Lateral (outer) elbow pain is a common complaint. Symptoms include local tenderness over the bony lateral epicondyle (shown above). There may also be pain with common gripping tasks such as shaking hands, opening jars or taking milk out of the refrigerator. Tennis elbow may occur after a direct injury to the outer bony aspect such as hiitng a door facing or from strenuous gripping. In many cases, the symptoms occur with no associated cause.
Tennis elbow is not a serious condition, but it can be persistent and interfere with use of your hand. Surgery is reserved for severe cases that fail to respond to conservative care.
Treatment of lateral epicondylitis (tennis elbow):
- NSAID medications, heat or ice
- Physical therapy, ultrasound
- Stretching exercises
- Cortisone injection
- Surgery: for refractory cases.
Surgery for tennis elbow involves excision of inflamed tissue which is typically right under the point that is most tender. Excision can be performed with a small incision, or in some cases with the arthroscope.
Golfer’s elbow is similar to lateral epicondylitis, but occurs on the inner aspect of the elbow.
Olecranon bursitis is a localized swelling of the bursa sack over the bone prominence on the back of the elbow. (olecranon). In some cases the swelling can be larger than an egg. Olecranon bursitis frequently follows local injury to the elbow, such as hitting it on a door or resting the elbow on hard surface for extended periods of time.
In some cases, the swelling will subside with rest and preventing further trauma to the area. IF the swelling persists, the fluid can be aspirated with a needle. In cases that fail to improve, or when infection is possible, the bursa sack may be surgically removed.
Septic olecranon bursitis:
Septic olecranon bursitis is considered when the olecranon bursa swelling becomes hot, red and tender. These symptoms require prompt treatment. We prefer to aspirate the fluid prior to starting antibiotic treatment. In a large percentage of cases, treatment of septic olecranon bursitis requires surgical drainage and may require intravenous antibiotics.
Cubital Tunnel Syndrome / Ulnar nerve entrapment:
Commonly called the “funny bone” cubital tunnel syndrome causes numbness in the ring and small finger, and may cause weakness in the fingers and loss of use in the hand. One of the medical terms for the pins and needles feeling is paresthesia. The ulnar nerve passes under the bone prominence on the inner aspect of the elbow as it heads toward the hand. The nerve is immediately under the skin in this area. Direct trauma to the area can cause the funny bone sensation. Prolonged compression of the area, for example from resting the arm on a hard armrest in the car, can cause persisting numbness and or weakness in the hand.
Similar symptoms may be caused by a pinched nerve in the neck or hand. Evaluation of cubital tunnel syndrome includes evaluation of the strength of the muscles in the hand, location of numbness or paresthesia. Often the nerve may be tender to touch, and tapping over the nerve may cause the finger symptoms (Tinel sign) Be sure to tell your doctor about other nerve conditions you may have including neuropathy, thyroid problems, rheumatoid arthritis or chemotherapy. These conditions may contribute to your symptoms.
Initial treatment is protection of the nerve to prevent further trauma. If numbness or weakness persists, further evaluation should not be delayed, as loss of function can sometimes be permanent. Your doctor may order nerve conduction tests to confirm the diagnosis. Xrays may also be obtained to look for bone abnormalities that may cause pressure on the nerve.
In late stages, muscle weakness from this condition can cause claw deformity of the hand with permanent loss of function.
Surgical treatment of cubital tunnel syndrome involves removing scar tissue from around the nerve, or moving the nerve from the back of the elbow to the front (transposition) These procedures relieve pressure from the nerve to prevent further damage. Recovery of sensation and strength depends varies from patient to patient. Expectations for recovery may be decreased with presence of diabetes, increasing age, longstanding symptoms and significant muscle loss in the hand.