Sunday, April 1, 2012

Elbow pain

Physical activity is a good way to feel better, get fit and beat pain. You can start your own home with simple free exercise videos for everybody, Tv-Gym.com.



Tennis Elbow

Elbow problems are common in office workers. While working at the computer, the points where the muscles attach to the elbow often get irritated, and elbow tendinitis may follow, especially if work posture and habits do not promote correct elbow positioning. This area can also become sore due to minor elbow injury or sudden overexertion.

The most common elbow problem is the so-called tennis elbow or lateral epicondylitis. Tennis players frequently suffer from this elbow pain symptom, thus the name. Not only tennis players but also people in professions where there are a lot of repetitive wrists and arm motions often have these problems. In tennis elbow the point in the elbow area where the outer part of the shoulder bone is attached to the tendons becomes irritated. A group of muscles that flex the wrist toward the top of the hand is attached to this area.

The tendons in the elbow develop degeneration with aging in the same way as other tendons. Continuous repetitions and overuse as for instance hitting numerous tennis balls or making work with constant, repetitive tasks like excessive computer mouse usage may give small tears in the tendon and its attachment giving ground for tennis elbow. Condition is partly caused by a direct trauma, a sudden pull or overextension of the forearm.

The pain may begin if an untrained person has repeatedly performed motions that require a lot of strength or in connection with overexertion. Typically this pain feels on the outside of the elbow, initially during exertion but later continuously and even at night. If the stress causing the irritation continues, the problem becomes worse.

There may be pain when lifting or extending arm. There is usually also pain during heavier exercises like lifting weights or throwing. Symptoms additionally with the pain and local tenderness in the outermost part of the elbow may be stiffness in the morning and a weak and painful grip.

Examination shows soreness at the outer part of the elbow and bending the wrist upward against resistance worsens the pain. The range of motion of the elbow is usually normal. There may be minor local swelling.

Diagnosis is made in doctor´s examination by typical clinical signs, symptoms and findings. Often no further tests or imaging are needed, and treatment can be started immediately. Sometimes x-rays, ultrasound, MRI or ENMG are used to exclude other possible causes for the pain. Elbow pain treatment usually gives good results.

Anti-inflammatory drugs and ointments, cold compresses several times a day, and the rest are the first part of the treatment. Finding the cause for the irritation and eliminating it is important. Sometimes changes have to be made at work or in one’s work habits in order to do this.

The following stretching exercise after cold compresses is recommended: bend your elbow and hold the wrist bent towards the top of the hand with your other hand. Straighten the elbow while holding the wrist bent with the other hand, which helps stretch the muscles that attach to the elbow. Hold the hand in this position for 20-30 seconds. Repeat the exercise several times a day.

A wrist splint can be used at the time of acute pain to prevent repeated wrist motion. This reduces the irritation at the point where the muscles attach to the elbow. A tennis elbow support may be useful later in an attempt to reduce stress at the muscle attachment site.

Work or hobbies that require repeated squeezing of the hand should be avoided. If you have been using a mouse with the sore arm, learn to use it with the other one.

Those working at computers should take short breaks several times a day. The sore arm can be lifted up, all muscles contracted and then relaxed. Shake the arm after the exercise. Make sure that there is enough space in front of your keyboard to place your hands. Try a wrist support and learn to rest your hands on it while you type.

A cortisone injection given by a doctor or physical therapy may be necessary if medication and the rest do not alleviate the situation. Surgery is sometimes necessary.

After the successful treatment, as the pain goes away, it is important to prevent tennis elbow problems in the future. One should limit the amount of playing and other repetitive motions of the arm to the level which can be tolerated without irritation. One should stay generally in good physical condition and gradually specifically strengthen the muscles of the forearm and other muscles of the upper extremity. Your physiotherapist or personal trainer can make a program of elbow pain exercises to keep the pain away for good.

While playing tennis, make sure that the racket handle is the right size, and that strokes are made with a straight wrist. Tennis is not racket ball. Softer strings and a racket with a smaller striking surface may also reduce the impact of strokes. When buying the tennis racket the grip size should be chosen with special care preferably with the help of an expert.


Golfer's elbow

A pain similar to that of tennis elbow, felt on the inside of the elbow, has been dubbed golfer's elbow or medial epicondylitis. A group of muscles that bends the wrist toward the palm connects to the inside of the arm in the elbow area and pain may develop in this region. A shooting pain down the forearm is also common.

The condition is of the same type as the tennis elbow, except the symptoms appear on the opposite side. Both are caused by overuse of the muscles and tendons of the forearm or minor injuries causing inflammation of the tendons and pain in their insertion into the elbow joint. If there is degeneration of the tendons, the irritation may form easier.

This site stresses in making a golf swing and also with many other physical activities. The irritation forms easier in the beginning of the golf season. The injury may form from a single strong action or with a repetitive stress containing wrist and finger motions with the unaccustomed force. This can be for instance weekend painting or hammering. Excessive typing may also cause this problem as well as throwing, weight training and similar activities.

Along with the pain and local tenderness there may also be symptoms of stiffness, numbness, tingling and weakness in hand or fingers. Usually doctor´s examination is enough with some testing of the painful area. Sometimes x-ray or MRI may be used to exclude other painful conditions.

In treatment rest is essential. All repetitive and forceful activity with the painful hand should be avoided until the pain disappears. Cold packs on the painful region several times a day for 15 minutes or more along with over-the-counter pain medication and stretching exercises may be used as self treatment in the acute phase. If the pain goes on, one can discuss with the doctor whether surgery might be needed. When there is no more pain one can gradually return to normal activities, As preventive measures targeted exercises at the gym or home are useful. A personal trainer or a physiotherapist can make a special program for this.


Ulnar Nerve

The most common of the nerve conditions in the elbow is the entrapment of the ulnar nerve. This nerve is superficial on the surface under the elbow and its inner edge. It goes through a groove covered with a ligament and a sheath called the cubital tunnel. It is not protected well, and injury is common.

It gives nerves to the skin of the ring and little fingers and supplies muscles of this area as well as the interosseus muscles between the metacarpals or the bones in the middle part of the hand and also the muscle pulling the thumb towards the midline.

It can get irritated either due to a direct injury or a long-term pressure. The nerve can be compressed in an extreme flexion of the elbow. Also a direct trauma, a prolonged outside compression or an anatomical changes in this area such as the degenerative spurs, tumors etc. may irritate the nerve.

Symptoms ,in addition to the pain include, numbness and reduced sensation in the 4th and 5th fingers, and in the more difficult cases, muscle weakness and wasting in the hand. In the most difficult situations the result may be a clawing of the 4th and 5th fingers.

Doctor´s examination needs to rule out other reasons of the reduced sense of the touch or the sensation of the ring and little fingers. Same type of symptoms may be caused by cervical degeneration and nerve irritation at the wrist level. The diagnosis can be confirmed with the nerve conduction studies and EMG, and the examination would show a lowered conduction velocity at the entrapment site.

Treatment consists of anti-inflammatory drugs if there is pain, avoiding bending the elbow or putting direct pressure on the site. Sometimes it is necessary to examine and liberate the area surgically.

Radial nerve

Radial nerve may compress in the elbow area. It is less common than the ulnar compression syndrome. Compression may arise with a fracture of the radius bone. In this case, there is pain and lack of muscle functions of the hand. Also, doing repeated forceful contractions of the forehand extensor muscles by one not accustomed to it in tasks like using a screwdriver with force or a heavy hammer may narrow the nerves space on its route and give irritation. This tension may also be referred to the same area where the outer part of the shoulder bone attaches to the tendons of the same muscles irritated in the problems of the tennis elbow.

Symptoms are local pain in the outer part of the elbow, and they may resemble symptoms of a tennis elbow. Diagnosis is made in doctor´s examination with typical history and findings of local tenderness and pain in the test movements with a straight elbow against resistance of forced extension of the wrist and the middle finger. With radial nerve compression in this area, there should be no changes in the sensation of the hand.

Usually avoidance of painful movements is all that is needed to take care of the problems. Sometimes surgery is needed.


Arthritis

The elbow area is often recipient of various injuries, which may leave the joint with the cartilage surface of the elbow damaged. The cartilage may also wear by aging and degeneration. The elbow is not very often affected with arthritis because it is quite stable and does not bear weight.

The standard symptoms of the arthritis are a reduced range of motion and pain. The elderly with the degeneration may experience arthritis pain especially during exertion. Elbow pain feels mostly inside of the elbow. There may also be some swelling, a scratching sound and temporary feelings of locking of the joint.

The typical symptoms, the findings and an x-ray will confirm the diagnosis. The treatment consists mainly of reducing the excessive physical stress on the joint, physiotherapy, and the pain medication. In the later stages, a cortisone injection can give relief if the usual pain medication does not give an adequate enough relief. Surgery may be needed in the form of the arthroscopy or the joint replacement operation.


Bursitis

Injuries may cause an inflammation of the mucous bursa in the elbow. There is little pain, but a soft bulge can be observed near the elbow. Treatment consists of draining the liquid from the bulge and of a shot of cortisone. If the mucous bursa is very enlarged, it may be necessary to remove it surgically.

See a Doctor

Limited range of motion in the elbow with pain present.
Pain in the elbow with radiating pain or numbness in the arm.
Swelling of the elbow.
Prolonged pain that cannot be alleviated by home remedies.

Elbow pain, more information:

Elbow exercise videos Tv-gym.com.
Eorthopod.com page about the anatomy of the elbow.
American Academy of Orthopedic Surgeons on tennis elbow.
Ezinearticles.com about tennis elbow strap.
Shoulderdoc.co.uk about tennis elbow operations.
webMD about golfer's elbow.
Mayoclinic.com pages on golfer's elbow.
eMedicineHealth about repetitive motion injuries.
American Academy of Orthopedic Surgeons on ulnar nerve entrapment.
Eorthopod.com article about arthritis of the elbow.
Wikipedia on elbow bursitis.
webMD about broken elbow.
American Academy of Orthopedic Surgeons on dislocation of the elbow.
HealthDesk.com about nursemaid's elbow.

1 comment:

  1. it hurts and i got caught at mid on!

    ReplyDelete