What is the elbow?

shoulder

What is the elbow?

The elbow is the joint that joins the arm to the forearm, connecting the humerus with the proximal ends of the ulna and radius. It is formed of bone, cartilage, ligaments, and fluid. The muscles and tendons help stabilise the elbow when we move it. Trauma to any of these structures will cause problems in the elbow.

The function of the elbow

The elbow enables a series of movements for straightening and bending the arm. These include:
⦁ Extension, using the triceps brachii muscles.
⦁ Flexion, using the biceps brachii, brachialis and brachioradialis.
⦁ Supination, using the short supinator muscle and biceps brachii.
⦁ Pronation, using the round and the square pronator muscles.

Pathologies of the elbow

Many factors can cause pain in the elbow, whether injured or not. The most common of these are:

Osteoarthritis. This is a degenerative process that rarely affects the elbow. When it does occur, it is mainly caused by intense, continuous exercise or repetitive trauma.

Arthritis. An inflammatory process that affects a joint, causing pain and an increase in temperature. Its causes are varied. In the elbow, the most common causes are rheumatoid arthritis, psoriatic arthritis, infectious arthritis, gout and chondrocalcinosis.

Epicondylitis, or tennis elbow, causes pain on the outside of the elbow.
Medial epicondylitis, or golfer’s elbow, causes pain on the inside of the elbow.

⦁ Olecranon bursitis, or student’s elbow. This is a rheumatic disease that affects the soft parts (not the bone) of the joint.

⦁ Elbow luxation. Though this is less common than shoulder luxation because the surfaces of the bones fit together perfectly. The main cause is a fall onto an outstretched hand and is usually associated with a fracture.

⦁ Painful pronation (babysitter’s elbow or radial head subluxation). The head of the radius moves from its normal position without completely dislocating and is therefore referred to as a subluxation. It is common in children under five years of age due to sudden traction on the forearm (e.g. when taking a child’s hand and pulling them to help them up steps, during physical contact sports such as judo, etc.).

Fractures: Most fractures are of the lower or distal extremity of the humerus, the head of the radius and the olecranon of the ulna.

⦁ Monteggia fracture. This is a complex and rare injury where luxation of the radial head at elbow level is associated with a fracture in the proximal third of the ulna.

⦁ The terrible triad of the elbow. This is a severe injury that is usually caused by a fall onto an outstretched hand. This type of injury is usually accompanied by luxation, with a fracture of the radial dome and the coronoid process of the ulna. Treatment involves surgery.

Treatments for elbow pathologies

Treatment will depend on the cause of the problem. To diagnose any elbow injury, various tests need to be performed: direct arthrography, radiography and nuclear magnetic resonance imaging, among others. Once the diagnosis has been made, the specialist will decide how best to treat the elbow pathology in each case. 
Normally, the main measure taken to treat the injured structure is to reduce inflammation, restrict mobility and alleviate pain, weakness and functional disability. This is why it is important, first of all, to administer NSAIDs (anti-inflammatory drugs), to put the arm in a sling, or similar, to limit mobility and to have physiotherapy. Physiotherapy will generally involve cryotherapy (application of cold), electrostimulation (TENS), a passive stretching programme for the pronation and supination muscles (those involved in twisting the forearm), wrist extensions and flexions, together with postural recommendations. Once the pain has subsided, exercises can be carried out to strengthen the muscles of the affected arm.
If the injury is more severe, the specialist may recommend other procedures. These may include elbow arthroplasty, surgery for tennis elbow or if surgery is not recommended, injections into the joints and soft tissues.

Elbow pain

What can cause elbow pain?

The elbow is a complex joint formed by bones, cartilage, ligaments and fluids. The muscles and tendons help to move the joint and if any of these parts suffers any damage, the pains and problems appear.

Elbow pain can occur as a result of:
Muscle strain or sprain – the muscles or ligaments in your elbow can be strained from overexertion. However, with rest and proper support, they should heal over time sand your symptoms should improve.

Bone fracture – this usually occurs as a result of playing sport or a fall, and is a sudden injury. You may still be able to move the elbow but it will be painful to do so. It’s important to seek medical help if you suspect you’ve had a fracture, as leaving the elbow untreated can lead to the bones not healing properly

Dislocation – this occurs when one of the bones in the elbow moves out of place, causing significant pain. You should get medical help for a dislocated elbow immediately.

Tendinitis – certain movement, such as arm movements involved in playing golf (golfer’s elbow or medial epicondylitis) or tennis (tennis elbow or lateral epicondylitis), can result in the tendons in your elbow becoming inflamed from overuse. These injuries are not limited to sports players – they can happen to anyone who frequently carries out a similar arm movement, such as at work.

Bursitis – another injury from repetitive arm movement, where sacs containing fluid become swollen and cause pain in the elbow.

Arthritis – both ⦁ osteoarthritis (wear and tear of the cartilage in your elbow) and rheumatoid arthritis (a condition causing inflammation in your joints) can result in joint pain in the elbow. In this situation a rheumatologist will recommend the best treatment.

Trapped nerve – everyone has a number of nerves travelling down the arm, through the elbow and the hand. Sometimes a nerve can get trapped in the elbow, causing constant pain and some tingling. This can also cause similar symptoms in the hand and fingers.

Who should I see about elbow pain?

You should see your GP in the first instance, who is likely to refer you to a specialist rheumatologist for pain management, or possibly an orthopaedic surgeon if surgery is required. As part of your diagnosis, imaging tests (such as an X-ray or MRI) may be required.
The relevant specialist will coordinate your care, which may involve:
⦁ medication
⦁ physical therapies, including rest, ice, ultrasound and massage
⦁ accupuncture laser therapy (this aims to stimulate the release of serotonin and endorphins, resulting in pain relief and improved mood, sometimes negating the need for taking NSAIDs)
⦁ splints and other support for the elbow
If no improvement is seen in the patient’s elbow pain, then the following treatments may be required:
⦁ anti-inflammatory injections
⦁ in severe cases, 
⦁ elbow surgery

The Elbow Joint

What is the anatomy of the elbow joint?