Elbow injuries are common in the active population with recreational and occupational activities often contributing to significant soft tissue injuries. Elbow tendonitis is a common problem sustained by tennis players, golfers, keyboard workers, and laborers. Conservative treatment consists of stretching and medications and sometimes injections of corticosteroids. New treatments are being developed for these conditions including use of novel ultrasound therapy (Tenex). Traditional open surgery also has a role and when patients are diagnosed appropriately can enjoy 80% or higher good to excellent results with surgery.
Another reason for elbow pain which sometimes is masked is the presence of nerve compression syndromes. The cubital tunnel syndrome affecting the ulnar nerve on the inside of the elbow and the radial tunnel syndrome affecting the radial nerve on the lateral or outside of the elbow often are part of the soft tissue injury picture with these patients.
Diagnosis is based on having experience and a “clinical suspicion” of these problems, as diagnostic tests such as MRI or Nerve conduction studies are not very sensitive in picking up these problems.
When indicated and desired by the patient, surgical treatments for these conditions are highly effective and can be done on an outpatient basis with limited incisions, minimal anesthesia and very quick recovery in a few weeks.
Forceful use of the biceps muscle to hold up heavy objects against resistance causes Eccentric loading of the elbow…which can lead to distal biceps tendon ruptures. I have had excellent success using an unique surgical repair technique that I have developed. This system incorporates an endobutton, requires only one incision, allows early rehabilitation and recovery to moderate activity within 6 weeks as opposed to the more traditional repairs which require 3 months of protection before the initiation of early motion and loading of the repaired biceps.
Throwing athletes have other conditions that are unique to them such as stress on the medial collateral ligament complex which in extreme cases may necessitate the “Tommy John” surgery with use of a tendon graft to reconstruct a deficient medial collateral ligament complex to the elbow. Younger throwing athletes also can have pre-arthritic conditions and alterations in the normal growth and development of the elbow joint and underlying bone structure due to excessive stress. These are commonly treated conditions in my practice.
Recognition of these conditions is important to stay healthy. Appropriate treatment can get players and workers “back in action” with minimal downtime and minimal or no permanent effects.
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