Elbow Pain

Clearwater, Tampa, St Petersburg, Florida

Elbow pain, caused by a variety of abnormalities, is increasing in frequency in individuals participating in sports, as well as non-athletic endeavors. Recreational sports, such as weight lifting in gyms and throwing in racquet sports for example, place undue stress on the elbow joint.

For more detail on a specific elbow injury, click on a topic below:

• Arthritis
• Bursitis
• Biceps / Triceps muscle rupture
• Elbow pain due to swollen lymph nodes
• Lateral & Medial Epicondylitis (Tennis & Golfer’s Elbow)
• Median neuropathy
• Ulnar nerve injuries

Anatomy of the Elbow

The anatomic relationships of the bones that form the elbow joint – the large bone of the upper arm, the humerus, and the two bones of the forearm, the radius and ulna – allow for two sets of complex motions to occur. Flexion and extension of the elbow joint is accomplished by the contraction of the biceps or triceps muscles, in conjunction with the minor elbow flexors. These muscles also assist in pronation and supination of the forearm – the rotation inward and outward from the body, across the elbow joint.

Pronation and supination occurs as the bony articulation of the forearm radius. The radius articulates with the capitellum of the humerus bone, allowing for pronation and supination while the ulna, the other forearm bone, articulates with the trochlea of the humerus in a hinge fashion, allowing flexion and extension to occur.

Pronation and supination also occur as a result of the articulation of the proximal portion of the radial ulnar joint. The radial ulnar joint is composed of the radial head, which rotates within the radial sigmoid notch of the ulna. This action, in conjunction with the radius articulating with the capitellum of the humerus, all account for the pronation and supination or lateral and medial rotation of the forearm. This allows twisting motions to occur such as seen in multiple sports.

Two thirds of the stability of the elbow occur from the articulation of the humeral head in contact with the radius, at the capitellum of the humerus, and the trochlea of the humerus in contact with the ulnar bone. The remaining one third of elbow stability is attributed to the radioulnar joint.

The bony anatomy and motions are important in understanding how chronic elbow problems may arise. As in all bony joints, ligaments connect the bones to one another. Since the elbow involves the articulation of three bones, there are multiple ligamentus structures necessary to allow this motion to occur. Any abnormality or undue stress on any of these ligaments will either result in acute or chronic elbow pain.

For simplicity, the elbow is usually defined as medial or lateral, and injuries to the medial or lateral ligaments, as well as the tendons that insert onto the medial or lateral aspects of the elbow, give rise to both acute and chronic elbow pain.

The muscles that are responsible for extension or backward bending of the wrist insert onto the lateral aspect of the elbow as well. Repetitive stress to these muscles, result in what is commonly known as, lateral epicondylitis or tennis elbow. The ligament and muscle also function to resist valgus or lateral stress across the elbow joint. The ulna collateral ligament is a main stabilizer of these bony structures. Injury to the ulna collateral ligament is a frequent source of elbow pain, especially in baseball pitchers and is famously referred to as Tommy John Syndrome – based upon the professional baseball player who had the ulna collateral ligament repaired.

The medial aspect of the elbow is also a source of acute and chronic elbow pain, but is less common than the lateral aspect of the elbow. The medial tendons and ligaments also resist valgus stress. Repetitive valgus stress injuries of the elbow are referred to as little leaguer elbow.

In addition to the bones, ligaments and tendons that insert about the elbow joint for pronation and supination, the elbow flexors, particularly where the biceps tendon crosses the joint, may be associated with chronic injury or acute elbow pain. The triceps tendon may also be a cause of chronic pain in sports, especially among javelin throwers and weight lifters.

Additionally, the three main nerves that descend through the forearm and cross the elbow – the radial nerve, the ulnar nerve and the median nerve – may also be involved in entrapment syndrome. Entrapment syndrome may give rise to acute or chronic pain in the elbow region or radiating down into the forearm or hand.

Due to the complexity of this joint, a careful physical examination by an astute physician is necessary to arrive at an accurate diagnosis. Diagnostic testing, such as x-rays, ultrasound, magnetic resonance imaging (MRI) or EMG/NCS testing, may be necessary to fully evaluate the etiology of acute or chronic elbow pain. Treatment for elbow pain may use a variety of different modalities, depending on if it is bony ligamentus, tendinous, muscular or nerve type pain. Physical therapy and oral medications are the first line of treatment, as well as decreasing the stress that may be part of the underlying etiology of the complaint, especially if it is a repetitive strain type injury. Frequently in the past, corticosteroid injections have been used, but in chronic injuries it may actually weaken the tendons and may have no affect on ligamentus or bony pathology.

An innovative technique that has been found to be quite useful for chronic medial epicondylitis or lateral epicondylitis (tennis elbow) has been the use of platelet-rich plasma (PRP) and stem cell therapy. In chronic injuries that are not responsive to normal physical modalities, a surgical intervention may restrict joint motion or possibly lead to other types of injuries, especially nerve injury syndromes. Platelet-rich plasma (PRP) and stem cell therapy may be used in the treatment of other chronic soft tissue injuries, for example chronic Achilles tendonitis.

Platelet-rich plasma (PRP) utilizes the body’s own healing growth factors and the body’s natural stem cells in a concentrated form to provide localized healing in the areas of chronic elbow pain. PRP may help injuries that failed conservative management efforts and continue to be a chronic problem. This helps people, not only in day-to-day activities that put a strain on the elbow, but also in sporting and recreational activities and in rigorous athletic maneuvers.

If you continue to suffer with elbow pain and your current treatment plan leaves you wanting more options, perhaps a fresh set of experienced eyes can change your outlook. Since 1990, Dennis M. Lox, M.D. has applied his personal interests in sports medicine, cutting-edge regenerative medicine and chronic pain management to helping patients increase their quality of life. Contact us for an appointment at 727-462-5582.

Regarding platelet-rich plasma or stem cell therapy: Neither statements nor treatments have been evaluated by the FDA. We do not claim that these treatments work for any listed or unlisted condition. Patient testimonials offer only the patient’s impression of how a therapy worked for them – individual results will vary; results are not guaranteed nor warranteed. As you consider any treatment, discuss them with your physician.