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Family Health Magazine
ACTIVE LIVING

Your Sore Elbow
Understanding the cause can prevent further injury

Imagine not being able to bend your elbow! Suddenly, daily activities like eating, dressing and grooming become difficult. Many sports, hobbies and tasks at home and work usually done without thought are now out of reach.

The elbow joint allows the upper arm to flex (bend) and extend (straighten). It also permits the forearm to turn inward (pronate) and outward (supinate). These movements support intricate actions of the shoulder, wrist and hand joints in a healthy arm.

Keeping the elbow in good shape during sports can be challenging, particularly if they involve throwing or using a racquet or club. When the elbow joint has been injured, it is hard to be sure of complete recovery. The joint can stiffen and lose range of motion quickly, often with some degree of permanence.

Understanding elbow injuries and caring for them properly is important. Medical knowledge about the elbow joint has increased considerably in the past several years. Both non-surgical and surgical care of the injured elbow have improved.

Tennis elbow

A common elbow injury in sports is tennis elbow (lateral epicondylitis). This condition can occur with repeated one-sided movements, like those in tennis, squash, badminton and golf. Such injuries are very common. As many as 45 per cent of people playing tennis daily, and 25 per cent of those playing once a week, will suffer from this ailment. Those over 40 are particularly vulnerable.

The stress placed on the arm during certain activities is high. For instance, hitting a tennis ball moving at 50 kilometres per hour is as hard on your arm as lifting a 25-kilogram weight. Using correct technique helps your arm absorb the impact.

Faulty stroke technique can magnify the problem. Using your wrist instead of the whole arm during a tennis stroke places more lateral or outside stress on the elbow. Involving the entire shoulder and trunk distributes the force on the arm as widely as possible. This helps avoid placing all the stress over the small area where the muscle attaches to bone.

Tennis elbow symptoms include pain, mainly at the elbow but also spreading up the arm to the shoulder and, or, down the forearm to the wrist. The wrist may be weak when lifting or twisting objects or shaking hands. A tender spot will appear over the bony prominence called the lateral epicondyle on the outer side of the elbow. Bending the hand up and back against resistance may be painful.

Treat tennis elbow by resting and avoiding activity that causes pain. Use an ice pack to reduce pain and inflammation. Physical therapy techniques can help with pain and swelling, and increase range of movement. Supervised exercise can increase muscle strength, flexibility and stamina. Medications such as anti-inflammatory drugs in oral or topical forms can be used. Shock-wave therapy may also help. If recovery is slow, cortisone injections may be considered. Supporting the muscles with a forearm band may also assist with healing.

While recovery is likely, symptoms may last for weeks to years depending on the degree of injury. Before (carefully) trying the activity again, be sure you have regained full mobility, normal strength and pain-free function.

Golfer’s or thrower’s elbow

Golfer’s or thrower’s elbow is similar to tennis elbow, but involves the inner epicondyle of the elbow. There can be marked tenderness over this bone. Flexing the hand down against resistance will cause pain. Treatment is similar to that for tennis elbow.

Little league elbow

Little league elbow affects adolescents. It is caused by the force of throwing with the wrist and fingers turned inward. These forces pass up the arm to the inner epicondyle growth plate, which is not yet fully formed (see adjacent diagram). Pain and tenderness appear over this part of the elbow. X-rays often show changes in the growth plate.

Treatment includes rest from throwing or any other related activity until pain is totally gone. Sometimes the arm is put in a cast. Occasionally, surgery may be needed.

Dislocation

When a joint is knocked out of alignment, it becomes dislocated. The blow is usually severe, and may include contact when the elbow is bent or straight. Backward displacement is most common. Fracture and soft tissue injury may also be involved. This can be serious because of nearby nerves and blood vessels.

Symptoms include severe pain, deformity and instability. Treatment consists of immediate medical care to correct the dislocation, keeping the joint immobile for two to five weeks, and physiotherapy. Activity can usually be resumed in eight to 10 weeks.

Cartilage fragments

Loose bodies are fragments of cartilage with bone attached. They appear when joint surfaces knock against one another. These fragments remain inside the joint. They cause locking, pain, swelling and tenderness. Diagnosis is made by x-ray or MRI. Treatment includes rest and often the removal of the loose bodies by arthroscopy. Depending on the extent of injury, return to sport is usual in two to three months.

Bursitis

A bursa is a fluid-filled sac that reduces friction on a surface. It is usually between a bony prominence and the skin. The olecranon bursa at the tip of the elbow can be injured from a fall or a blow. This can happen during sport activities if elbow guards are not worn or fit poorly. Bleeding into the bursa causes pain, swelling, and tenderness. Sometimes, it can even affect the range of the joint.

Treat it by resting and icing the area. The fluid may be removed by a needle, under sterile conditions. If pain persists, a cortisone injection may be given. Occasionally, surgery is needed to remove the sac if local treatment and physiotherapy fail.

In a mild case, an athlete may return to careful activity after one week. Longer rest periods are required if the condition persists. Sometimes, the bursa becomes hard (calcified). This can be felt with the fingers.

Nerve damage

The elbow area contains many nerves (see adjacent diagram) that may become damaged when the joint is injured. Occasionally, nerves are trapped or stretched. The radial nerve may be trapped where it passes through the large muscle just below the elbow.

The nerve at the elbow (ulnar nerve) can be involved after a blow to the inside of the elbow (hitting your funny bone). Pain can radiate to the fourth and fifth fingers. With throwing or racquet sports, the ulnar nerve can be stretched or can slide out of its groove behind the upper arm bone, causing irritation.

Symptoms may include pain in the inner elbow, especially after long tennis or golf matches. Pain may spread to the fourth and fifth fingers, along with numbness in these fingers. There can be tenderness over the nerve in its groove, and tapping over the nerve can increase pain.

Treatment consists of rest and anti-inflammatory medication. Rarely, surgery may be necessary to move the nerve to a less exposed place in the front of the elbow. Thanks to its protected location in front of the elbow joint, the median nerve is seldom affected unless there is a serious elbow fracture.

Fractures

Bones around the elbow can be fractured during sports. Severe pain, swelling, abnormal shape or movement of the elbow after an injury all suggest a fracture. If this is the case, splint the arm and get medical help immediately.

Over the past few years, we have developed better imaging techniques to show bones and new surgical hardware designed specifically to treat elbow fractures. As a result, outcomes after elbow surgery have improved dramatically.

Prevention

Many sports involve the risk of developing an elbow injury. Prevention is the best solution. Correct playing and working techniques, and adequate stretching and warm-up are necessary.

In ball and racquet sports, approach the ball with shoulders turned and the entire body involved in each stroke. A firm wrist and complete follow-through are necessary. Good footwork is crucial. A slow court surface will help, as will light balls (not ‘dead’ or wet). Use a custom-measured, well-balanced racquet with individually adjusted string tension (looser is better). A suitable grip and large ‘sweet spot’ (centre where ball hits) also make a big difference.

The elbow is a very important joint that must be protected during sports. Staying fit, with good muscle strength and function, can help. Proper warm-up and cool-down routines improve elbow function and, along with protective equipment like elbow pads, can help reduce the risk of injury.