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Elbow Pain

  • Elbow pain can be intrinsic (caused by elbow joint component pathology) or extrinsic (caused by a disease outside the elbow) like heart attack or pinched nerve in the neck.
  • The elbow joint is non bearing joint so wear and tear osteoarthritis is very rare in the absence of a prior trauma, however auto immune diseases like Rheumatoid Arthritis can cause elbow joint inflammation leading to pain, swelling, redness and warmth.
  • The most common causes for intrinsic elbow pain other than Rheumatoid arthritis are:
  1. Epicondylitis
  2. Olecranon Bursitis
  3. Ulnar nerve entrapment

Epicondylitis

It refers to non-inflammatory conditions of tendons surrounding the elbow

  • Lateral Epicondylitis (Tennis Elbow) is caused by repetitive use of extensor tendons such as tennis players. It causes localized pain at the outside of the elbow.
  • Medial Epicondylitis (Golfer Elbow) is less common and is caused by repetitive  flexion at the wrist and it causes localized pain at the inner side of elbow.
  • Treatment: avoidance of pain inducing activities and Ibuprofen. Steroid injection may be of short term benefit.

Olecranon Bursitis

The bursa is a pad that surround major joints to prevent tendon friction with bones.

Elbow bursitis can be caused by trauma (repetitive bumping of back of elbow), infections and Gout.

Typically it is manifested by focal swelling behind the elbow with fluid collection.if infected or inflamed (Gout) it will exhibit redness, warmth and tenderness.

Aspiration is recommended for severe cases or when infection is suspected.

Treatment:

  1. Non infectious traumatic bursitis —> avoidance of trauma and NSAIDs (Ibuprofen)
  2. Infectious: aspiration + culture + Antibiotics

Ulnar Nerve Entrapment (Cubital Tunnel Syndrome)

The Ulnar nerve is pinched at the elbow by fibrous scar tissue, Ulnar nerve displacement, Ganglion cyst or bone spur.

It causes elbow pain with numbness of 4th and 5th digits and weakness in hand muscles. 

Treatment is NSAIDs and elbow splinting at night. Surgery is an option if conservative treatment fails.

Carpal Tunnel Syndrome

  • Carpal Tunnel develops from increased pressure within the wrist causing Median nerve compression
  • It causes wrist pain that shoots up to forearm and down to hand
  • It causes numbness and weakness in the thumb, index and middle finger
  • Pain is worse at night or after work

Risk factors are: obesity, Diabetes, Female gender, Hypothyroidism, pregnancy and autoimmune disease.

Diagnosis: is made by physical exam, if questionable —> EMG (nerve         conduction study)

Treatment:

  • Early —> Activity modification, wrist splinting
  • Not responding —> Steroid Injection
  • Advanced not responding to above treatment —> Surgery
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