Elbow

The elbow joint connects the forearm to the upper arm. The bones of the elbow consist of the humerus (upper arm), the radius and the ulnar (two bones of the lower arm). The elbow, a hinge joint, bends, extends and rotates. Imagine a horseshoe. The end of the humerus represents a horseshoe in shape so that the olecranon process of the ulnar fits nicely into the horseshoe of the humerus. The horseshoe’s two sides are called the lateral and medial epicondyles.

Seven major muscles of the elbow allow the flexion (bending), extension (stretching) and rotation (turning sideways) of the forearm; while, another nine muscles of the forearm traverse the elbow to move the wrist and fingers of the hand.

Cartilage, the cushion to protect bone on bone, covers the end of the humerus, ulnar and radius in the elbow. Since the elbow does not weight-bear, a thin cartilage lines the bone instead of thick material like in the hip or knee. The cartilage in the elbow bears a rubbery, slippery consistency so the bones slide easily over each other in this joint.

The elbow contains several important tendons. The biceps tendon attaches the biceps muscle to the radius; the triceps tendon connects the triceps muscle to the ulna; the lateral epicondyle tendon crosses the elbow and links the humerus to muscles that straighten the fingers and wrist; and, the medial epicondyle tendon connects the humerus to muscles that bend the fingers and wrist.

The main elbow ligament that attaches bone to bone comprises the ulnar collateral ligament (also known as the medial collateral ligament) that connects the humerus and the ulnar. The front band of this ligament absorbs the major stress to the elbow from twisting and bending. The radial collateral ligament (also known as the lateral collateral ligament) extends from the humerus to the head of the radius bone. The ligaments stabilize the elbow during activities.

The bursa, a fluid filled sac, sits between the structures of the elbow so the joint can move easily. Synovial fluid fills the bursa like sudsy water that allows a reduction in the friction amongst the tendons, ligaments and end of the bones.

Lateral epicondylitis or tennis elbow occurs from repetitive strenuous contraction of the muscles causing strain and pain to the tendons of the forearm extensor muscles like in tennis, weight lifting, jobs or hobbies using recurring arm movements. The condition develops over time and represents the leading, elbow, ailment seen in the doctor’s office. Pain and tenderness on the bony knob of the elbow comprise the usual symptoms; though pain can radiate into the upper or lower arm. Despite the damage in the elbow, any use of the hands will precipitate pain. The doctor will take x-rays or MRIs to diagnose the problem. If you remove the repetitive activity, the elbow can heal with a few treatments to speed the healing. Initiate helpful treatments after discussing them with your doctor include icing the elbow when swelling is present, nonsteroidal anti-inflammatory medication (like ibuprofen, naproxen or aspirin), range of motion exercises, physical therapy, and injections of steroids or pain relievers. The doctor advises surgery to remove damaged sections of the tendon, only when basic treatment for several months fails to relieve symptoms.

Medial epicondylitis or golfer’s elbow takes place from the repeating activity that transpires from hitting golf balls. Symptoms and treatment are the same as with lateral epicondylitis.

Ulnar collateral ligament tear occurs commonly due to over use of the elbow such as in baseball pitchers and tennis players or from trauma to the elbow. Pain alerts the individual to injury to the ligament along with problems bending the arm. Swelling and bruising near the inner elbow may appear with severe injuries. Conservative treatment encompasses rest, immobilization and physical therapy, but severe tears may require surgery for repair.

Radial collateral ligament tears also arise in tennis and baseball sports. Symptoms consist of pain, swelling, deformity and weakness of the affected arm. For minor tears, the treatment consists of rest, immobilization and physical therapy, but surgery may be needed for severe tears.

Chronic olecranon (elbow) bursitis usually begins with a previous blow or fall onto the elbow that damages the bursa. The olecranon bursa lies between the point of the elbow and the overlying skin. This bursa allows the elbow to smoothly bend and straighten. After initial trauma, bleeding fills the sac with blood and is thought to trigger an inflammatory reaction. The inflammatory reaction causes thickening and swelling of the walls, but with repeated injury, the bursitis continues. Conservative treatments encompass the use of cold packs when painful or tender, compressive wrap for active swelling and protective pads on the elbows if needed. Since more problems arise with surgery, the surgeon usually advises no surgery or injections to the elbow. Other conditions lead to chronic bursitis such as gout, lupus and rheumatoid arthritis, but dealing with the underlying condition remains the treatment of choice with systemic conditions.

Traumatic arthritis begins with injuries such as fractures, tears or sprains, that precipitate the wearing away of the cartilage on the ends of the humerus and ulnar bone. Eventually, the cartilage is lost, ongoing pain, swelling and stiffness ensues and the person loses the ability to straighten and extend the elbow. The condition progressively worsens with age. A variety of treatment exists that range from lifestyle modifications, anti-inflammatory drugs, physical therapy and surgery.