Common Conditions of the Elbow

• epicondylitis

• bursitis

EPICONDYLITIS (TENNIS ELBOW)

The muscles that allow your wrist and forearm to move at the elbows, attach to bony prominences in the humerus called an epicondyles.  When these muscles are overused or experience some kind of trauma, such as with repetitive activities like painting, turning screwdrivers, or playing tennis, the tendons that attach to the bone can become strained, irritated, and painful up at their point of attachment.

Epicondylitis occurs more frequently on the lateral epicondyle, resulting in a condition called lateral epicondylitis.  Patients usually feel pain when extending their wrist or turning their wrist in the motion one would use to turn a screwdriver (called supponation).  Medial epicondylitis is also possible and results in similar but opposite symptoms.  With medial epicondylitis, tenderness is over the medial epicondyle in the elbow and pain is felt with downward flexion of the wrist and/ or turning the wrist and forearm in the direction towards the body.

Epicondylitis is diagnosed with a careful history and physical examination.  Treatment involves decreasing activities that overuse and stress the affected muscles.  A “tennis elbow” strap can be used to transfer the pressure from the point of attachment at the tender epicondyle to the area of the strap, thus alleviating the pain when using the wrist and forearm.  The strap must be placed correctly just downward from the tender epicondyle.  This point is often not understood by patients and results in a common perception that they have “tried the strap and it didn’t work”.  If the condition does not improve with rest, the use of a strap, in addition to other adjunctive treatments like heat/ ice, anti-inflammatory medications, or a course of physical therapy, a cortisone injection into the area to settle down the irritation and inflammation might be recommended.  Lastly, casting might be recommended to assure adequate resting of the muscles. Surgical options for epicondylitis have only shown a 60-70% success rate and are rarely recommended. 

OLECRANON BURSITIS

The bony point in the bend of the elbow is called the olecranon process.  A fluid filled sac, called a bursa, overlies this process and helps to cushion the area.  When this sac becomes inflamed, a condition called olecranon bursitis results.  As with bursitis conditions in other areas of the body, bursitis commonly results from some kind of bump or trauma to the area.   

Bursitis usually causes obvious swelling or inflammation in the area which can cause painful and limited motion.  The swelling can range from a feeling of a lump or “gravel” in the elbow to a discrete and obvious mass.  The bursa might even drain a yellowish clear fluid.  Additional abrasions or redness, or systemic signs such as a fever might be more concerning that bursa fluid or even the entire elbow joint might be infected.

Removal of fluid from the bursa, called an aspiration, is helpful both in diagnosis and treatment of olecranon bursitis.  The fluid from the bursa can be analyzed for infection, gout, or other possible problems.  Other blood tests might be recommended if infection is a strong concern.  Aspiration provides relief from a painfully fluid-filled bursa.  Anti-inflammatory medications and a compression dressing, such as with an ACE bandage or even a splint might be recommended to try to get the bursa to settle down.  If infection is not a risk, a cortisone injection might be recommended as an additional strategy to help decrease the inflammation.  Removal of the sac surgically is recommended when these conservative measures have failed, but it is important to note that the body will likely grow the sac back, and recurrence of the same problem in the new sac is unpredictable.  Hospitalization and the administration of antibiotic medications as well as consideration of surgical removal of the bursa are all management strategies if there is a known infection in the bursa fluid and are used to avoid the entire joint becoming infected.