics in the case of an infected bursa, has not improved your symptoms. After surgery, the bursa would gradually, over several months, grow back into a symptomless, fully functioning structure. If infection caused your elbow bursitis, you would probably continue with a course of antibiotics for a time.

    A splint would be worn temporarily to protect the surgical site, and after a period of a few days, you would be able to begin some exercises to restore the full range of motion to your elbow. Continuing to protect the elbow with a pad for several months would be advisable.

    Prevention:
    The most effective way to prevent elbow bursitis from returning is to avoid excessive leaning on your elbows. For those people whose occupations require such leaning, protect the elbows with pads and use the methods outlined above (rest, ice, compression, elevation, NSAIDs) if you begin to feel any pain.

  • Elbow Hyperextension

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    Elbow Hyperextension

    Hyperextension of the elbow is the term used to describe the injury caused when an elbow joint is forced backwards beyond its normal range of motion, resulting in damage to the soft tissues in the joint.

    Three bones articulate with each other to form the elbow: the humerus in the upper arm, and the radius and ulna in the lower arm. Together they allow the arm to move in a hinge-like manner, and also to turn the hand palm up or palm down. Between articulating surfaces are areas of cartilage, smooth, strong tissue that both cushions the ends of the bones and allows them to glide easily over each other.

    Tendons are tough cords of connective tissue called collagen. They originate in muscles and attach the muscles to bones. When muscles are contracted, tendons pull on bones, causing movement. Stress placed on a tendon can damage some or all of the collagen fibers that make up the tendon, fraying or breaking them.

    Ligaments are bands of strong connective tissue that join one bone to another. They support joints, keeping them in position and, in some cases, limiting excessive movement.

    Causes:
    Elbow hyperextension often occurs during contact sports or martial arts when a strong blow forces the elbow backwards. The stress placed on the structures of the joint is more than they are designed to withstand, and the connective tissues fray or break.

    Symptoms:
    • Severe pain at the moment of injury
    • Pain felt at the crease of the elbow
    • Increasing swelling, stiffness, and reddening with time
    Diagnosis:
    Although most cases of elbow hyperextension are self-limiting, in that they heal by themselves with time and rest, it is a good idea to seek medical attention in order to rule out serious damage to the ligaments, tendons, and bones of the elbow. Your doctor will take your medical history, including details of any previous elbow injury, and then ask you about the circumstances and symptoms of your current injury.

    Your elbow will then be physically examined for stability, strength, range of motion, and any swelling of the joint will be noted. X-rays or other diagnostic scans might be ordered if your doctor suspects a bone fracture or seriously torn connective tissues.

    Treatment:
    Treatment of elbow hyperextension usually consists of the following conservative (non-surgical) methods:
    Rest: Rest the joint completely. This is best achieved by using an elbow support such as a strap or brace.
    Ice: During the acute stage of the injury, which is normally two or three days, apply ice, crushed in a bag and wrapped in a towel, to the elbow for as long as is comfortable, several times a day. This will help to reduce swelling.

    Compression: Wrap the elbow in a compression bandage, or tape it firmly, but not tight enough to cause swelling in your hand or discoloration of your fingers.
    Elevation: Raise your elbow above the level of your heart whenever you can. You can achieve this by resting your arm on a pile of cushions or pillows.

    NSAIDs: Non-steroidal anti-inflammatory drugs such as ibuprofen (Advil), naproxen (Aleve) or aspirin will help reduce inflammation and pain.
    Physical therapy: After a week or two of resting the elbow, you can begin a program of graduated exercises to restore range of motion and strength in your elbow. It would be sensible to wear an elbow support or apply tape in order to prevent hyperextension. There are several supports available and you should try different ones to find the support best suited to your arm.

    If the damage to the structures in your elbow is severe enough you may need surgery. The goal of any surgical procedure would be to eliminate symptoms and restore full function to your elbow. The surgeon might need to stitch together torn ligaments or tendons, or construct a replacement structure from another part of your body to replace irreparably damaged tissue. A period of rehabilitation lasting several months, with dedicated physical therapy, would be necessary to achieve the best possible outcome. Again, wearing a protective elbow support during any future sporting activity would be recommended.

    Exercises:
    Only begin exercises with the approval of your doctor or physical therapist. Do not try to do too much too soon, and stop if you feel any pain. Ten repetitions make 1 set. Build up to 3 sets.

    Wrist Flex:
    Sitting or standing, raise your injured arm until it is parallel with the floor, palm facing the ground. Use your other hand to gently press on your wrist. You should begin to feel a stretch in the forearm and elbow of the injured arm. Hold for 10 seconds.

    Wrist extension:
    Sitting or standing, raise your injured arm until it is parallel with the floor, palm facing up. Place your other hand under the wrist and use it to gently lift the injured arm, bending the elbow as far as it will go without force. To get the best stretch, relax the injured arm. Hold for 10 seconds.

    Biceps contraction:
    Keeping your elbow at your side throughout, bend the injured arm so that the forearm is parallel to the ground and the palm is facing up. Use your other hand to press down on the palm. Resist the pressure by contracting the biceps muscle in the injured arm. Hold for 5 seconds.

    Triceps contraction:
    Keeping your elbow at your side throughout, bend the injured arm so that the forearm is parallel to the ground and the palm is facing inwards (handshake position). Make a fist with the hand. Place your other hand under the fist. Press down with the fist, as though trying to straighten the elbow, while the other hand resists and prevents any movement in the elbow. Hold for 5 seconds.

  • Golfers Elbow

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    Golfer's Elbow

    Golfer’s elbow is a term used to describe an overuse injury to the elbow, commonly suffered by, but not restricted to, golfers. Medically known as medial epicondylitis, this condition refers specifically to pain and inflammation of the forearm tendons where they attach to the medial epicondyle, the bony protuberance on the inner side of the elbow. It is a similar injury to tennis elbow but occurs on the opposite side of the joint.

    Tendons are tough cords of connective tissue called collagen. They originate in muscles and attach the muscles to bones. When muscles are contracted, tendons pull on bones, causing movement. Damage to these tendons as a result of overuse causes the painful symptoms associated with golfer’s elbow.

    Causes:
    Golfer’s elbow is caused by excessive repetitive stress to the muscles and tendons of the forearm. The stress causes small tears in the tendon fibers. Continued use without allowing time for healing will make the condition worse. Many recreational activities, occupations, and sports require the particular wrist and hand movements that can be responsible for causing the condition. Apart from golfers, racket sport players, pitchers, weight trainers, painters, typists, and others are all susceptible to developing symptoms associated with golfer’s elbow.

    Cases of golfer’s elbow are common at the beginning of the sporting season when players return to their sport after a period of non-participation. Suddenly increasing the duration or intensity of play can also lead to the condition.

    Symptoms:
    • Pain, normally localized on the inner side of the elbow, but sometimes extending down the inner side of the forearm
    • Pain may appear suddenly or may gradually increase with use
    • Pain, possibly shooting down the forearm, made worse when gripping, squeezing, rotating or bending the wrist
    • Stiffness in the elbow joint
    • Possible weakness of the wrist and hand
    • Possible numbness or tingling extending into the fingers, usually the ring and little finger
    Diagnosis:
    Your doctor will ask you about your medical history, including any previous injuries to your elbow or forearm. Your general lifestyle, activities, and participation in sport will be discussed. You will be asked about the circumstances of your current injury and the onset, duration, and severity of your symptoms.

    Diagnosis of golfer’s elbow is usually made through the description of your symptoms and a physical examination of your elbow. Your doctor will manipulate and touch your elbow, wrist, and hand in specific ways to assess the degree of pain and stiffness.

    X-rays may be taken if your doctor thinks that there may be a reason other than golfer’s elbow that is causing your pain, for example a fracture or arthritis. Very occasionally an MRI (magnetic resonance imaging) scan may be needed to get a clear view of the soft tissues in the elbow.

    Treatment:
    Golfer’s elbow usually responds with time and conservative (non-surgical) treatment. Surgery is rarely necessary and is usually only performed if you have failed to respond to non-surgical treatment.

    Conservative treatment of tennis elbow may include:

    Rest:
    Avoid any activities that make your symptoms worse, but continue to use your arm to prevent stiffness developing. Keep your wrist rigid whenever you have to lift something.
    Ice:
    Applying ice, crushed in a bag and wrapped in a towel, to the sore area for as long as is comfortable, several times a day, will help to reduce swelling and inflammation.
    NSAIDs:
    Non-steroidal anti-inflammatory drugs such as ibuprofen (Advil), naproxen (Aleve), aspirin or acetaminophen (Tylenol) can be taken to relieve pain and inflammation.
    Cortisone injection:
    Your doctor may administer a corticosteroid injection directly into the elbow joint. This can provide rapid relief from pain and inflammation.
    Compression:
    Your doctor may recommend that you put a supportive bandage on your elbow or wear a forearm strap to reduce stress to the damaged tendon.
    Physical therapy:
    Physical therapy can include massage, ultrasound, and electrical stimulation, all of which are designed to encourage the flow of blood to the damaged area.

    After the acute stage of the injury you can begin a program of exercises to restore flexibility and improve strength in your elbow forearm, and wrist. You should review your techniques (method of swinging the club, if you are a golfer) to make sure that you use proper posture and grip.

    If your case of golfer’s elbow is severe, it may take several months for the pain to completely disappear. It is extremely important to be patient and not to return to normal activities before your elbow is healed. Rushing your recovery can result in further injury.

    Exercises:
    Only perform these exercises if doing them causes no pain. Start gently and build up gradually.
    Triceps stretch:
    Sitting in a chair, slowly raise your elbow over your head as high as you can so that your palm is facing the back of your shoulder. Bring the elbow back down. Repeat 10 times for 1 set.
    Biceps stretch:
    Sitting in a chair with your arm down by your side and your palm facing forward, bring your arm behind you as far as you can. Repeat 10 times for 1 set.
    Flex, extend, and side-to-side:
    Simply bend the wrist forwards and hold the stretch for 5 seconds. Then bend the wrist backwards and hold the stretch for 5 seconds. Move the wrist from side to side (as in a handshake) and hold at the furthest point at each side for 5 seconds.
    Ball grip:
    Hold a foam or rubber ball in your hand. Gently squeeze it 25 times for 1 set.
    Can exercises:
    1. Hold a can in your hand with your palm down. Keeping your forearm on the table, slowly bend the wrist backwards towards you. Hold for 5 seconds.
    2. Hold a can in your hand with your palm up. Keeping your forearm on the table, slowly bend the wrist towards you. Hold for 5 seconds.
    3. Hold the can upright with your thumb pointing up and slowly move your wrist up and down.
    4. Hold the can upright with your thumb pointing up. Slowly curl your wrist towards you as far as you can without forcing, hold for 5 seconds then slowly curl the wrist away from you as far as you can and hold for 5 seconds.
    Elastic band:
    Interweave a thick elastic band around your fingers. Keeping your elbow straight, try to spread your fingers out as far as possible. Hold for 5 seconds.

  • Little League Elbow

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    Medial Epicondylar Apophysitis (Little League Elbow)

    Little League elbow (medial epicondylar apophysitis) is a term used to describe an overuse injury often sustained by children and adolescent baseball players, usually those who spend a lot of time pitching. Excessive overhead throwing places too much strain on the growth plate of the medial epicondyle, which is a bony protuberance on the inner side of the elbow. The muscles of the forearm attach onto the medial epicondyle by way of tendons, as does one of the ligaments in the elbow that provides stability to the joint when throwing.


    A growth plate (apophysis) is an area of supple, delicate cartilage found near each end of the long bones in a growing child. Growth plates determine the eventual length and shape of each long bone. During periods of growth, and particularly during an adolescent growth spurt, they are particularly vulnerable to damage as they are weaker than the surrounding ligaments and connective tissues. They are in fact the weakest part of the skeleton. Over time the cells in the apophysis harden, and by the time the child has stopped growing, the apophysis has been entirely replaced by solid bone.

    Injuries to the growth plate are therefore unique to children and young people who have yet to finish growing.

    Causes:
    When a ball is thrown overhead, tendons and ligaments pull on the growth plate in the medial epicondyle. Too much throwing without proper periods of rest between sessions can irritate and inflame the tendons and ligaments, tearing fibers. Small fragments of bone can be pulled away from the medial epicondyle. Small cracks can develop in the apophysis and sometimes, if the damage is severe enough, the apophysis may actually become detached from the humerus.

    Although this is a common injury for adolescent baseball players, any young person who repetitively throws overhead is at risk. For example, water polo, football or volleyball players may also suffer Little League elbow.

    Symptoms may develop if the rate of pitching has suddenly increased or the type of throw has changed, for example if curve balls or sliders have been introduced at too young an age.

    Symptoms:
    • Pain felt on the inner side of the elbow when throwing. The pain may appear suddenly or it may develop over a period of time
    • Possible difficulty straightening the elbow completely
    • Possible swelling with redness and warmth
    • Diminished ability to throw
    • Tenderness to the touch at the medial epicondyle
    • Possible locking of the elbow
    Diagnosis:
    Your doctor can usually diagnose Little League elbow by asking about the symptoms, type, and amount of participation in sporting activities, and any previous injuries to the elbow. The elbow would then be physically examined for range of motion, areas of tenderness, and stability of the joint.

    X-rays will be taken to view the growth plates in the elbow. These can often appear normal, even when the apophysis has suffered some damage. X-ray pictures will show any other bone injury, such as a stress fracture. Very occasionally an MRI (magnetic resonance imaging) scan may be taken in order to see the growth plates in greater detail, or to assess the ligaments and tendons in the elbow.

    Treatment:
    It is important to treat this condition in order to avoid further complications.

    The primary treatment for Little League elbow is to rest the elbow for at least four to six weeks, by not throwing anything at all. This will give the apophysis time to heal.

    Crushed ice, placed in a bag and wrapped in a towel, can be applied to the injured area for as long as is comfortable, several times a day. This will help reduce any swelling.

    NSAIDs (non-steroidal anti-inflammatory drugs) can be administered, according to instructions, for relief from inflammation and pain.

    The elbow can be wrapped in a compression sleeve or elastic bandage. This will make the patient more comfortable.

    When the period of rest is over and there is no pain, a specialized program of physical therapy can be started. This will probably include instruction on proper throwing technique, exercises to strengthen the body core, and stretching and strengthening exercises for the elbow.

    A return to throwing and pitching will depend on the severity of the initial injury, but is normally possible within three to four months. The return should be gradual and ideally should be under the supervision of a sports physical therapist.

    Surgery for Little League elbow is rarely necessary. Situations that might call for surgery are if a fragment of bone has broken away and is impeding elbow function, or a ligament needs to be reattached to the bone. Surgery would be performed arthroscopically, using narrow instruments inserted through small incisions around the elbow. A period of rehabilitation post-surgery would be necessary before a return to sports could be considered.

    Exercises:
    Do 10 repetitions for 1 set. Build up to 3 sets per day.
    Flex, extend, and side-to-side:
    Simply bend the wrist forwards and hold the stretch for 5 seconds. Then bend the wrist backwards and hold the stretch for 5 seconds. Move the wrist from side to side (as in a handshake) and hold at the furthest point at each side for 5 seconds.
    Strengthening: Sit in a chair with your elbow resting on the arm of the chair or on a table, with your wrist hanging over the edge. Do the following exercises:
    1. Hold a can in your hand with your palm down. Keeping your forearm on the table, slowly bend the wrist backwards towards you. Hold for 5 seconds.
    2. Hold a can in your hand with your palm up. Keeping your forearm on the table, slowly bend the wrist towards you. Hold for 5 seconds.
    3. Hold the can in your hand and slowly rotate your palm up and then down.
    4. Stand for this exercise. Hold the can in your hand. With your arm straight down at your side and your thumb pointing forward, slowly raise the can by bending your elbow. Slowly lower the can.

    Prevention:
    As Little League elbow is an overuse condition, by restricting the amount of throwing, re-injury can be prevented. The accepted guideline is 75 pitches per week for children 8-10 years old, 100 for children 11-12, and 125 for 13-14 year olds.

    Curve balls and sliders should not be thrown until a child is in high school, by which time the apophysis would have hardened into bone.

    Warming up properly before pitching will decrease the chances of injury.

  • Nursemaid Elbow

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    Nursemaid Elbow


    Definition:
    This injury is commonly found in children under school age, usually aged between one and three. Nursemaid elbow describes a condition where two of the three bones of the elbow joint have become displaced. The medical term for this injury is radial head subluxation. The term nursemaid elbow comes from when women had to carry heavy milk buckets. Now, workers such as baggage handlers are more vulnerable to this sort of injury. In children, girls tend to suffer from this condition more than boys, and the left arm is usually the injured limb.

    The humerus (upper arm bone) meets the radius and the ulna (the two bones of the forearm) to form the elbow joint. The way the bones fit together allows the joint to move in a hinge-like manner and the forearm to rotate enough to turn the hand palm up or palm down. Surrounding and supporting the bones are ligaments, strong elastic bands of connective tissue that help to hold the bones in their correct positions.

    The joint between the humerus and the ulna (the ulna runs down the little finger side of the forearm) is strong and not easily disrupted. The joint between the humerus and radius (bone on the thumb side of the forearm) is more dependent on a tight ligament (the annular ligament) to keep the head of the radius properly located. The radial head is slightly concave. In a toddler or young child, it shallowly encircles a rounded part of the distal (far) end of the humerus called the capitellum. As the child grows, the radial head becomes wider, forming a lip that encloses the capitellum more completely and makes the joint more secure. The shallow joint in a small child is coupled with a loose annular ligament that is vulnerable to tearing.

    This arrangement in a child’s elbow means that the annular ligament is able to shift over the radial head when a particular pulling movement is made. The specific movement requires the forearm to be slightly rotated when the pulling force is exerted on the elbow. The ligament can then get trapped between the head of the radius and the capitellum.

    As a child’s ligaments become stronger with time, the likelihood of suffering this injury decreases. Nursemaid elbow is not often diagnosed in children over the age of six.

    Causes:
    A sudden jerk, or repeated pulls, on the arm can tear the fibers of the ligament, weakening it enough so that the radius slips out of position. One common cause of nursemaid elbow is swinging a child by its arms. It might also occur by grabbing a child’s arm to prevent a fall, or lifting the child from the ground. Tugging along a recalcitrant toddler by the hand can also cause the injury. Nursemaid elbow is, in fact, sometimes called temper tantrum elbow. Occasionally an infant can suffer this injury by rolling over awkwardly and trapping the arm. The mechanism is that an adult holds a child by the wrist or hand and exerts a sudden, strong tug. An adult is much stronger than a child, and the annular ligament responsible for holding a child’s radius in position is a relatively weak structure. Adults are often unaware that innocently pulling on a child’s arm can cause such damage.

    Symptoms:
    • Crying with pain at the moment of injury
    • Refusal to use the injured arm
    • The child will usually cradle the injured arm against the body, elbow slightly bent and the palm facing down. If the arm is held in this position, the child often does not show any signs of pain.
    • Pain felt if the forearm is rotated so that the palm faces up
    • Pain sometimes felt in the wrist and shoulder (described if the child is old enough to talk)
    • Possible tenderness over the elbow, but no swelling or bruising
    • After the injury the child will normally seem unchanged except for the refusal to use the injured arm
    Diagnosis:
    You should seek immediate medical attention for this injury. An untreated subluxation can result in permanent loss of function in the elbow. With treatment, nearly every case results in a complete recovery. Either see your doctor or visit the emergency department. Nursemaid elbow is a partial dislocation injury and the bones can be easily and quickly repositioned in a procedure known as reduction.

    You will be asked about the circumstances of the injury and the symptoms your child has been displaying or describing. Your child’s shoulder, elbow, and wrist will be physically examined. The doctor will be looking for areas of tenderness or other injuries. X-rays do not show soft tissues such as ligaments, but may be taken to rule out a bone fracture. A fracture might be suspected if there is bruising or significant swelling around the elbow.

    Treatment:
    Treatment for nursemaid elbow is to reduce the subluxation, that is, to reposition the bones properly within the elbow joint. The child will sit on a lap and the doctor will hold the straight arm in a particular way and then bend it suddenly and precisely. The bones will click back into place. This will probably cause brief pain to the child, but it is a very quick procedure taking a matter of seconds and normally provides complete pain relief as soon as it is done. Occasionally it may have to be attempted more than once. If the dislocation cannot be successfully reduced, X-rays may be taken to look for a bone fracture. In many instances the reduction then happens while the technician is positioning the arm ready for the X-ray. Sometimes a splint may be temporarily placed on the arm and a reduction attempted later. Often, the elbow will have spontaneously reduced itself by the time of the follow-up appointment.

    Surgery is rarely needed for nursemaid elbow, and may only be considered if the child suffers from repeated incidents. Any surgery would be aimed at tightening up the annular ligament. A cast to completely immobilize the elbow while the ligament heals would probably be tried first.

    Prevention:
    Pulling strongly and sharply on a child’s arm can cause nursemaid elbow, so prevention consists of avoiding such movements. Lift your child by holding him or her under the armpits. After one incidence of nursemaid elbow a child is more likely to suffer from it again, particularly during the first few weeks after the initial injury, so especial care must be taken.

    Never lift a child by one arm only. If you want to swing your child around in circles, do not hold onto the hands or wrists, but support your child under the arms and hold the upper body close to yours.


  • Olecranon (Elbow) Fractures

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    Olecranon (Elbow) Fractures

    Definition:
    An olecranon fracture is a break of the ulna, one of the three bones that make up the elbow joint. It is often called the ‘funny bone’.

    Three bones articulate with each other to form the elbow: the humerus in the upper arm, and the radius and ulna in the lower arm. Together they allow the arm to move in a hinge-like manner, and also to rotate the palm up or down. The shape of the bones keeps the elbow joint in its correct alignment, with the upper part of the ulna, the cup-shaped olecranon, holding the end of the humerus and moving around it as the elbow bends. The triceps muscle, that pulls on the olecranon and causes the elbow to bend, has its attachment on the olecranon.

    When the elbow is bent, it is easy to feel the olecranon as the bony tip of the elbow, just under the skin. It is not protected by muscles, fat, or other soft tissues, so is vulnerable to breaking if subjected to a strong force, or by falling directly onto it. An olecranon fracture is therefore a fairly common injury.

    Causes:
    The most common reason for a fracture of this sort is a fall directly onto the tip of the elbow, or a heavy blow. Examples of such situations are motor vehicle accidents and sporting injuries.

    It is also possible to fracture the olecranon by falling onto an outstretched arm. In this instance the triceps muscle pulls a piece of bone off the olecranon.

    Symptoms:
    • Pain, often severe, at the moment of injury
    • Often a complete inability to move the elbow
    • Tenderness, swelling, and bruising of the elbow
    • Possible numbness or tingling in the fingers
    Diagnosis:
    Due to the pain and obvious severity of the injury, most patients are diagnosed in the emergency room. The doctor will ask about the circumstances of the injury, and also about your general health. Your elbow will be examined to assess the injury and to check if there are associated injuries to other structures. Proper blood flow to the hand and fingers will be checked, as will nerve responses. It is likely that your shoulder, upper arm, forearm, hand and fingers will also be examined to rule out other injuries.

    X-rays will be taken to view the bones of the elbow and, if other injuries are suspected, possibly taken of the arm and shoulder as well.

    Treatment:
    First aid will include icing the elbow to begin reducing swelling, administering pain medication, and immobilizing the elbow in a splint. The splint runs under the elbow, forearm, and wrist, and is usually open on the top to allow for varying degrees of swelling.

    Treatment then depends on the extent of the fracture. If the bone is broken but still in its correct position, treatment may consist of continued wearing of a splint, cast or hinged fracture brace for several weeks, combined with regular visits to the doctor and X-rays to monitor healing. If, during this time, the bone shifts out of position, surgery might become necessary. If the bone remains stable, after a few weeks you would begin rehabilitative exercises, probably under the supervision of a physical therapist. Prolonged immobilization in a splint causes the elbow to become very stiff so recovering full range of motion can be a lengthy process.

    If the fractured olecranon pierced the skin (an ‘open’ fracture), the risk of infection is serious. Surgery would take place immediately to thoroughly clean the wound and fix the bone into a proper healing position.

    Surgery is always required if the bone pieces are displaced. Your surgeon would realign the bone pieces and hold them, using fixation devices such as orthopedic screws, plates or pins, in a proper position for healing. It is also possible for the bone pieces to be held by means of sutures (stitches). In some cases the bone is so shattered that the fragments are simply removed and the triceps tendon is attached to the remaining stable bone. Fixation devices can sometimes become irritating due to their position, and may be removed after a year.

    After surgery your arm is likely to be placed in a splint. You may also use a sling for a time. Because an olecranon fracture results in considerable elbow stiffness, exercises to regain mobility will likely begin quite soon after surgery. Your doctor or physical therapist will develop a graduated program of exercises for you. To achieve the best result it is extremely important that you follow advice and do the exercises as often as recommended.

    Prognosis:
    Normally it takes about three months for an olecranon fracture to completely heal. It is not unusual for some residual stiffness to remain in the elbow joint. You may never be able to fully straighten your arm, but the loss of extension is usually only a very small amount, and should not cause any problems.

    Very occasionally the fracture does not heal properly, or the bone fragments do not remain aligned. Such a situation would probably require further surgery.

    Due to possible damage to the articular surfaces in the elbow, you may have an increased risk of developing osteoarthritis, which may or may not cause painful symptoms.

    Exercises:
    You should only begin rehabilitation exercises when your doctor has confirmed that the fracture is stable enough for you to do so. Try to do the exercises three times a day. You should not feel any pain when doing these exercises. If you do, stop.
    Elbow Flex and Extend:
    Standing, simply bend and straighten your elbow as far as it will go without force. You should not feel any pain. Repeat 10 times.
    Rotations:
    With your elbow by your side and bent to 90 degrees, carefully turn your hand up and down as far as it will go without force. Repeat 10 times.
    Ball Squeeze:
    Hold a soft ball, about the size of a tennis ball, in your hand. Squeeze the ball as hard as possible with causing yourself pain. Hold for 5 seconds. Repeat 10 times.

  • Osteochondritis Dissecans Elbow

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    Osteochondritis Dissecans (OCD)

    Osteochondritis dissecans (OCD) of the elbow is an increasingly diagnosed condition in which a portion of articular cartilage, together with a layer of bone, becomes damaged. Osteo- refers to bone, chondro- refers to cartilage, and -itis describes inflammation. With OCD, the affected area of bone loses its blood supply. That portion of bone then dies, cracking and eventually breaking away from the main part of the bone. The fragment or fragments of bone and cartilage may then become stuck within the elbow joint, causing the more severe symptoms associated with this condition. Although OCD can occur in other joints of the body, this condition most commonly affects the elbow or knee.

    Three bones articulate with each other to form the elbow: the humerus in the upper arm, and the radius and ulna in the lower arm. Together they allow the arm to move in a hinge-like manner, and also to turn the hand palm up or palm down. Between articulating surfaces are areas of cartilage, smooth, strong tissue that both cushions the ends of the bones and allows them to glide easily over each other. Bone fragments associated with OCD usually come from the capitulum of the humerus, a rounded part at the base of the bone that articulates with the head of the radius bone of the forearm.

    Causes:
    Although the exact cause of osteochondritis dissecans of the elbow is unknown, it is thought that the condition may result from disturbances of the normal growing process, or from relatively mild but recurrent injuries to the elbow. Weight-bearing stress placed repeatedly on the immature elbow, without allowing sufficient time for damaged tissues to heal, is believed to be one cause of OCD. Occasionally the damage may be the result of a sudden trauma, such as a heavy blow, to the elbow joint.

    OCD occurs primarily in young people whose bones are still maturing. Patients are normally aged between 10 and 16 years old. Young athletes whose sports demand significant and repetitive upper arm movements, such as gymnasts, baseball or softball players, and javelin throwers, tend to be most at risk from OCD of the elbow.

    There may be a genetic component to the development of OCD, as it is often found in members of the same family, or in subsequent generations.

    Symptoms:
    • Pain, often described as ‘aching’, felt within the elbow
    • Stiffness of the joint
    • Diminished ability to fully straighten or rotate the arm
    • ‘Locking’ of the joint at a particular angle
    • Possible ‘clicking’ heard or sensed in the elbow
    • Possible tenderness at the site of injury
    • Possible swelling due to synovial fluid leaking from the articular capsule around the elbow joint.
    Diagnosis:
    Your doctor will ask you questions about your medical history, including any previous injuries to your elbow. You will be asked about your lifestyle, occupation, and recreational and sporting activities. Your elbow will then be physically examined and compared with the unaffected arm.

    Imaging tests such as X-rays and an MRI (magnetic resonance imaging) scan will probably be taken. The MRI is generally considered to be the best diagnostic tool for osteochondritis dissecans as it can clearly show the condition of the soft tissues and any developing or present detachment of an osteochondral fragment from the body of the bone. A CT (computerized tomography) scan or an arthrogram are other possible ways of diagnosing OCD. The arthrogram procedure consists of injecting dye into the elbow joint and then using a special form of X-ray to view where the dye is within the joint.

    Treatment:
    Occasionally, particularly if the patient is young, osteochondritis can resolve itself. If the OCD has been diagnosed at an early stage conservative (non-surgical) treatment can be successful, particularly if an MRI has revealed no separation of the cartilage and bone. About 50% of these patients should recover full function of the elbow.

    Conservative treatment consists of complete rest of the elbow, usually achieved with the use of a brace or sling to immobilize the joint. Ice, crushed in a bag and wrapped in a towel, can be applied to the elbow for as long as is comfortable, several times a day, to relieve swelling and pain. NSAIDs (non-steroidal anti-inflammatory drugs) can be taken according to directions. Examples of NSAIDs are ibuprofen (Advil), naproxen (Aleve) and aspirin. Only when no more symptoms are present can a gradual return to activity begin, and a program of stretching and strengthening exercises for the elbow and shoulder initiated.

    Often, a surgical procedure is necessary to reattach or remove loose pieces of cartilage and bone in the elbow that are restricting elbow movement or causing pain, or if conservative measures have failed to resolve the condition. Surgery is carried out arthroscopically if possible, but open surgery is sometimes necessary in order to properly fix the fragment.

    Prognosis:
    The chance of a good recovery from OCD depends on the age of the patient, and the severity and location of the damage. Younger patients tend to heal more successfully. Surgical repair can have a successful outcome, particularly if the fragment has been fixed and allowed to properly heal, although some residual stiffness may be present.

    Early development of arthritis is a condition associated with severe cases of adolescent osteochondritis dissecans.

    Exercises:
    Exercises should not be performed without medical approval. Returning to activity before OCD has completely healed increases the risk of permanent damage. Your physical therapist will design an exercise program for you, but the following can help you begin to regain flexibility and strength in your elbow.
    Pendulum:
    Standing, bend over at the waist and let your arm hang down at your side. You can hold onto a support with the other hand. Allow your arm to swing from side to side and back and forth, then in small circles. Keep the distances short. Repeat this exercise for 3-7 days then add a small weight (1-2 lbs). Gradually increase the range of motion.
    Elbow Flex and Extend:
    Standing, simply bend and straighten your elbow as far as it will go without force. You should not feel any pain. Repeat 10 times.
    Rotations:
    With your elbow by your side and bent to 90 degrees, carefully rotate your palm up and down as far as it will go without force. Repeat 10 times.
    Ball Squeeze:
    Hold a soft ball, about the size of a tennis ball, in your hand. Squeeze the ball as hard as possible with causing yourself pain. Hold for 5 seconds. Repeat 10 times.

  • Tennis Elbow (Lateral Epicondylitis)

    Tennis Elbow (Lateral Epicondylitis)

    Definition:
    Tennis elbow is the common name for the inflammation or injury of elbow tendons, which are tough bands of tissue that connect muscle to the bone. Despite its name, this condition is not limited to tennis players. Any occupational or recreational activity that involves repetitive elbow use (weight lifting, hammering, etc.) can lead to lateral epicondylitis.

    Symptoms:
    · Pain in the elbow that spreads into the upper arm or down the forearm
    · Weakness and difficult time with activities that require arm strength
    · Pain can be sudden or develop gradually over time
    · Usually affects the dominant arm (e.g. right arm in people who are right-handed)

    Diagnosis:
    The diagnosis is usually based on symptom description and physical exam. It should be differentiated from medial epicondylitis, which affects the inner part of the elbow (also known as “Golfer’s Elbow”).

    Therapy:
    · Over the counter NSAID medications such as Advil or Motrin usually provide pain relief and may help to decrease the inflammation.
    · Elbow bracing: a specially designed brace helps to reduce pressure on the injured tendon in the elbow. It can be used while working or playing sports. You may need to wear the brace for up to six weeks.
    · Elbow exercises can help to improve your arm’s strength and ability to move.

    Outcome:
    Most people with improve with the conservative therapy outlined above. You may have some pain during work or sports for up to 6-12 weeks.
    If your pain is very severe or persists for longer than expected, a steroid injection into the painful tendon might help to relieve the pain. However, the injections should only be used sparingly and only in addition and not in place of the elbow
    rest, otherwise they can make the problem more likely to reoccur.
    Surgery is usually not needed unless symptoms have not improved after six or more months of treatment.

    Prevention:
    · Reduce or avoid lifting objects with the arm extended
    · Reduce repetitive gripping and grasping
    · Work or weight-train with the elbow in a partially bent position. Use wrist supports when weight-training.
    · Wear gloves when using tools repetitively to increase griping surface
    · Use a two-handed backhand in tennis. When hitting a tennis stroke, use your entire lower body and focus on the proper technique. It may also be beneficial to find the largest grip that is comfortable and to use softer string

  • Tricep Tendonitis

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    Tricep Tendonitis

    Triceps tendonitis is a term used to describe inflammation, damage or rupture of the triceps tendon. The triceps muscle runs down the back of the upper arm and is responsible for straightening the elbow. At its proximal (upper) end it is attached to the shoulder blade and humerus (the bone in the upper arm) and at its distal (lower) end it inserts into the ulna (one of the two forearm bones) by means of the triceps tendon. Like all tendons, the triceps tendon is a very strong, dense sheath formed by strands of connective tissue. When the triceps muscle is contracted, the tendon pulls on the ulna and causes the arm to straighten.

    Damage to the triceps tendon can cause inflammation and progressive degeneration of the tendon fibers. Such damage and its symptoms are known as triceps tendonitis, triceps tendinopathy, triceps tendinitis, or triceps tendonosis.

    Causes:
    Triceps tendonitis occurs when some or all of the fibers that make up the tendon become frayed or broken. This leads to pain, weakness, and impaired function of the triceps muscle. Tendon strands can heal themselves with time, but if the muscle is not rested the tendon fiber cells do not have adequate time to regenerate and tendonitis can develop.

    Tendonitis usually arises as a consequence of wear and tear through repeated overuse of the tendon. A sudden increase in the amount of use can overstress the tendon and cause damage. Sometimes the tendon is injured as a result of sudden trauma, but normally the damage accrues over time. In extremely severe cases the tendon may completely rupture (break into two pieces). This injury would require prompt surgical repair.

    Exercising without properly warming up the arm muscles will increase the risk of injuring the tendon.

    Symptoms:
    Typical symptoms of triceps tendonitis may include:
    • Pain felt at the back of the elbow
    • Stiffness in the elbow joint, particularly after a period of rest following intense or repetitive elbow straightening
    • Tenderness when touching the area over the tendon
    • Aching pain made worse with movement
    • Possible swelling near the tip of the elbow
    • Possible weakness when straightening the elbow against resistance
    Diagnosis:
    Your doctor will ask for your medical history and the details of any previous injury to your elbow. You will be asked about the circumstances of your current injury and the onset, duration, and severity of your symptoms. Your lifestyle, occupation, and recreational activities will be discussed and then your elbow and arm will be physically examined. Areas of tenderness or swelling will be noted and your elbow flexed and extended in order to assess the level of pain or weakness.

    Occasionally an X-ray or MRI (magnetic resonance imaging) scan may be taken to better view the structures within the elbow. X-rays can reveal a displaced bone chip or fracture, while an MRI will clearly show any damage to the triceps tendon.

    Treatment:
    In order to achieve the best possible outcome, you must be prepared to completely rest your elbow until healing of the tendon fibers is complete. Failing to do so can result in the tendonitis becoming a chronic condition, which takes much longer to heal, and you would be left with an increased risk of developing tendonitis again.

    During the initial, acute stage of the injury, which is normally the first two or three days, you should try the following techniques:
    Rest: This is crucial to a good recovery. Avoid any and all activities that put stress on the triceps tendon.
    Ice: Apply ice, crushed in a bag and wrapped in a towel, to the damaged area for as long as is comfortable, several times a day. This will help to reduce swelling and inflammation.
    Compression: Wear a compression bandage on the elbow. This will direct force away from the tendon and make you feel more comfortable.
    Elevation: Raise your elbow above the level of your heart to reduce swelling. This can be achieved by resting the elbow on a pile of cushions.
    NSAIDs: Non-steroidal anti-inflammatory drugs such as ibuprofen (Advil), naproxen (Aleve), or aspirin can be taken to relieve pain and inflammation.

    Following the acute stage, and with the approval of your doctor or physical therapist, you should begin a graduated program of exercises designed to stretch and strengthen the triceps muscle. Other physical therapy may include ultrasound, massage, and the application of heat. You may be advised to wear a strap over the lower part of the triceps if you have to do particular activities that aggravate your symptoms.

    In some cases of triceps tendonitis, conservative treatment fails to resolve the problem. A corticosteroid injection can be administered into the tendon and further diagnostic tests can be performed. Surgical repair or reconstruction of the tendon is only performed for complete ruptures of the tendon.

    Exercises:
    These should only be performed with medical approval. Stop immediately if you feel any pain when performing them. Try to do them twice a day.
    Triceps stretch:
    Standing, raise your bent elbow so that your palm gradually slides down your back as far as it can without causing any pain. You can use your other hand to gently assist the stretch. Hold for 15 seconds. Repeat 5 times.
    French stretch:
    Standing, with your hands clasped together, raise your arms above your head. Keep your elbows close to your ears as you reach back with your arms, as though trying to touch your upper back. Hold for 15 seconds. Repeat 5 times.
    Triceps contraction:
    Standing, with your bent elbow at your side and your palm facing inwards, make a fist with that hand. Place your other hand under the fist. By tightening the triceps muscle push your fist down onto your other hand. Hold for 5 seconds. Repeat 10 times.
    Triceps lift:
    Supporting yourself with one hand on a table, lean forward and hold a small weight in the hand of the affected arm. Bend the elbow to a 90 degree angle and draw the upper arm back and up until it is parallel with the floor. Keeping the upper arm still, raise the forearm until the entire arm is straight. Repeat 10 times.

Common Elbow Injuries

The elbow is a relatively complicated joint. It’s made up of and connected to several different types of moving parts, and it’s responsible for the extension, bending and rotating of the entire forearm. Athletes and non-athletes alike use their elbow joints to do just about everything—just try holding your elbow straight for a day and see how difficult it is to go about your everyday tasks.

There are several causes of elbow pain, some far more serious than others. MMAR Medical’s comprehensive resource library can help you diagnose elbow joint pain and arthritis, and assist you and your sports medicine professional in choosing a treatment plan or appropriate elbow brace. With our professionally written articles, you can learn everything from how to treat a sprained elbow to how to deal with a more serious chronic condition.

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