Elbow Anatomy

It is the most congruous joint in the body with good bony capture. The distal humerus is shaped into two complex prominences called trochlea and capitellum which articulate with the Olecranon and the radial head respectively. Stability is also increased by the medial and lateral collateral ligaments and the capsule.

For reasonable function 30 to 130 degrees flexion-extension of the elbow is needed for daily activities. Similarly 50 degrees pronation and supination is required for most activities.

Painful Elbow

  • Tennis elbow - painful
  • Golfers elbow - painful
  • Ulnar neuritis - painful
  • Arthritis - painful and stiff
  • Bursitis - painful

Tennis Elbow

  • Lateral epicondylitis is misnomer as the bony epicondyle itself is normal. The tendon most commonly undergoes hypoxic, degeneration especially the ECRB origin.
  • Pain/tenderness is felt over lateral epicondyle (i.e. The outer bony prominence of the elbow) exacerbated by gripping and forearm release.
  • Pain - on resisted wrist dorsiflexion (Mills' Test)
  • Middle finger test = Pain on resisted extension of MCPJ of middle finger (because ECRB inserts into the base of the 3rd MC)

Different Diagnosis

  • Radial tunnel syndrome - 5%. Compressive neuropathy of the radial nerve tender distally in the extensor muscle mass.
  • Raio - Capitellar arthritis (Elbow Joint)

Treatment - 95% Nonoperative

  • Relative rest! Wait and see.
  • Activity Modification
  • Exercises, stretching
  • Splintage
  • Ultrasound
  • Steroid injection
  • Extra Corporeal Shock Wave Therapy
  • Surgery: Surgery is reserved for those that fail to respond to the above. Excision of diseased tissue is most commonly performed. It elicits inflammation leading to scar formation. This help resole the pain. This surgery can be done arthoscopically with the added advantage of addressing any intra articular problems at the same time.
  • Other surgical procedures that are sometime done include Extensor Origin Release, Release of portion of the annular ligament, ECRB lengthening in the distal forearm, Localised denervation of the lateral epicondyle.

Olecranon Bursitis

Bursa of the olecranon (back of the elbow prominence) – This superficial bursa (fluid filled sac) helps as a lubrication between the prominent bone and the skin. It can be swollen and inflamed in the following situations and can cause pain:

  • Traumatic – overuse (Miner’s, student’s)
  • Inflammatory
  • Infective

Usually painless, but if painful it indicates a septic, or inflammatory process. Radiograph usually show an olecranon spur (overuse).
Bursa communicates with joint in Rheumatoid Arthritis and is treated with resting splint, elbow pads and Anti-inflammatory medications.

Surgery

  • Acute inflammation or infection sometimes warrants an aspirate – and an analysis of the aspirated fluid is done including for bacterial infection. Depending on same antibiotics are started.
  • Chronic bursitis – repeat aspirate – suction drain.
  • Excision of the bursa-may rarely be indicated.

Elbow Arthroscopy

Elbow Arthroscopy

The operation is done by key hole surgery; usually through two or three 5mm punter wounds. It involves examination of the elbow joint using tiny telescope with television camera introduced through key hole. Key hole surgery in the elbow is helpful for:

  • Removing loose bodies within joint seen with arthritis, osteochondral injuries or rarely in a disease called synovial osteochondromatosis.
  • It is also used to relieve stiff elbows.
  • In debridement and synovectomy in arthritic elbows.
  • In testing pain from tendonitis of the extensor muscles (commonly know as Tennis Elbow)

 

Elbow Replacement

Useful in all arthritis which have failed other treatments.

Purpose of Operation

To provide a stable and pain free elbow joint. This is mainly a pain relieving procedure for arthritis of the elbow joint and rarely for complex fractures. Rheumatoid arthritis of the elbow is the other common indication for the elbow replacement. The implant that we use is a well tested joint replacement technique and is a hinged construct.

Benefits

To reduce or alleviate the pain in your elbow. Pain relief is significant.

Risks

  • Anaesthetic risk, Pain following surgery.
  • Infection which may need antibiotics and may delay healing. Rarely may need re-operations. (Ask your surgeon)
  • Unsightly scar.
  • Bleeding.
  • Instability or Stiffness of the joint.
  • Neurovascular damage

Alternatives

Most people will have received other treatments from family Doctors or Rheumatologist such as:

  • Painkillers.
  • Anti-inflammatory drugs.
  • Injection of steroids and other drugs into the joint and Physiotherapy.

Other operations available include making the joint solid and immoveable (Arthrodesis) or cleaning it out either by open surgery or through the key hole (Debridment). If the lining of the joint is very inflamed it can be removed through the key hole (Synovectomy). If you do nothing the joint tends to get worse over time. Your surgeon will advice if waiting would be harmful or make the situation more difficult to deal with.

Book a Consultation

Louise McGuire (Spire Elland)
appointments 01422 324041

01422 324020

sec: 01422 324085

Email: info@spireelland.com

Louise.mcguire@spirehealthcare.com

 


Elaine Ingham

Spire Leeds Nuffield Leeds

0113 3882009

07939160416

Elaine.ingham@nuffieldhealth.com