Elbow Pain
Anatomy
 The elbow is a hinge joint made up of the humerus, ulna and radius. The unique positioning and interaction of the bones in the joint allows for a small amount of rotation as well as hinge action. This rotation is easily noticed during activities such as hand-to-mouth eating motions.
The primary stability of the elbow is provided by the ulnar collateral ligament, on the medial (inner) side of the elbow. However, one of the most common injuries to the elbow occurs on the lateral, or outer, side of the elbow -- it is called Lateral Epicondylitis, or Tennis Elbow.
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Conditions
Tennis Elbow
 Tennis elbow, or lateral epicondylitis, is one of the most common elbow problems seen by physicians. It is actually a tendinitis of the muscle called the extensor carpi radialis brevis which attaches to the lateral epicondyle of the humerus.
It may be caused by a sudden injury or by repetitive use of the arm. Many doctors feel that micro tears in the tendon lead to a hyper-vascular phenomenon resulting in pain. The pain is usually worse with strong gripping with the elbow in an extended position, as in a tennis back hand stroke, but this problem can occur in golf and other sports as well as with repetitive use of tools. Mechanics and Machinists seem to be particularly predisposed to this disease due to the demanding nature of their work.
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Golfers Elbow
 Similar to lateral epicondylitis, this is an inflammation at the origin of the flexor muscles of the wrist. It presents with pain with resisted wrist flexion, such as with lifting objects with the palm facing upwards. Golfers have additional stress at this region of the elbow when hitting a ball, hence the name. It is treated in a manner similar to TENNIS ELBOW, with surgery reserved for cases which fail conservative management.
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Olecranon Bursitis
 This is an inflammation of a small fluid filled sac overlying the bony prominence at the 'point' of the elbow. Treatment may consist of withdrawal of the fluid and possibly sending this fluid for testing. An Ace wrap sometimes help the swelling subside. Accurate assessment by a physician is necessary prior to treatment. Usually it will go away with activity modification and minimization of any direct trauma. In severe cases, surgery may be necessary to remove the irritated inflamed tissue.
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Arthritis
Elbow arthritis is a complex process and can result in pain and loss of range of motion. Accurate assessment is necessary, and may include diagnostic imaging as well as a comprehensive exam. Treatment varies depending on the complexity of the disease and the degree of functional deficit and pain.
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Ulnar Nerve Entrapment
One of the large nerves of the arm, the ulnar nerve, can end up getting entrapped at the level of the elbow. This nerve is the same one which is stimulated when you hit your "funny bone". Symptoms may include a tingling sensation or pain radiating down to the fingers, in particular the ring and little fingers of the hand. Symptoms may worsen with bending the elbows, for example when you are talking on the phone or driving a car. Diagnosis may include an EMG/NCS as well as an accurate history and physical exam by physician. Treatment may include splints or if necessary surgery.
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Procedures
 Injections
Injections can be performed for some of the common elbow pathologies to help decrease inflammation and alleviate pain.
Nonprocedural Treatments
Physical and Occupational Therapy
This type of therapy may consist of exercises to improve range of motion, strength and conditioning. A good therapist will examine you, assess your deficits and disease and formulate a plan based on optimizing function and minimizing pain. These exercises are specific for the nature of your injury and should be executed under the supervision of a physician who understands your case.
Modalities
Modalities include simple age-old treatments such as heat, cold and massage as well as newer treatment methods such as acupuncture, manipulation, and electrical stimulation. Your physician and therapists should formulate an optimal treatment protocol to maximize your healing potential. These modalities are often used in conjunction with Physical and Occupational therapy.
Medications
Depending on the nature of your problem, Non-steroidal antiinflammatory drugs ['NSAIDS'], corticosteroids, and opioids [narcotic] medications may be used. If there is a muscular spasm, a muscle-relaxant may help alleviate that aspect of your pain. Narcotics should be minimized and used only for short periods if at all possible due to rapid tolerance and all the attendant risks associated with abuse of a controlled substance.
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Surgery
Dr. Sandhu performs minimally invasive surgeries which result in a rapid recovery and minimal risk to the patient. Although we do not perform large-scale open surgeries in our clinics, there are occasions where a problem requires surgical intervention.
We can help screen potential surgical candidates and send them for evaluation by the appropriate specialist. These surgeons are usually orthopedic surgeons or neurosurgeons with specialized training for the particular disease process involved.
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