Elbow Conditions
Distal biceps tendon tears
Distal biceps tendon tears at the elbow are common causes of elbow pain and weakness. Tears may be 'full' - involving the whole attachment of the tendon on the bone, or 'partial' - involving only part of the attachment. Full tears are often caused by a significant injury mechanism - often involving extension of the elbow and rotation of the forearm under a load. Partial tears may be more gradual in onset over a number of months.​Full tears often present soon after injury, with a deformity to the biceps muscle, pain and weakness. These usually require surgery to improve pain and strength, particularly elbow 'supination' (ability to rotate forearm so the palm is facing up). Surgery involves an incision over the from of the forearm. The tendon is cleaned up and repaired to the bone using strong stitches through the tendon, tied to a small metal button through drill holes in the bone). Partial tears can settle without surgery. A trial of physiotherapy and an injection may be beneficial. In cases that fail to improve, then surgery to repair the torn part of the tendon may improve symptoms. In some cases, a large spur of bone on the radius may have contributed to the partial tear. This can be removed at the time.
Image on left showing normal attachment of the biceps tendon onto the radius bone. Right - an MRI scan showing rupture and retraction of the distal biceps tendon (white star)
Tennis Elbow
Tennis elbow is a term for pain on the outer aspect of the elbow. It is often caused by the gradual process of thinning and degeneration of the tendons that control wrist extension. Symptoms of pain are therefore often worsened by activities that involve significant strain through the elbow and wrist.​Most cases of tennis elbow resolve spontaneously. Some patients require specific physiotherapy or localised injections to help symptoms. ​In cases that do not resolve with non-operative measures, then open or arthroscopic (keyhole) surgery may be beneficial. The aim is to debride ('tidy-up') the disease degenerate tendon and adjacent bone, thereby encouraging healing in the area. The tendon is often reattached to the bone following debridement.
Olecranon bursitis
Olecranon bursitis is a condition leading to inflammation and swelling of the tissue (bursa) that overlies the point of the elbow (olecranon process of the ulna). Olecranon bursitis can be caused in a number of ways. We see the condition in inflammatory arthritis, including rheumatoid arthritis and gout. It is also common in manual workers whose work involves rubbing or pressure on their elbow and forearms.
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Often olecranon bursitis fluctuates in size and requires no treatment. If it becomes uncomfortable or a nuisance then surgery may be beneficial. Either an open or endoscopic (keyhole) procedure can be performed. It is a simple procedure involving removal of the bursal sac, however there is a small risk of recurrence.
Elbow stiffness
Stiffness in the elbow is not always the result of arthritis but can occur after an injury, when there is thickening and scarring of the elbow joint capsule.​In some cases, physiotherapy can be of significant benefit. In cases which are long-standing however, arthroscopic (keyhole) or open surgery can be beneficial. By releasing the capsule in a controlled way, a long-lasting improvement can be achieved with significant improvement in elbow function.
Elbow arthritis
Elbow arthritis can occur as gradual wear-and-tear, or after an injury. It is more often seen in men and manual workers.
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There are a number of joints that can develop arthritis in the elbow, and this determines often where the symptoms are experiences. Pain, stiffness, clicking and locking are the most common symptoms. Locking is caused by small loose pieces of bone and cartilage which can become trapped in the joint. When this occurs, the elbow may 'lock' and struggle to fully straighten.
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In the majority of early cases of elbow arthritis, patients can have good symptom control and maintain an effective range of motion with simple painkillers, activity modification, rest, physio and occasional injections.
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In some case where non-operative treatment is not successful, then surgery may be beneficial. Arthroscopic (keyhole) surgery can be a simple, effective way of debriding ('tidying up') the surfaces and removing any loose fragments causing clicking or locking. In more advanced cases, open surgery to clean up the joint can be a successful treatment option.
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In patients with very severe disease, then a total elbow replacement is often a reliable option for pain relief.
An anteroposterior (a) and lateral (b) radiographs showing osteoarthritis in the elbow. Osteophytes (extra bone) shown by white arrows. A loose body is shown by the yellow arrow.