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.