ELBOW
Doctor Emilio López-Vidriero is an elbow superspecialist through the University of Ottawa, Canada. In this section you can consult the different elbow injuries and their treatments, both conservative and surgical.
ELBOW INJURIES
The elbow is one of the most complex joints in the body and the most unknown. These elbow injuries are common in sports that require a strong hand grip and activate the tendons which are inserted into it, or in falls supported by the hand which cause it to leave its site. It is the joint with the greatest tendency to lose mobility or become rigid. Ideally, we would diagnose the injury as soon as possible and try to avoid surgery whenever you can. If necessary, while performing surgery tailored to each athlete’s sport is crucial for success.
Pain in the outer region of the elbow. What can it be?
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Injury of the tendons inserted in the laterals: epicondylars, epicondilitis, epicondilalgia, tennis elbow. Extensor and supinator tendons. With or without breakage. With or without calcifications.
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Injury/entrapment of the posterior interosseous nerve (Froshe): neuropatic pain sometimes accompanied by tingling sensations.
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Synovial plica: with pain it is usually accompanied by blockages or clicks.
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Chronic compartment system: typical of motocyclists, tennis players and other sports requiring a strong grip.
Pain in the inner region of elbow. What can it be?
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Injury of the tendons that are inserted in the internal region: epitrochlear, epitrocleitis, medial epicondylalgia, golfers’ elbow. Flexor/pronator tendons. With or without breakage. With or without calcifications.
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Chronic compartmental forearm syndrome: typical of motorcyclists, tennis players and other sports with strong grip.
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Ulnar neuropathy: it’s accompanied by tingling in the pinky and ring fingers.
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Anterior interosseous neuropathy (Kiloh-Nevin): it is accompanied by an inability to make the OK sign with the index finger and the thumb.
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Internal collateral ligament injury: typical of pitchers.
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Snapping/jumping triceps: painful highlight when bending the elbow.
Pain in the posterior region of the elbow. What can it be?
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Olecranian bursitis: accompanied by inflammation with a feeling of granules when on support.
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Injury of the triceps tendon. With or without breakage.
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Rotary posterolateral instability.
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Elbow dislocation: the elbow usually tends to displace towards the back.
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Increased joint fluid: trauma, synovitis, rheumatic diseases.
Lack of elbow mobility. What can it be?
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For fibrosis: arthrofibrosis, frozen elbow, for a blow or prolonged immobilization.
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For pain: epicondylalgia, neuropathies, trauma.
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For osteoarthritis: typical cartilage wear of fighters, boxers, bodybuilders.
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For free bodies/particles within the joint: synovitis, osteochondritis, chondromatosis.
The elbow comes out from its place. What can it be?
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After a severe trauma or due to infiltrations or surgeries which have damaged the stabilizing ligaments.
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Posterial elbow dislocation.
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Rotary posterolateral instability.
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Medial subluxation of the pitcher.
Epicondylitis or tennis elbow
Epicondylalgia, or pain in the lateral (external) or medial (internal) region of the elbow, is very common in sports which require a strong grip such as tennis, golf, motorcycling, climbing, etc. It is a syndrome that can be generated by multiple causes with very different treatmends depending on the origin.
When it’s originated by tendons, we treat it with high precision infiltrations thanks to ultrasound, in order to control the pain or with regenerative therapies, physiotherapy with shock waves or invasive physiotherapy with EPI type intratissue electrotherapy, according to the needs. We also use individualized therapeutic exercise.
If it is of neurological origin, we treat it with ultrasound guided blocks, neuromodulation, and neurodynamics, as well as individualized therapeutic exercise.
If it is of muscular origin, we use shock waves, individualized physiotherapy and exercise with our own protocol.
The success rate with our individualized protocols is very high, but if needed, there exists the possibility of treating each of the lesion’s origins with minimally invasive individualized surgery.
Epicondylitis
Informative video on treatments related to epicondylitis or tennis elbow
Elbow dislocation
Elbow dislocation (where the elbow leaves its place) is usually caused by a fall stopped by the hand with a flexed elbow. The elbow can come out in different, breaking different ligaments and bones depending on the direction and mechanism.
The diagnosis of stability is key to deciding on treatment, since some dislocations have a very high recovery rate with conservative treatment through individualized physiotherapy and a dynamic brace which allows the elbow to move quickly in a stable range. Other dislocations require immediate surgery to stabilize the elbow and follow the same physiotherapeutic protocol as with previous ones.
The success rate with our individualized protocols is very high.
The elbow has a high tendency to become rigid with prolonged immobilizations, so one must try to avoid them. If it remains rigid, arthroscopic surgery can always be performed to recover mobility with a very high success rate.
Rotary posterolateral instability
This is a special type of elbow dislocation in which instability is generated by compression and rotation. The most common cause is traumatic, followed by injury to the lateral (external) ligaments of the elbow due to infiltration or surgery for epicondylitis. In mild or moderate cases, the patient notices it especially when leaning to get up from a chair and noticing a painful click, or feeling that the elbow is coming out.
If the lesion greatly impacts the quality of life of the patient, then surgery manages to solve the problem by replacing the injured ligament complex with tendons from another region.
Rotary posterolateral instability
Informative video on treatments related to rotary posterolateral instability
Synovial plica
The synovial plica is a pinching of the membrane surrounding the elbow on the inside which causes pain and a typical click, especially when it flexes a lot and the elbow and wrist rotates. It is a phenomenon similar to when one bites their mouth. If it is mild, we treat it with ultrasound guided infiltrations to control pain and with individualized physiotherapy by associating invasive techniques such as EPI type intratissue electrotherapy. If it is necessary to operate, we do it by arthroscopy treating all the injuries inside the joint which may cause the lesion. The rate of success with our individualized therapeutic protocol is very high.
Snapping triceps
Jumping or snapping triceps is a typical injury in athletes with a large muscle mass in the triceps, especially in bodybuilders, although we have also operated athletes who use their elbows a lot like basketball players or swimmers.
A bump with typical pain is generated in the medial (internal) region when the elbow flexes a lot. The treatment in this case is always surgical, removing the protruding parts of muscle and tendons which generate pain. The success rate is very high with our surgery and physiotherapy protocol
Snapping triceps
Informative video on treatments related to snapping triceps
Professionalism and honesty
Our commitment is to make our extensive experience and professionalism available to all our patients, offering personalized attention to achieve a complete recovery which, depending on each injury, allows our patients to return to their activities in the shortest possible amount of time.
