“Sudden short-term sharp pain in the front of the elbow?”
Biceps tendon tear at the elbow
Description
The biceps muscle is a large muscle on the front of the upper arm. The muscle is attached to the forearm via a tendon. Its main function is to bend the elbow. A tear of the biceps tendon at the elbow usually occurs after a trauma, such as a fall or after a very high load, where the arm is forcibly extended from a bent position. The use of some medications such as corticoids can reduce the quality of the tendon, making it more likely to rupture. Smoking is also one of the risk factors. This problem is much more common in men than in women. A biceps tendon rupture occurs in about 1.2 per 100,000 inhabitants per year.
Symptoms
Usually, one feels a sudden short-lasting sharp pain at the front of the elbow, followed by a less strong dull ache. The main complaint is a reduced bending strength of the elbow. Usually, the elbow can still be actively bent by the action of other muscles around the elbow. It is often also difficult to turn the palm up. Persistent pain in the front of the elbow and a bluish discoloration of the front of the elbow region usually occurs. When the tendon is completely torn, the biceps muscle is pulled upwards and this is especially visible when compared to the other side.
Physical & additional examination
The orthopedic surgeon will view and feel the elbow and the shape and position of the biceps muscle. The bending force of the elbow should be examined, as well as the twisting force of the forearm. The orthopedic surgeon will do this by holding back the forearm while the patient tries to bend the elbow. While the flexor muscles are contracted, the orthopedic surgeon will try to feel the biceps tendon by pressing the front of the elbow with the thumb. Normally, the biceps tendon will press against the thumb. If in doubt, other tests can be done, such as an ultrasound or an MRI scan of the elbow. However, these are not always necessary.
Therapies
The only possible therapy for a complete tear is surgery to repair the tendon. The faster the tendon is repaired, the better. Then in the majority of cases, it is possible to immediately restore the attachment of the tendon. If one waits for longer, or if the tear is not recognized until later, it is often necessary to adjust or lengthen the tendon. With partial tears, one can wait longer because recovery without surgery is sometimes possible. Furthermore, the tendon and muscle will not shorten too far because a part is still normally attached.
Surgery
The tendon must be reattached to the front of the forearm. Various techniques for this have comparable results. The choice of technique depends on the surgeon’s preference. Depending on the technique, one or two cuts in the skin will be required. If the tear has existed for a long time, or if it proves impossible to repair the tendon immediately during surgery, the tendon must be adjusted. This is usually done by using another tendon from the forearm or even the leg, but sometimes one can also choose to use a donor’s tendon. For this, a new skin incision has to be made.
Complications
Possible complications are (temporary) nerve injuries, with tingling, numbness, and loss of strength in the forearm and hand or bone formation in the muscles at the front of the elbow. These complications are rather rare. The only complication specific to this procedure is re-shedding or tearing of the tendon, but this also happens very rarely. Other complications are similar to those of most surgeries. Among other things, subcutaneous bleeding or infections are possible.
Revalidation
Immediately after the operation, the forearm will be very temporarily secured with the arm bent 90 degrees, using a bandage. After this, the arm may be moved quickly. Based on the recovery, the surgeon will further decide how quickly one can start building up strength and mobility.
Nerve entrapment
Description
Nerve entrapment at the elbow is a common problem. This concerns the ulnar nerve or the ulnar nerve. This runs through a tunnel on the inside of the elbow. The tunnel is formed by the bone of the upper arm on one side and a solid band-like structure over it. The nerve can be wedged in this tunnel. A rarer condition is compression of the radial and medial nerves at the elbow.
Symptoms
Impingement of the ulnar nerve usually presents symptoms in the hand. In particular, the little finger of the hand, and the little and ring finger may tingle, become numb or hurt. Also, at the height of the medial side of the elbow, one can sometimes feel pain at the site of the impingement. Resting on the elbow or bending the elbow can sometimes make the complaints worse. With long-term complaints, the strength of the little finger and ring finger can be reduced and a thinning or atrophy of the pinky mouse can be seen. Impingement of the median nerve can cause tingling and numbness in the middle and index fingers. Loss of strength in the thumb can also be observed. Radial nerve compression can mimic tennis elbow with forearm pain with tingling and numbness in the thumb.
Physical & additional examination
In the first place, the location of the nerve will be examined. The orthopedic surgeon can feel the nerve by applying light pressure to the elbow tunnel. This is usually not a pleasant feeling and can often trigger symptoms in the hand as well. Rolling the thumb over the nerve can often trigger the symptoms. Elbow mobility and stability will be examined. The sensitivity of the hand will be examined and the grip strength of the hand and fingers compared to the healthy side. Often an X-ray will be taken to rule out bone abnormalities. Finally, an electromyographic examination can be performed. In this way, one can study the electrical functioning of the nerves.
Therapies
Initially, an attempt can be made to follow a conservative, functional policy. If this fails, surgery is indicated for these conditions.
Surgery
When suffering from an ulnar nerve, the skin on the inside of the elbow is incised. The tunnel is then located and opened by cutting the band-like structure at the top. To prevent the nerve from being pinched again later by scar tissue, it is moved out of the tunnel. Usually, the nerve is moved to the front of the tunnel and is then placed under the skin. Radial nerve compression is operated on the same access route as a tennis elbow. Median nerve compression is performed through the anterior side of the elbow. Usually, a scar cord at the level of the muscles is the cause of this compression in these last two nerves.
Complications
The result of the procedure depends on the condition of the nerve before the operation. Tingling, loss of strength and numbness may persist. It is important to ensure that these do not increase. Scar tissue will form after surgery that could potentially re-engage the nerve. There is a very small chance that the nerve could be injured during surgery if it is released. As with any surgery, bleeding may occur in the area of surgery. This is accompanied by swelling but usually will not require additional treatment.
Revalidation
This procedure does not require any special rehabilitation. Anti-inflammatory drugs and pain medication can be given after the procedure to reduce pain caused by the operation.
Elbow Prosthesis
Description
The elbow joint consists of three bony elements normally covered with cartilage (the humeral end or end of the upper arm, the radial head, and the beginning of the ulna or olecranon). These structures can be subject to wear and tear processes (arthrosis, arthritis, rheumatism, hemophilia). Some conditions affect the joints as well as muscles, nerves, and organs. In such a wear and tear process, the articular cartilage is destroyed. This is accompanied by pain, stiffness, loss of function, and disability. The cartilage surface of the elbow can also be acutely damaged and impossible to repair as a result of a radial head crush or crushing of the humeral tip. These fractures can lead to a lot of pain, stiffening, loss of function, and disability if they are not optimally repaired. The ulnar nerve or ulnar nerve is usually also involved in all these conditions (accident or wear) and can cause tingling and numbness in the little finger and ring finger and sometimes accompanied by a loss of strength in the hand and fingers. An elbow prosthesis may be indicated in such conditions. Different types of elbow prostheses can be used depending on the condition, severity, and condition of the patient. For example, a radial head prosthesis can be placed on a patient with a crushed radial head after an accident. In case of wear and tear and/or rheumatism and arthritis, it may be necessary to replace the joint with a prosthesis.
Complaints
Arthrosis and wear and tear of the articular cartilage are associated with pain, swelling, loss of strength, loss of function, and disability of the elbow joint. These complaints can be accompanied by tingling, numbness, and loss of strength s in the hand when the ulnar nerve is involved in the disease process.
Physical & additional examination
The orthopedic surgeon will thoroughly examine the elbow for swelling, abnormal position, pressure pain, tingling, and sensory disturbances. He will also determine the mobility of the elbow. This examination is usually supplemented with a standard X-ray. To further investigate the severity of the joint damage, it may be suggested to perform a CT or an MRI. A standard blood sample is also necessary to check for rheumatism and other inflammatory factors and to rule out an infection. If there is tingling and numbness, an EMG examination can be performed to examine the nerve of the elbow and see how far it has been affected.
Therapy
The treatment aims to make the elbow joint functional again as quickly as possible and to immobilize it as little as possible (plaster). In the case of wear and tear (arthrosis, arthritis, and rheumatism) an attempt will initially be made to get this disease process under control using rest, work adaptation, ergonomics, medication, and physiotherapy. Such treatment is sometimes approached multidisciplinary. Surgical intervention should be considered in the event of failure of a conservative policy and in the event of increasing complaints.
Surgery
If conservative therapy fails, surgery can help. We distinguish two large groups of interventions. The first procedure, the so-called Outerbridge and Kashiwagi (OR) procedure, can be considered in very young patients or in patients where it is impossible to place a prosthesis. Here, fenestration of the olecranon fossa takes place with the removal of anterior and posterior osteophytes. The second group of interventions also consists of removing the damaged joint surfaces and replacing them with a prosthesis. There are different types and types. Depending on the condition, the local condition of the elbow, the patient, a fracture, etc., a certain type of prosthesis can be placed.
Complications
All surgical procedures can be associated with infections or wound problems. Fortunately, these are rare. If the choice is not made to replace the joint, the elbow may be unstable and/or painful. If a prosthesis is placed, there is a risk of loosening, infection, and in some cases instability. In very rare cases, a prosthesis can break if it is overloaded. Fortunately, such complications are not frequent. The elbow sometimes shows reduced mobility, which fortunately usually does not hinder too much. Irritation of the ulnar nerve (ulnar nerve) can sometimes cause temporary – and to a lesser extent permanent – hindrance.
Revalidation
A very long rehabilitation usually follows after the procedure. This consists of careful exercise with or without physical therapy. The patient will be seen regularly by the orthopedic surgeon and the elbow will be subjected to a routine radiological examination. The elbow should not be loaded with more than 0.5 kg during the first three months. Ultimately, the patient should not load more than 1 kg repetitively and not lift weights above 5 kg. It is possible to return to work if the patient complies with the previous rules. So, sports and manual work should be performed very carefully, preferably after consultation with your treating orthopedic surgeon.
Elbow Bursitis or Olecranon Bursitis
Pathology
The bursa at the back of the elbow may be inflamed and swollen. If an infection is present, your orthopedic surgeon will first treat you for this infection with antibiotics. Such swelling is often caused by trauma, but also sometimes by overload. If the swelling keeps coming back, your orthopedic surgeon will suggest surgery to remove this bursa.
The operation
The operation is usually performed under a regional anesthetic, and sometimes under short general anesthesia. This procedure can be performed as a day case. Through an arcuate incision, your orthopedic surgeon will clear and completely remove the bursa.
Post-operative care and rehabilitation
You will be given a pressure bandage around the elbow for 2 days. After 10 days, the stitches can be removed, either by your GP or by your specialist. Only gentle movements are allowed in the week after surgery to cause as little friction as possible.
Potential Problems and Complications
The major problem is that a postoperative hematoma often disappears very slowly and can even lead to a recurrence of bursitis. The body then makes a kind of bursa again. Recurrence is therefore possible. The area around the wound may be deaf after the operation, but this area decreases over time. As with any surgery, there is a risk of infection and dystrophy.
Golfer’s Elbow or Epicondylitis medialis
Description
One speaks of a golfer’s elbow or medial epicondylitis when there is inflammation of the attachment of the tendons to the bone on the inside of the elbow joint. Such inflammation usually arises as a result of an overload of these tendons by performing repetitive (or: repetitive) movements. This can occur with repeated, continuous heavy loads such as manual labor, tire work, dock work, painting, assembly work, and sports, and with repeated, continuous light loads such as typing, working with computers, and ironing. Such inflammation can be accompanied by irritation of the ulnar nerve or a nerve that runs in a gutter just behind the inflamed zone.
Complaints
Usually, there is pain during work or sports. These pain complaints can lead to stiffness and stiffness of the elbow joint. With persistent pain complaints, there may also be a reduction in strength. These pain complaints can be accompanied by numbness or tingling in the pinky and ring finger.
Physical & additional examination
When examining the elbow, there is very intense pressure pain over the inside of the elbow joint. This is usually the region where the inflamed tendons attach to the bone. The orthopedic surgeon will also provoke the movements and thus put stress on the tendons, as is the case during work or sports practice. This can be done, for example, by bending the wrist against resistance, or by overstretching the attachment of the tendons. An X-ray and ultrasound of the elbow may be performed to confirm the diagnosis and to investigate the extent and severity of the inflammation. If the orthopedic surgeon presses or taps lightly at the level of the gutter, and this causes or makes the numbness in the fingers worse, there is clinically an irritated nerve or inflammation of the ulnar nerve.
Therapy
The treatment aims to remove the inflammation at the tendon attachment to the bone and prevent it from coming back. Acute, short-lived golfer’s elbow with or without an inflamed nerve is usually treated through physical therapy, anti-inflammatory drugs, and rest. If this does not help, an injection of corticosteroids can also be performed in the area of the inflamed tendons. This can temporarily aggravate deafness or reduce strength in the fingers. A plaster or brace can also offer a solution in some cases. If the complaints do not improve in the long term and become chronic and severely hinder the patient, a decision can be made to perform surgery.
Surgery
The procedure aims to remove the chronic inflammatory tissue at the point where the tendons attach to the bone. Different techniques can be used for this. If the nerve is found to be irritated, the inflammatory tissue can be removed with or without repositioning the nerve.
Complications
All surgical procedures can be associated with infections or wound problems. Fortunately, these are rare. If the nerve was also treated surgically, it can continue to cause pain and discomfort for a long time, such as pain, numbness, tingling, and loss of strength. Usually, this is temporary, but sometimes also permanent depending on the damage to the nerve.
Revalidation
Physiotherapy can be followed after the procedure, depending on the degree or extent of the inflammation. When resuming work, it is important to consult an ergonomist to be able to work in better or more optimal working conditions. In athletes, aids such as relief straps can be worn at the height of the elbow. In rocket sports, foot positions are important and so is the grip on the rocket.
Tennis Elbow or Epicondylitis Lateralis
What is it?
Lateral epicondylitis or more commonly known as tennis elbow is an inflammation of the fibers that connect the muscles on the outside of the elbow to the wrist and fingers.
Pain can be felt when these fibers are attached to the bone. the outside of the elbow or also along with the muscles in the forearm. The pain is generally more present during or after repeated use of the arm. In more severe cases, even picking up or grasping light objects can be very painful and difficult. Because people who play tennis or other racket sports sometimes develop this problem due to poor technique, it has come to be known as “tennis elbow”.
What is the cause?
Excessive use of the arm or injury to the arm can damage the muscle attachment and cause the symptoms of tennis elbow.
Complaints and symptoms
The most affected area is usually the bony prominence on the outside of the elbow. This is known as the lateral epicondyle. This area usually feels painful when pressed. The pain is more provoked when stretching the wrist or fingers, mainly against resistance. Often X-rays are performed as well as an ultrasound to see if there are no other causes that could explain the inflammation problem.
Therapy
The treatment aims to relieve the pain. Initially, the treatment is not surgical.
The causative factor must certainly be eliminated. This sometimes means stopping repetitive activities or certain sports activities. In the first phase, patients will be advised to wear a tennis elbow bandage from the morning when getting up until nighttime when going to sleep. This is for about 3 weeks. If there is no clear improvement, an injection with cortisone is given at the start of the treatment. the side of the elbow. The tennis elbow bandage is then worn for another three weeks. If after this second period of three weeks the pain is less but not completely gone, a second infiltration is administered. If this therapy fails, surgical therapy is proposed in consultation with the patient. The surgical procedure involves clearing the inflamed area and slightly repositioning the tendon attachment so that the tension on these tendons is reduced. In this way, they can begin to heal, but this process often takes several weeks. Immediately after the procedure, a plaster or brace immobilization of about 3 weeks is necessary. This immobilization is usually followed by a period of physiotherapy.
The surgery is usually done as a day case.
Triceps Tendon Tear
Description
The triceps muscle is a large muscle on the back of the upper arm. The muscle is attached to the elbow via a tendon. Its main function is to extend the elbow. A tear of the triceps tendon at the elbow usually occurs after a trauma, such as a fall or after a very high load, where the arm is forcibly bent from an extended position. It can also occur after previous elbow surgery. The use of some medications such as corticoids can reduce the quality of the tendon, making it more likely to rupture. Smoking is also one of the risk factors.
Symptoms
The main complaint is a reduced elbow extension. Usually, the elbow can still be stretched a little actively by the action of other muscles around the elbow. Pain at the back of the elbow and a bluish discoloration just above the elbow are common. When the tendon is completely torn, the triceps muscle is pulled upwards and this can be seen especially when compared to the other side.
Physical & additional examination
The orthopedic surgeon will look at the elbow and the shape and position of the triceps muscle. Elbow extension should be examined. The orthopedic surgeon will do this by holding back the forearm while the patient tries to extend the elbow. While the extensors are contracted, the orthopedic surgeon will try to feel the triceps tendon by pressing the back of the thumb just above the elbow. Normally, the triceps tendon will press against the thumb. An X-ray of the elbow is taken to see if there are any bone lesions at the elbow. Sometimes a piece of bone can break off when the tendon is ruptured. If in doubt, other tests can be done, such as an ultrasound or an MRI scan of the elbow. However, these are not always necessary.
Therapies
Small tears, can repair without surgery. The arm is then placed in a cast or brace for several weeks so that the tendon can recover. The best therapy for larger tears is surgery to repair the tendon. The faster, the better the result. Then in the majority of cases, it is possible to immediately restore the attachment of the tendon.
Surgery
The ruptured tendon must be sutured. The choice of technique depends on the surgeon’s preference. If the tear has existed for a long time, or if it proves impossible to repair the tendon immediately during surgery, the tendon must be adjusted. This is usually done by using another tendon from the forearm. For this, a new skin incision has to be made. However, the relevant tendon in the forearm is not present in every patient. It may therefore be necessary to use a tendon from the thigh. The surgeon will be able to examine this and discuss this with the patient before the operation.
Complications
Permanent loss of strength is present to a greater or lesser extent in almost every patient. Many patients lose some mobility after the procedure. This will depend on the size of the tear, time to surgery, and the ability to repair the tendon. The only complication specific to this procedure is re-letting or tearing of the tendon. However, this happens very rarely. Other complications are very rare and rather similar to those of other procedures. Among other things, subcutaneous bleeding or infections are possible.
Revalidation
This is highly dependent on the findings during surgery. Depending on the size of the tear and the firmness of the repair, the surgeon will decide when the patient is allowed to build up strength and mobility. Immediately after surgery, the arm will be temporarily secured in an extended position. This can be done with a bandage, plaster, or with a brace. This will be done as short as possible to avoid stiffening. Sometimes the arm may be moved immediately after surgery.
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