Elbow Injuries

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Tennis Elbow (Lateral Epicondylitis)

Tendonitis of the common extensor tendon of the forearm.


Causes

Degeneration due to ageing
Overuse of the forearm against a resistance (tennis, golf)
Faulty technique in sport i.e. tennis
The term tennis elbow is a misnomer as the condition has a higher incidence in golf, squash, rowing, manual labour and even violin playing


Signs and Symptoms

Pain at the lateral epicondyle and lateral elbow
Common during middle age at the dominant arm
Pain may radiate down to hand
Pain will be sharp on exertion, but it may be a dull and constant ache
Gripping an object or squeezing the hand may be painful
Lifting a heavy bag or working at a pc will aggravate
Tenderness, heat and slight swelling over the epicondyle if acute
Pain and weakness on wrist extension (test for tennis elbow)

Test for tennis elbow: client makes a fist with the affected arm, therapist places a thumb on the lateral epicondyle and with the other hand offers resistance to the clients fist as they bring the wrist into extension. This will cause pain if there is a tendonitis present.


Treatment

If swelling is present apply ice to the arm. Otherwise contract. Therapy treatments help to relieve the pain.
The aggravating factors should be kept to a minimum
All the forearm muscles can be treated in the supine position with the clients elbow resting on the plinth. Extensors, flexors, supinator, biceps, brachioradialis should all be treated.
Friction to the common extensor tendon (usually found by locating the most tender point) for approx 1 minute on the inital treatment working up to 5 minutes on subsequent treatments
Application of ice immediately following the friction massage can be very beneficial to ease the pain
Ice followed by heat and ice later that evening
Stretching for extensors and flexors

Next treatment 3 to 4 days. Approx 6 treatments may be required, providing the client rests from any aggravating factors. Strengthening exercises for the extensors when stretching is no longer causing any ill effects.

To stretch the flexors stretch your arm out straight, palm upwards, and grasp your hand with the other hand, gently bending your wrist towards the ground until you feel a stretch in the forearm. Hold for ten seconds and repeat three times. Do three times a day. To stretch the extensors stretch the arm out palm downwards and gently bend the wrist towards the ground until you feel a stretch. Repeat as above.

Once these stretches no longer cause any pain you can do strenghtening exercises for your extensors.

Exercises for extensors: most dumb-bell exercises, reverse wrist curl, wrist roller (palm down)
 

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Golfers Elbow (Medial Epicondylitis)

Cause

Repeated over-strain of the flexors of the forearm
Strong forehand drive in tennis
Hitting the ground by mistake in golf


Signs and Symptoms

Pain over the medial epicondyle, signs and symptoms are generally the same as tennis elbow
Less common than lateral epicondylitis


Treatment is same as for tennis elbow, but focusing on the flexors and the medial epicondyle attachments.
 

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Olecranon Bursitis

Elbow bursitis, also called olecranon bursitis, causes fluid to collect in a sac that lies behind the elbow, called the olecranon bursa. A bursa is a slippery, sac-like tissue that normally allows smooth movement around bony prominences, such as the point behind the elbow. When a bursa becomes inflamed, the sac fills with fluid. This can cause pain and a noticeable swelling behind the elbow.


Why did I get elbow bursitis?

Elbow bursitis may follow a traumatic accident, such as a fall onto the back of the elbow, or it may seemingly pop up out of nowhere. People who rest their elbows on hard surfaces may aggravate the condition and make the swelling more prominent.


Signs and Symptoms

The common symptoms of elbow bursitis include:

o Pain around the back of the elbow
o Swelling directly over the bony prominence of the tip of the elbow
o Slightly limited motion of the elbow

There are other conditions that can cause elbow pain and swelling, and these should also be considered as a possible diagnosis. Your doctor can usually diagnose elbow bursitis on examination, but an x-ray will often be done to ensure the elbow joint itself appears normal. A MRI is not necessary to diagnose elbow bursitis, and will only be done if there is uncertainty about the diagnosis.

Are there complications of elbow bursitis?
Occasionally, the swelling and inflammation can be the result of an infection within the bursa, this is called infected elbow bursitis. Patients with systemic inflammatory conditions, such as gout and rheumatoid arthritis, are also at increased risk of developing infected elbow bursitis.


What are the signs of infected elbow bursitis?
The follow are signs of infection within the bursa. If you experience these symptoms, you should alert your doctor so he or she can evaluate for the possibility of an infected elbow bursitis:

o Fevers
o Chills or sweats
o Significant redness around the back of the elbow
o Breaks in the skin (scrapes/cuts) around the swollen area


Treatment

The treatment for elbow bursitis is usually best accomplished with a few simple steps:

* Draining the Bursa
The first step of treatment is accomplished by draining the fluid from the swollen bursa. This is done in the doctor's office using a needle to aspirate (suck out) the fluid from the swollen bursa.

Your doctor will sterilize the skin around the swollen elbow bursa, and place a needle into the area of inflammation. By removing this excess fluid, patients often have significant relief of symptoms. There is a chance the fluid can re-accumulate, and therefore an injection of cortisone is also often performed.

* Cortisone Injection
After removing the excess fluid, your doctor may often administer a cortisone injection into the bursa. Cortisone will suppress the inflammatory response to increase the chance of a lasting solution.

* Rest
Patients with elbow bursitis should rest and protect their elbow until the elbow bursitis has been completely treated. Usually no special protection or bracing is needed, and simply avoiding strenuous activity, lifting, and pressure on the elbow will allow the inflammation to subside.

In addition, some of the following steps may be done:

* Anti-inflammatory Medications
An oral anti-inflammatory medication is also commonly prescribed. These medications are most helpful with the pain that is caused by elbow bursitis, but they may also help control some of the inflammation.

* Brief Immobilization
Immobilization with a splint is usually not necessary, but may be helpful in some patients. Caution should be used with immobilization as a frozen (stiff) elbow joint can easily develop. Therefore, immobilization beyond a few days should be avoided, and gentle motion of the elbow joint should be encouraged.

What is the treatment for infected elbow bursitis?

If there is a question of infection within the bursa, the fluid will be sent for analysis. Treatment of infected bursitis requires repeated drainage of the fluid, antibiotic treatment, and sometimes a surgical procedure to remove the infected bursa.

Because of this specific treatment needed, all cases of elbow bursitis should be evaluated by a physician to ensure there is no evidence of infection.


Will elbow bursitis come back?

Elbow bursitis can come back, but in a routine case, followed by drainage and resting the elbow, the inflammation usually subsides and the problem resolves.

If the bursitis returns persistently, the bursa can be surgically removed, but this is rarely necessary. Often patients will feel a marble-like bump of thickened bursa even months after an episode of elbow bursitis. This is the tickened, scar that was the inflamed bursa.


How can I prevent elbow bursitis?

Patients who are prone to developing elbow bursitis are most often those people who place pressure on the point of the elbow for prolonged periods. In these patients, elbow pads can protect the elbow and help to prevent elbow bursitis.
 
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