How to eliminate elbow pain
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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Elbow pain is not often an arthritis problem. Rather, pain is more often due to strain or inflammation involving the supporting structures such as ligaments and tendons.
The elbow is a hinge joint that consists of the articulation of three bones. The olecrenon process of the ulna (one of the lower arm bones interacts with the humerus (upper arm bone). The radius (the other lower arm bone) also interacts with the humerus as well as the ulna. As with other joints, the elbow is stabilized by tendons and ligaments and cushioned by bursae.
Inflammatory forms of arthritis such as rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, gout, and pseudogout may cause elbow pain and swelling.
Occasionally loose pieces of cartilage can flake off in the joint and cause pain and swelling. The treatment of choice is surgery.
Tendinitis affecting the tendons that allow extension of the wrist is a very common cause of elbow pain. Discomfort is felt at the lateral (outside part of the elbow) and is aggravated by gripping or resisted extension of the wrist. This is known as “tennis elbow.”
Tendinitis affecting the tendons that allow flexion of the elbow occurs less often. Pain is felt at the medial epicondyle (inside part of the elbow) and is aggravated by resisted flexion of the wrist. This is also known as “golfer’s elbow.”Nerve entrapment of the ulnar nerve or radial nerve can also be associated with elbow pain.
Bursitis can also affect the elbow. Most commonly, bursitis can cause the olecrenon bursa (the sac at the tip of the elbow) to become swollen and full of fluid. This can occur as a result of trauma or can also occur as a consequence of inflammatory forms of arthritis such as rheumatoid arthritis or gout.
Entrapment of the ulnar nerve at the elbow (the nerve that causes pain when you hit your “funnybone”) can cause pain, numbness, tingling, and weakness involving the 4th and 5th fingers. In severe cases, a “claw hand” may develop.
Trauma can cause fracture.
The history and physical examination almost always point towards the diagnosis.
The laboratory exam is usually not a valuable part of the work up.
X-rays are helpful for excluding fracture. Magnetic resonance imaging is a more sensitive and specific method of detecting soft tissue abnormalities.
Treatment will vary, depending on whether there is a systemic reason for the elbow problem or not. If the patient has an inflammatory form of arthritis, that needs to be treated in concert with the elbow problem.
If it is a soft tissue abnormality, effective measures include splints and “tennis elbow bands”, anti inflammatory medicines, and physical therapy. Specific stretching and strengthening exercises are beneficial. For patients who don’t respond to these measures, glucocorticoid injection may be helpful.
When there is fluid inside the joint that causes discomfort or hampers movement, removal of the fluid may be therapeutic. If there is inflammation involving the joint, simultaneous injection of glucocorticoid is indicated.
Since olecrenon bursitis sometimes results from infection, fluid drawn from this area should be cultured before steroid injection is considered. Antibiotics are required if infection is the culprit
Some patients who have refractory pain may need surgery.
Patients with severe arthritis of the elbow may require joint replacement.
For more information and up-to-date treatments for elbow tendonitis go to:
Arthritis Treatment Center A premier private arthritis center specializing in clinical research involving rheumatoid arthritis and osteoarthritis. Located in Frederick, Maryland
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