Elbow injuries can be troublesome to elite and recreational athletes. Problems with the elbow are commonly seen in athletes who participate in racket or throwing sports. In addition, elbow pain can occur even from everyday activities unrelated to sports.
The elbow is a hinge joint composed of three bones: the humerus, ulna and radius. The humerus constitutes the upper arm; the other bones form the forearm.
The most common condition affecting recreational athletes is lateral epicondylitis, commonly known as tennis elbow. Although this may occur from a traumatic event, more commonly it is insidious in nature and occurs from microtrauma. Typically, patients note tenderness on the outside of their elbow and pain with activities.
Treatment of this condition usually begins with physical therapy as improving flexibility and strength of the forearm muscles helps to alleviate the symptoms. A cortisone injection also can be given safely and usually diminishes symptoms rapidly. In recalcitrant cases, surgery can be performed to excise the degenerative tendon tissue.
Medial epicondylitis, or golfer’s elbow, is a similar condition that involves the common tendon on the inside of the elbow. It, too, usually is caused by degeneration of the tendon. Treatment for this condition is essentially the same as for lateral epicondylitis, with surgery rarely being needed.
Injuries to the ulnar collateral ligament are becoming increasingly common in athletes who throw. This ligament is found on the inside of the elbow and connects the humerus to the ulna. It undergoes tremendous stress during the throwing motion and can tear slowly, from repeated trauma, or from a single event.
It is a very interesting injury in that it is usually well tolerated in nonthrowing athletes. Baseball pitchers, however, are rarely able to pitch effectively if this injury is untreated, as the ligament does not heal well. As a result, we commonly reconstruct this ligament by harvesting a tendon from the patient’s forearm and transferring it to the elbow to recreate the ligament. This is a highly successful operation that gives the athlete a 90 percent chance of returning to play.
In addition, young throwing athletes may incur injuries to the cartilage on the outside of their elbow. Because of the high forces generated in throwing, tremendous compressive forces occur between the lateral end of the humerus (the capitellum) and the radius. This can lead to bone and cartilage death, with resultant loose pieces and cartilage defects in the elbow. If detected early, these injuries can sometimes be treated with rest, allowing the bone and cartilage to heal. Unfortunately, many of these cases present late and require arthroscopy to remove detached pieces and stimulate new cartilage growth with a special surgical technique, known as a microfracture. Though this is quite successful, full recovery takes several months.
Dr. Noonan is the head physician for the Colorado Rockies and a partner at the Steadman Hawkins Clinic Denver. For more information, go to www.shcdenver.com.
