Treatment of Elbow Injuries

What are the Different Types of Elbow Injuries?

Some of the common elbow injuries include:

Elbow Sprain: Elbow sprain is an injury to the soft tissues of the elbow. It is caused due to stretching or tearing (partial or full) of the ligaments which support the elbow joint. Ligaments are a group of fibrous tissues that connect one bone to another in the body.

Golf Injuries to the Hand, Wrist or Elbow: Golf, a famous sport, involves the action of the wrist. Insufficient strength in the forearms is the major cause for wrist and hand injuries in golfers. Common injuries in golfers include:

• Tennis Elbow/Golfer's Elbow: Tennis elbow is the inflammation of muscles on the outside of the elbow whereas tendinitis on the inner side of the elbow is golfer's elbow. Overuse of the arms or a traumatic blow to the hand may cause tennis elbow or golfer's elbow. These injuries may cause severe pain and tenderness of the affected muscles that radiate down into the forearm, particularly with use of the hand and wrist.
• Tendonitis: Tendonitis is inflammation of any of the tendons in the wrist. Tendonitis is usually treated with adequate rest, splinting, ice application, and with non-steroidal anti-inflammatory medicines to reduce the inflammation.

Any problem causing pain, swelling, discoloration, numbness or a tingling sensation, or abnormal position of the hand, wrist, or elbow that persists for more than two or three days should be evaluated by your doctor to establish the cause and obtain the best treatment as early as possible.

Treatment of Elbow Injuries

Conservative Treatment Options

Your physician will recommend conservative treatment options to treat the symptoms associated with elbow injuries. These may include the following:

• Activity Restrictions: Limit the use and rest your arm from activities that worsen symptoms.
• Orthotics: Splints or braces may be ordered to decrease stress on the injured tissues.
• Ice: Ice packs applied to the injury will help reduce swelling and pain. Ice should be applied over a towel to the affected area for 20 minutes, four times a day for a couple of days. Never place ice directly over the skin.
• Medications: Anti-inflammatory medications and/or steroid injections may be ordered to treat the pain and swelling.
• Occupational Therapy: OT may be ordered for strengthening and stretching exercises to the forearm, once your symptoms have decreased.
• Professional Instruction: Consulting a sports professional to assess and instruct in proper swing technique and appropriate equipment may be recommended to prevent recurrence.

Surgical Treatment for Elbow Injuries

If conservative treatment options fail to resolve the condition and symptoms persist for 6 -12 months, your surgeon may recommend surgery. The goal of surgery is to remove the diseased tissue around the inner elbow, improve blood supply to the area to promote healing, and alleviate the symptoms. The different surgical approaches may include:

Tendon Repair

The repair of the damaged tendon is broadly classified into two types- tendon debridement and tendon release.

• Tendon Debridement: This procedure is commonly used in the management of tendinitis. In this procedure, the surgeon removes any damaged tissue from the tendon and cleans the tendon.
• Tendon Release: It is the most commonly used surgery for tendon repair. In this procedure, the surgeon locates the attachment of the extensor or flexor tendon on the elbow and splits the damaged tendon as well as removes the scar tissue or other overgrowth, around the tendon. Sometimes, the loose end of the tendon may be sutured to the surrounding connective tissue (fascia).

Ligament Reconstruction

Ligament reconstruction is considered in patients with ligament rupture. Your surgeon will make an incision over the elbow. Care is taken to move muscles, tendons and nerves out of the way. The donor tendon is harvested from either the forearm or below the knee. Your surgeon drills holes into the bones of the upper arm and the forearm, around the elbow joint. The donor tendon is inserted through the drilled holes in a pattern like that of the original ligament complex. The tendon is then attached to the bone surfaces with special sutures. The incision is closed with sutures and covered with sterile dressings. A splint is applied to support the elbow for a few weeks. After the surgery, you might be advised for regular follow-up and for a rehabilitation program for a better and quicker recovery.

Complications of Elbow Tendon and Ligament Repair

Common complications of the elbow ligament and tendon repair surgeries include infection, injury to the adjacent nerves and blood vessels, and a loss of strength or flexibility of the elbow joint.

Rehabilitation after Elbow Tendon and Ligament Repair

The success of the surgery depends on the post-operative rehabilitation program which includes the use of a removable splint immediately after surgery as well as ice therapy, electrical stimulation and massage for reducing pain, swelling or muscle spasm. Isometric exercises, strengthening and range of motion exercises may be useful for long term rehabilitation.