Elbow Disorders

1. Tennis Elbow

What is tennis elbow?

Lateral epicondylitis, commonly known as tennis elbow, is swelling of the tendons that bend your wrist backward away from your palm.

A tendon is a tough cord of tissue that connects muscles to bones. The tendon most likely involved in tennis elbow is called the extensor carpi radialis brevis. Tennis elbow is usually diagnosed in both men and women between the ages of 30 to 50 years.

What causes tennis elbow?

Tennis elbow, as the name implies, is often caused by the force of the tennis racket hitting balls in the backhand position. Your forearm muscles, which attach to the outside of your elbow, may become sore from excessive strain. When making a backhand stroke in tennis, the tendons that roll over the end of our elbow can become damaged. Tennis elbow may be caused by:

  • Improper backhand stroke
  • Weak shoulder and wrist muscles
  • Using a tennis racket that is too tightly strung or too short
  • Other racquet sports, like racquetball or squash
  • Hitting the ball off center on the racket, or hitting heavy, wet balls

However, many people who suffer from tennis elbow do not play tennis. The problem can be caused by any repetitive movement. Other causes of tennis elbow include:

  • Painting with a brush or roller
  • Operating a chain saw
  • Frequent use of other hand tools on a regular basis
  • Using repeated hand motions in various professions, such as meat cutters, musicians, dentists, and carpenters

What are the symptoms of tennis elbow?

The following are the most common symptoms of tennis elbow. However, you may experience symptoms differently.

At first, you may have pain, burning, or an ache along the outside of your forearm and elbow. With time, the pain gets worse. If you continue the activity that caused your condition, the pain may spread down to your wrist, even at rest. Pain may also persist when you place your arm and hand palm-down on a table, and then try to raise your hand against resistance. You may also feel pain when you try to lift and grip small objects, such as a coffee cup. A weak grip is another symptom of tennis elbow.

The symptoms of tennis elbow may resemble other medical problems or conditions. Always see your health care provider for a diagnosis.

How is tennis elbow diagnosed?

Your health care provider can usually diagnosis your tennis elbow by a physical exam. In some cases, you may certain tests, such as:

  • An X-ray to look at the bones of your elbow to see if you have arthritis in your elbow.
  • Magnetic resonance imaging (MRI) can show your tendons and how severe the damage is. An MRI of your neck can show if arthritis in your neck, or disk problems in your spine are causing your arm pain.
  •  Electromyography (EMG) of your elbow may show if you have any nerve problems that may be causing your pain.

How is tennis elbow treated?

It’s important to avoid the movement that caused your injury in the first place. Treatment may include:

  • Rest and stopping the activity that produces the symptoms
  • Ice packs (to reduce inflammation)
  • Strengthening and stretching exercises
  • Anti-inflammatory medications (such as ibuprofen or naproxen)

If these treatments do not work, your health care provider may talk to you about:

  • Bracing the area to keep it still for a few weeks
  • Steroid injections to help reduce swelling and pain
  • A special type of ultrasound that can help break up scar tissue, increase blood flow, and promote healing
  • Surgery (rarely necessary)

What can I do to prevent tennis elbow?

  • Keep your arms flexible and strong
  • Avoid repetitive movements
  • Warm up before exercising or using your arms for sports or other repetitive movements
  • If you play a racquet sport, make sure your equipment is right for you

2. Nursemaid’s Elbow

What is nursemaid’s elbow?

Nursemaid’s elbow occurs when the radius (one of the bones in the forearm) slips out of place from where it normally attaches to the elbow joint. It is a common condition in children younger than 4 years of age. It is also called pulled elbow, slipped elbow, or toddler elbow. The medical term for nursemaid’s elbow is radial head subluxation.

What causes nursemaid’s elbow?

A sudden pulling or traction on the hand or forearm, such as when a parent reaches out and grabs a child about to fall or to walk into the street, causes nursemaid’s elbow. This causes the radius to slip out of the ligament holding it into the elbow. It can occur when an infant rolls himself or herself over, from a fall, or from pulling or swinging a young child by the hand.

What are the symptoms of nursemaid’s elbow?

The following are the most common symptoms of nursemaid’s elbow. However, each child may experience symptoms differently. Symptoms may include:

  • Immediate pain in the injured arm
  • Refusal or inability to move the injured arm
  • Anxiety

The symptoms of nursemaid’s elbow may resemble other conditions or medical problems. Always consult your child’s doctor for a diagnosis.

How is nursemaid’s elbow diagnosed?

The diagnosis of nursemaid’s elbow is made with a physical examination by your child’s doctor.

It is important to call your child’s doctor immediately, or promptly take your child to the emergency department, if you suspect an injury.

Treatment for nursemaid’s elbow

Specific treatment for nursemaid’s elbow will be determined by your child’s doctor based on the following:

  • Your child’s age, overall health, and medical history
  • The extent of the condition
  • Your child’s tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the condition
  • Your opinion or preference

Treatment may include:

  • Acetaminophen (for pain), as directed by your child’s doctor
  • Prompt medical treatment while providing reassurance for your child

The injury can usually be reduced (fixed) by your child’s doctor with ease and often without the need for X-rays (unless other type of injury or fracture is suspected).

Once the elbow has sustained this type of injury, it is more likely to recur. If this happens again, call your child’s doctor or return to the emergency department for further evaluation and treatment. Most children outgrow the tendency for nursemaid’s elbow by the age of 5.

Prevention of nursemaid’s elbow

  • Avoid pulling or swinging your child by the arms or hands.
  • Avoid lifting your child up by his or her arms or hands.

3. Medial Epicondylitis (Golfer’s and Baseball Elbow)

What is medial epicondylitis?

Illustration of the anatomy of the arm
Click Image to Enlarge

Medial epicondylitis is also known as golfer’s elbow, baseball elbow, suitcase elbow, or forehand tennis elbow. It’s characterized by pain from the elbow to the wrist on the inside (medial side) of the elbow. The pain is caused by damage to the tendons that bend the wrist toward the palm. A tendon is a tough cord of tissue that connects muscles to bones.

What causes medial epicondylitis?

Medial epicondylitis is caused by the excessive force used to bend the wrist toward the palm. This can happen when swinging a golf club or pitching a baseball. Other possible causes of medial epicondylitis include:

  • Serving with great force in tennis or using a spin serve
  • Weak shoulder and wrist muscles
  • Using a too tightly strung, too short, or too heavy tennis racket
  • Throwing a javelin
  • Carrying a heavy suitcase
  • Chopping wood with an ax
  • Operating a chain saw
  • Frequent use of other hand tools on a continuous basis

What are the symptoms of medial epicondylitis?

The most common symptom of medial epicondylitis is pain along the palm side of the forearm, from the elbow to the wrist, on the same side as the little finger. The pain can be felt when bending the wrist toward the palm against resistance, or when squeezing a rubber ball.

The symptoms of medial epicondylitis may look like other medical problems or conditions. Always see your doctor for a diagnosis.

How is medial epicondylitis diagnosed?

The diagnosis of medial epicondylitis usually can be made based on a physical examination. The doctor may rest the arm on a table, palm side up, and ask the person to raise the hand by bending the wrist against resistance. If a person has medial epicondylitis, pain usually is felt in the inner aspect of the elbow.

Treatment for medial epicondylitis

Treatment for medial epicondylitis includes stopping the activity that produces the symptoms. It is important to avoid the movement that caused the condition in the first place. Treatment may include:

  • Ice pack application (to reduce inflammation)
  • Strengthening exercises
  • Anti-inflammatory medicine
  • Bracing
  • Corticosteroid injections
  • Surgery (rare)

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