Elbow conditions

The elbow is a complex joint involved in all movements of the arm. Elbow conditions are common both in athletes and in the general population, and require a specialist assessment to determine the most appropriate treatment.

Common elbow conditions

• Lateral epicondylitis (tennis elbow): pain on the outer aspect of the elbow due to inflammation of the extensor tendons
• Medial epicondylitis (golfer's elbow): pain on the inner aspect caused by flexor tendon involvement
• Ligamentous instability: following dislocations or repetitive trauma
• Joint stiffness: loss of range of motion after fractures, surgery or prolonged immobilisation
• Cubital tunnel syndrome: compression of the ulnar nerve at the elbow, causing tingling in the ring and little fingers
• Elbow fractures: olecranon fractures, radial head fractures or complex fracture-dislocations

Diagnosis

A thorough clinical examination guides the diagnosis in most cases. Radiographs, ultrasound and MRI are used to complement the assessment depending on the suspected condition. In cases of stiffness or intra-articular loose bodies, CT with 3D reconstruction is particularly helpful.

Non-surgical treatment

Many elbow conditions respond well to non-surgical management: targeted physiotherapy, elbow bracing or orthoses, injections (corticosteroids, hyaluronic acid, platelet-rich plasma) and extracorporeal shockwave therapy. Tennis elbow, for example, resolves without surgery in over 90 per cent of cases.

Surgical treatment

When non-surgical treatment fails, surgery may be considered. Arthroscopic techniques allow treatment of stiffness, loose bodies, refractory epicondylitis and synovial pathology with a faster recovery. Complex fractures and ligamentous instability require open surgery with fixation and repair of the damaged structures.

Recovery

Elbow rehabilitation is of paramount importance and should begin as early as possible to prevent stiffness, one of the most common complications. Recovery timescales vary: from six to eight weeks for epicondylitis to three to six months for complex fractures.