Elbow Injury Education from Dr. Kumar - Brandon Orthopedic Associates
Neil Kumar, MD, MBA

Orthopaedic Surgeon

Neil Kumar, MD, MBA - Orthopaedic Surgeon
Elbow Injury Educational Information - Sports Medicine

ELBOW EDUCATION

Expand the titles below for Elbow Injury Education about Tommy John Surgery, Tennis Elbow, Golfer’s Elbow, and Osteochondritis Dissecans of the Elbow
Ulnar Collateral Ligament (UCL) tear – Tommy John surgery

The ulnar collateral ligament (UCL) connects the humerus (arm bone) to the olecranon (one of the forearm bones). The ligament is located at the medial (inner) part of the elbow. The UCL provides critical stability to the elbow, particularly during the throwing motion. UCL injuries are typically seen in patients who participate in repetitive throwing sports and activities.

How do injuries occur?

During the throwing motion, a significant amount of stress is placed on the UCL. Repetitive stress on the ligament causes it stretch, weaken, and develop small tears. This can lead to irritation, inflammation, and medial elbow pain. Continued use of the elbow for high-demand activities can cause further damage to the ligament. Eventually, the ligament tears and becomes non-functional, leading to elbow instability and poor function. UCL tears can often be related to inadequate rest between throwing sessions. Patients with throwing arms that are poorly conditioned and weak can also place the UCL at risk for injury.

 

Signs and Symptoms

Patients with UCL tears have pain at the inner elbow which is worse while throwing. Some patients can feel a ‘pop’ on a particular throw. Patients often notice a significant decline in throwing ability and function, with loss of velocity and poor control. Motion may be restricted due to pain and certain elbow positions can be particularly aggravating.

 

Treatment

Pain at the medial elbow, particularly in throwers, can be the result of multiple issues. An understanding of what these issues are and how function is being affected is critical. Treatment for UCL tears is based on multiple factors, including age, sport, and severity of tear. Patients with UCL tears may also have other elbow issues which combine to worsen pain and function.

Non-surgical treatment is typically the first step. Treatment is focused on reducing pain, restoring motion, and regaining strength with a specific physical therapy program. A critical aspect of treatment is an initial active rest period. During this time, activities and sports which aggravate the pain are avoided in order to give the ligament time to heal. Once the rest period is complete, a rehabilitation program focused on strengthening the upper back, shoulder, and arm muscles is implemented to recondition the upper limb and improve joint mechanics. Shoulder flexibility is also a focus, particularly with stretching of the internal rotators and pectoralis muscles. Once the arm has improved in strength and flexibility, sport-specific training is performed to prepare the patient for return to sports and activities. For patients involved in overhead and throwing sports, a focus on strengthening the core, hip, and legs is included along with a throwing program.

 

For some patients, non-surgical treatment may not provide the necessary relief to return to sports or the tear may be too severe. In these cases, surgery may be recommended. Because the UCL is not repairable, the ligament must be reconstructed. There are multiple graft options which can be used to accomplish this goal, and Dr. Kumar will discuss these options with you prior to surgery. After surgery, a rehabilitation program specific for each patient is created with a physical therapy team in order to reduce post-surgical pain, restore motion, and regain strength. Sport-specific training is a critical aspect of recovery in order to return patients to sports and activities as quickly and safely as possible.

Lateral Epicondylitis (tennis elbow)

Lateral epicondylitis, commonly known as tennis elbow, occurs when the muscles that extend the wrist and hand are overused. Repetitive stress of these muscles causes the tendon at the lateral (outer) elbow to develop small tears, which can cause inflammation and pain.

 

How do injuries occur?

Lateral epicondylitis can occur in patients of all ages, particularly laborers and patients involved in sports that require repetitive wrist extension. Lateral epicondylitis is an overuse injury and leads to tears of the common tendon at the elbow. Inadequate rest and healing results in further damage to the tendon, worsening pain and function.

 

Signs and Symptoms

Patients with lateral epicondylitis have pain located at the lateral aspect of the elbow. Pain is worsened with sports and activities that require repetitive wrist extension or lifting heavy objects. Swelling and tenderness can develop over the lateral elbow. Motion of the elbow can be restricted due to pain as well. In patients with chronic injury, regular activities such as opening jars or gripping objects can also be uncomfortable.

 

Treatment

For most patients with lateral epicondylitis, non-surgical treatment can allow for successful return to sports and work activities. Treatment is focused on reducing pain and swelling, restoring motion, and regaining strength with a specific physical therapy program. Initially, treatment is focused on reducing pain and restoring normal elbow motion. Once the tendon is allowed to heal, a rehabilitation program focused on strengthening the elbow, forearm, and wrist is implemented.

 

For many patients, non-surgical treatment can provide the relief necessary to return to sports and work activities. However, some patients may not improve as expected, especially those with chronic injuries. In these cases, surgery may be recommended. The goals of surgery are to repair the torn tendon, prevent further degeneration, and allow for effective rehabilitation. Dr. Kumar will discuss the surgery and expected recovery course with you. After surgery, a rehabilitation program specific for each patient is created with a physical therapy team in order to reduce post-surgical pain, restore motion, and regain strength. Sports and work training is a critical aspect of recovery in order to return patients to sports and activities as quickly and safely as possible necessary.

Medial Epicondylitis (golfer’s elbow)

Medial epicondylitis, commonly known as golfer’s elbow, occurs when the muscles that twist and flex the wrist and hand are overused. Repetitive stress of these muscles causes the tendon at the medial (inner) elbow to develop small tears, which can cause inflammation and pain.

 

How do injuries occur?

Medial epicondylitis can occur in patients of all ages, particularly laborers and patients involved in sports that require repetitive wrist flexion and turning. Medial epicondylitis is an overuse injury and leads to tears of the common tendon at the elbow. Inadequate rest and healing results in further damage to the tendon, worsening pain and function.

 

Signs and Symptoms

Patients with medial epicondylitis have pain located at the medial aspect of the elbow. Pain is worsening with sports and activities that require repetitive wrist flexion or twisting. Heavy lifting can also be problematic. Swelling and tenderness can develop over the medial elbow. Motion of the elbow can be restricted due to pain as well. In patients with chronic injury, regular activities such as opening jars or gripping objects can also be uncomfortable.

 

Treatment

For most patients with medial epicondylitis, non-surgical treatment can allow for successful return to sports and work activities. Treatment is focused on reducing pain and swelling, restoring motion, and regaining strength with a specific physical therapy program. Initially, treatment is focused on reducing pain and restoring normal elbow motion. Once the tendon is allowed to heal, a rehabilitation program focused on strengthening the elbow, forearm, and wrist is implemented.

 

For many patients, non-surgical treatment can provide the relief necessary to return to sports and work activities. However, some patients may not improve as expected, especially those with chronic injuries. In these cases, surgery may be recommended. The goals of surgery are to repair the torn tendon, prevent further degeneration, and allow for effective rehabilitation. Dr. Kumar will discuss the surgery and expected recovery course with you. After surgery, a rehabilitation program specific for each patient is created with a physical therapy team in order to reduce post-surgical pain, restore motion, and regain strength. Sports and work training is a critical aspect of recovery in order to return patients to sports and activities as quickly and safely as possible necessary.

Osteochondritis Dissecans of the Elbow

Osteochondritis dissecans (OCD) is a condition that weakens the bone which supports cartilage inside a joint. Eventually, this leads to cartilage softening and damage and can sometimes cause a piece to break off. OCD usually affects younger patients ages 10-20 years old and can be found in multiple joints.

What does it do?

The cartilage inside each joint is supported by bone. The bone provides structural support and nutrition to the cartilage to keep it healthy and strong. OCD causes the bone in certain locations of the knee to become weak, soft, and diseased. Over time, this can lead to the cartilage becoming damaged and non-functional. In severe cases, the cartilage eventually dies and cannot heal.

How do injuries occur?

The exact cause of OCD is unknown. It has been associated with a disruption in the blood supply to the bone and with repeated impact stresses to the elbow, such as with overhead throwing or gymnastics. Genetics may also play a role as there may be an association with family history.

Signs and Symptoms

Patients with OCD of the elbow will oftentimes have gradual elbow pain and soreness with sports and activities. Some patients will have swelling that comes and goes, particularly after times of intense training. The pain and swelling usually get more frequent and more bothersome over time.

Sometimes, patients will describe an acute, sharp, sudden pain in the elbow and develop much more swelling than normal. Throwing or sports that require weight bearing through the arm can be difficult and uncomfortable. The elbow may start to click. These symptoms might indicate that the OCD has broken off inside the elbow joint. This can also cause the elbow to lock and lose motion.

Treatment

Treatment is based upon various factors including patient age, open or closed growth plates, and severity of disease. In early stages of OCD (“stable OCD”), non-surgical treatment can allow the body to heal the bone and cartilage. Usually this involves a period of rest to allow the elbow to recover. This is followed by physical therapy designed to rehabilitate the shoulder and elbow to restore strength and conditioning for return to sports and activities. In some patients, the OCD has difficulty healing and surgery may be recommended. Surgery is performed arthroscopically using a minimally invasive technique to help increase the blood flow to the area of sick bone.

In patients with severe or advanced disease, the OCD can become loose and even come out of place (“unstable OCD”). In such cases, surgery is may be recommended to either fix the unstable lesion to allow it to heal or to replace the bone and cartilage if the OCD is too advanced. There are multiple options which can be used to accomplish these goals, and Dr. Kumar will discuss these options with you prior to surgery. Many factors are considered, including prior surgeries, patient age, status of the growth plates, and severity of disease. Surgery can be performed arthroscopically or open depending on the exact procedure. After surgery, a rehabilitation program specific for each patient is created with a physical therapy team in order to reduce post-surgical pain, restore motion, and regain strength. Sport-specific training is a critical aspect of recovery in order to return patients to sports and activities as quickly and safely as possible.

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