The elbow is a hinge and pivot joint between the humerus (upper arm bone), and radius and ulna (forearm bones). Articular cartilage lines the ends of these bones in the elbow joint and allows for smooth, easy movements of the elbow. The Ulnar Collateral Ligament (UCL – or “Tommy John Ligament”) is the main ligament on the inside of the elbow and it attaches the end of the humerus to the ulna. The UCL provides stability the elbow joint during loading activities (push-ups) and especially during throwing. The UCL is most commonly torn as a result of repetitive overhead movements like pitching, but can also be torn after trauma to the elbow, such as a dislocation, and several other causes. A torn UCL is often referred to as a Tommy John injury.
Several tendons attach muscles to the ends of the bones that make up the elbow. The distal biceps tendon attaches both the long and short heads of the biceps (muscles of the upper arm) to the radius (forearm bone). The distal biceps tendon can rupture or tear off its attachment site. This leads to tenderness, bruising and swelling of the biceps near the elbow. On the distal end of the humerus, several bony prominences (known as epicondyles) serve at the attachment sites for tendons of the muscles in the forearm. The medial epicondyle is the attachment site for the flexor tendons and the lateral epicondyle is the attachment site for the extensor tendons. Elbow epicondylitis results when these tendons become inflamed. The ulnar nerve innervates regions of the forearm and hand, and it also runs close to the medial epicondyle. When this nerve becomes irritated or compressed by structure near the medial epicondyle, it leads to a condition known as ulnar nerve compression. The severity and the duration of the numbness and pain caused by the ulnar nerve compression will determine if an ulnar nerve decompression is the appropriate surgical treatment.
Acute damage to the articular cartilage that covers the surface of the humerus, radius and ulna can be very painful and cause swelling in the elbow. Pieces of the articular cartilage can break off and form loose bodies that cause a ‘catching and locking’ sensation in the elbow. Long term damage to this layer of cartilage can result in osteoarthritis. Osteoarthritis (arthritis) is a loss of the cartilage surface in a joint, resulting in painful bone-to-bone contact. When it becomes advanced and painful enough, an elbow arthroscopic procedure will provide relief by removing loose bodies and damaged cartilage from the joint.
Tennis elbow and golfer’s elbow are common injuries seen in the elbow and they are specific types of elbow epicondylitis. These injuries along with others and their respective treatments are listed below. Several of the surgical procedures listed below are performed arthroscopically, and they can help identify and repair elbow injuries that involve the soft tissues (muscle, tendon, ligament) surrounding the elbow joint. If you have any of the following conditions or undiagnosed elbow pain, please contact us for an appointment.