Elbow
Soft-tissue
injuries
Rupture of the triceps near its insertion into the olecranon is caused
by resisted elbow extension or a fall. The diagnosis is quite often missed as
the defect is not readily palpable because of swelling and as gravity can extend
the elbow the loss of active extension may not be recognised by the patient
immediately. Surgical repair of the avulsion is required for good function.
Avulsion
of the biceps tendon from its insertion into the radial tuberosity occurs after
violent trauma in young athletes and due to degeneration in older patients.
Early reattachment using a small antecubital incision to retrieve the tendon end
and a posterior approach to identify the tuberosity usually restores full
function.
Nerve
entrapments occur at the elbow, commonly the ulna nerve in the cubital tunnel
and occasionally the anterior interosseus nerve within pronator teres.
Electrophysiology should be used to confirm the diagnosis before surgical
release.
Loose
bodies
Throwing sports can lead to repeated minor trauma of the elbow which can
manifest in loose bodies. The history of intermittent locking is diagnostic and
arthroscopic removal is very satisfying for both surgeon and patient.
Epicondylitis
Medial (‘golfer’s elbow’) and lateral (‘tennis elbow’) Epicondylitis
are in fact misnomers as inflammation is secondary to the primary pathology,
tendon degeneration. The common flexor origin and the extensor carpi radialis
brevis are the respective culprits. Anti-inflammatories, oral and locally
injected, are usually ineffective and attention should focus on correcting
playing style, grip size (tennis racquet) and equipment (light, graphite
racquet) before reducing the frequency of playing. Local physical therapies are
beneficial but if these measures fail, the degenerate area is excised and the
tendon repaired.