THE STRUCTURES OF THE ELBOW JOINT
The elbow joint is formed by the Humerus,the Ulna and the Radius bones of the forearm.It assists in opening-closing and rotational movements of the forearm.It also assists in grasping,holding and positioning of the wrist in space.
Carrying heavy load,rotational and forcefull movements of the wrist and elbow (using screwdriver,knitting), wrist forcing sports (tenis,golf) ,trauma of the wrist and elbow may cause elbow pathologies.
WHICH GROUP OF PATIENTS ARE AFFECTED MOST?
Besides those who play racket sports,elbow pathologies are frequently seen among profession groups wjo use forced elbow movements (painters,carpenters,house wives etc).It is encountered in both genders,between 30-50 years.
Medical history: initiation of the complaint,profession,hobby etc
Imaging procedures ;(X-ray,MR,EMG if necessary)
THE MOST COMMON ELBOW PATHOLOGIES
Neural Entrapment Syndromes
The most typical symptom is pain sensed on the bony spur (the lateral epicondyle of humerus) on the lateral side of the elbow joint.The pain increases with the resistive upward movement and may radiate to forearm and elbow.As the pain increases in time,weakness and tension can be felt on the muscles of the forearm.
Instanteneous and forced trauma or overuse (profession,hobby or sports) of the extensor muscles (upward movement) of the wrist.
Preliminary measure is to avoid painful movements by splinting the wrist and elbow.
Alleviation of pain and inflammmation with adequate medical care.
Physical therapy equipments (magnetotherapy,ultrasound,compex,laser,infrared etc)
Cold/Hot pack fomentations
Stretch and strengthening exercises.
Injection to the painful area.
Hence medical care fails,surgery can be considered.Post-operative physical therapy is inevitable.
MEDIAL EPICONDYLITIS (Golfer’s Elbow)
Similar to Lateral Epicondylitis,is pain sensed on the bony spur (the medial epicondyle of humerus) of the elbow joint,which radiates through the medial side of the forearm anf increases with the elbow and wrist motions.
Pain increases with the downward (flexion)and fist position of the elbow.In time,muscle weakness in the forearm and while grasping will be encountered.
Instantaneous,repetitive or forced movements of the wrist flexor muscles (golf players,racket players,bowlers,weight lifters,carpenters,writers).
Same as Lateral Epicondylitis; medical and conservative care must be taken.
Stretching and strenghtening exercises are performed.
CUBITAL TUNNEL SYNDROME
There are three important nerves that run through the upper extremities; Median,Ulnar and Radial nerves.
Cubital Tunnel Syndome is a condition that is caused by pressure or stretching of the unlar nevre,which runs in a groove (Cubital Tunnel)on the inner side of the elbow.It can cause numbness and tingling in the ring and small finger,weakness in the forearm and hand.
Previous elbow fractures
Prolonged stretch and pressure on the elbow joint (keeping the elbow in a bent position during sleep or working on the desk).
Swelling (edema in Rheumatoid Arthritis)
SIGNS AND SYMPTOMS:
Pain and tingling sensation radiating from the medial side of the elbow to the ring and small finger.
Increasement of the symptoms when the elbow is bent such as holding a phone ,reading or sleeping.
In the proceeding period,weakness in grasping and atrophy in the hand muscles can be seen.
EMG (to confirm the diagnosis)
In the early period, positioning the elbow to hinder pressure is adviced.
Stretching and strengthening exercises are recommended.
In case of failure,surgery may be considered.