Elbow
There are numerous ligamentous injuries and joint conditions of the elbow. Please select a condition below to learn more. If you do not see a specific condition listed, please feel free to discuss your concerns during your visit with Dr. Dedhia.
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Background
The biceps muscle is located in the front of your upper arm. The biceps muscle has two tendons that attach the muscle to the shoulder and one tendon that attaches at the elbow. The tendon at the elbow is called the distal biceps tendon. It attaches to a part of the radius bone called the radial tuberosity, a small bump on the bone near your elbow joint.
Causes
Injuries to the biceps tendon at the elbow usually occur when the elbow is forced straight against resistance. It is less common to injure this tendon when the elbow is forcibly bent against a heavy load.
Lifting a heavy box is a good example. Perhaps you grab it without realizing how much it weighs. You strain your biceps muscles and tendons trying to keep your arms bent, but the weight is too much and forces your arms straight. As you struggle, the stress on your biceps increases and the tendon tears away from the bone.
Risk Factors
Men, age 30 years or older, are most likely to tear the distal biceps tendon.
Additional risk factors for distal biceps tendon tear include:
Smoking. Nicotine use can affect tendon strength and quality.
Corticosteroid medications. Using corticosteroids has been linked to increased muscle and tendon weakness.
Symptoms
- Swelling in the front of the elbow
- Visible bruising in the elbow and forearm
- Weakness in bending of the elbow
- Weakness in twisting the forearm (supination)
- A bulge in the upper part of the arm created by the recoiled, shortened biceps muscle
- A gap in the front of the elbow created by the absence of the tendon
Treatment
Treatment for a distal biceps tear depends on many factors including age, activity level, and vocation. In certain patients, conservative non-operative treatments including therapy and anti-inflammatories may be indicated. Tears affecting younger, more active patients may require surgical repair. Advanced imaging, such as an MRI, is usually required to fully evaluate the extent of the injury. Dr. Dedhia will take into account these various factors when determining an optimal treatment plan.
When surgery is indicated, the procedure involves an open biceps tendon repair. During this procedure, Dr. Dedhia begins by making a small incision, approximately 4 cm in length, just below the elbow over the location of the radial tuberosity. The biceps tendon sheath is identified, which is opened to expose the biceps tendon. If there is significant retraction of the tendon into the upper arm, the incision may need to be extended for retrieval.
Once Dr. Dedhia has retrieved the torn tendon, he removes up the torn, unhealthy tissue. Sutures are then woven into the tendon end. The suture ends are passed through a small button which is the fixation device used to secure the tendon into the radius. Next, Dr. Dedhia drills a tunnel into the radial tuberosity. The button is passed through the tunnel and secured to the radius. The sutures are then shuttled back and forth until the biceps tendon is docked into the bony socket. The suture is knotted and secure fixation of the tendon is achieved. The wound is copiously irrigated and the incision is then closed.
Overview
Tennis elbow, medically known as Lateral Epicondylitis, is inflammation of the extensor tendons of the forearm that attach to the bony prominence on the outside of the elbow called the lateral epicondyle. The extensor tendons of the forearm are responsible for cocking up the wrist and extending the fingers.
Your elbow joint is a joint made up of three bones: your upper arm bone (humerus) and the two bones in your forearm (radius and ulna). There are bony bumps at the bottom of the humerus called epicondyles. The bony bump on the outside (lateral side) of the elbow is called the lateral epicondyle.
Causes
Often, tennis elbow arises from overuse and repetitive motions of these tendons this leads to pain and tenderness on the outside of the elbow. The tendon usually involved in tennis elbow is called the Extensor Carpi Radialis Brevis (ECRB). When this tendon is weakened from overuse, microscopic tears form in the tendon where it attaches to the lateral epicondyle.
Symptoms
Symptoms often include:
- pain localized to the outside of the elbow
- weak grip strength.
Treatment
Treatment is initially approached conservatively and may include:
- physical therapy
- bracing
- cortisone injections
- Rest
- Non-steroidal anti-inflammatory medicines
When these methods fail, surgery may be indicated. Surgery for this condition involves debriding (removing) the diseased portion of the extensor tendon.
When surgery is indicated, Dr. Dedhia utilizes an open repair technique. He begins by making an incision (approximately 4cm long) above the lateral epicondyle. Directly below the skin incision is connective tissue, which is dissected to expose the lateral epicondyle and extensor tendons where they attach on the lateral epicondyle. The ECRB is then identified and isolated. Once visible, scissors are used to excise the diseased portion of the tendon. Once the extensor tendon has been successfully debrided, Dr. Dedhia closes the skin incision.
The decision to move forward with surgery is based on numerous factors and can be discussed in detail during your office visit with Dr. Dedhia.
Anatomy
Radial head fractures are common injuries, occurring in about 20% of all acute elbow injuries. Many elbow dislocations also involve fractures of the radial head. Radial head fractures are more frequent in women than in men, and are more likely to happen in people who are between 30 and 40 years of age.
Symptoms
- Pain on the outside of the elbow
- Swelling in the elbow joint
- Difficulty bending and straightening the arm and rotating the forearmr
Treatment
Treatment depends on the type of fracture. Below are the classifications.
Type I fractures are generally small cracks in the bone but the fracture is not displaced. Conservative treatment is recommended with use of a sling for a short period of time followed by gradual increase in range of motion depending on the patient’s level of pain.
Type II fractures are slightly displaced and involve a larger piece of bone. these fractures are also typically treated conservatively in a sling for approximately 2-4 weeks followed by progressive range of motion depending on the patient’s level of pain.
Small fragments may need to be removed surgically if the piece limits range of motion of the elbow joint.
If the displaced piece is large, surgery may be indicated which involves putting the piece back to its anatomic location and securing it with screws.
Type III fractures have multiple broken pieces of bone which cannot be put back together for healing. There also tends to be injuries to surrounding elbow ligaments. Surgery is typically recommended to remove all loose fragments and fix any torn ligaments. If some circumstances, the radial head fragments may be too numerous to be fixed and will have to be removed entirely. An artificial radial head will then be inserted.
Content courtesy of AAOS
Background
Ulnar nerve entrapment occurs when the ulnar nerve in the arm becomes compressed or irritated.
The ulnar nerve is one of the three main nerves in your arm. It travels from your neck down into your hand. The most common place for compression of the nerve is behind the inside part of the elbow, the medial epicondyle, commonly referred to as the “funny bone.” Ulnar nerve compression at the elbow is called “cubital tunnel syndrome.”
Causes
In many cases of cubital tunnel syndrome, the exact cause is not known. The ulnar nerve is especially vulnerable to compression at the elbow because it must travel through a narrow space with very little soft tissue to protect it.
Some factors put you more at risk for developing cubital tunnel syndrome. These include:
- Prior elbow fracture or dislocation
- Elbow arthritis
- Swelling in the elbow
- Repetitive activities involving the elbow
Symptoms
- Numbness and tingling in the little finger and half of the ring finger. This feeling can come and go and usually occur more often when the elbow is bent
- Grip weakness
- Difficulty with fine motor skills such as trying or playing an instrument
- In severe or prolonged cubital tunnel syndrome, there can be muscle wasting
Treatment
In most cases, symptoms can be managed with conservative treatments like activity modification. Avoid activities that require you to keep your arm bent for long periods of time.and bracing. Avoid leaning on your elbow or putting pressure on the inside of your arm. Keep your elbow straight at night when you are sleeping. This can be done by wrapping a towel around your straight elbow or wearing an elbow pad backwards.
Other conservative treatments include:
- Non-steroidal anti-inflammatory medicines.
- Bracing or splinting
- Nerve gliding exercises
If conservative methods do not improve your symptoms, or if the nerve compression is causing muscle weakness or damage in your hand, Dr. Dedhia may recommend surgery.
Surgery for this condition involves a cubital tunnel release. In this operation, Dr. Dedhia cuts the tight ligament roof from the cubital tunnel. This increases the size of the tunnel and decreases pressure on the nerve. After the procedure, the ligament begins to heal and new tissue grows across the division. The new growth heals the ligament, and allows more space for the ulnar nerve to slide through.
Content courtesy of AAOS
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