Elbow

Distal biceps tendons can rupture during heavy lifting activities.

Symptoms of a tendon tear in this region include:

• Swelling in the front of the elbow
• Visible bruising in the elbow and forearm
• Weakness in bending of the elbow
• Weakness in twisting the forearm (supination)
• A bulge in the upper part of the arm created by the recoiled, shortened biceps muscle.

When is surgery appropriate?

Distal biceps tendon tears commonly occur in men in their 40s and when the tendon ruptures, a deformed high-riding biceps muscle can cause a loss of about 50% of elbow strength.

It is important therefore to seek treatment early if you notice these symptoms as surgical repair is most effective in the first 2 weeks.

After one month, the chances of not being able to stretch the tendon far enough and requiring a tendon graft become higher.

Following surgery, there is normally a 3 month recovery process involving a sling and physiotherapy that your surgeon will guide you through.

Some elbow conditions can be treated arthroscopically (where a surgeon can look inside the joint using a small cut with instruments the width of a pencil).

The benefit of arthroscopic surgery includes a quicker recovery as only small punctures through the skin are used to access the joint as opposed to formal, open incisions.

Elbow arthroscopy can be useful in diagnosis and treatment of arthritis, loose bodies in the joint, tennis elbow, stiffness and fractures.

After a physical examination and imaging, your surgeon may recommend arthroscopy for treatment of your elbow issue.

Arthroscopic elbow surgery is usually a day surgery procedure but is often associated with prolonged rehabilitation to avoid stiffness.

A physiotherapist is an important part of your post-operative rehabilitation.

Lateral epicondylitis is a painful condition that affects the muscles and tendons of the forearm.

It is commonly referred to as “tennis elbow” but rarely occurs as a result of tennis these days.

Symptoms of this condition include:

• Tenderness on the outer bony part of the elbow
• Morning stiffness of the elbow with persistent aching
• Soreness in the forearm
• Pain worse when grasping or holding an object
• The forearm tendons that attach to the outer aspect of the elbow may become inflamed and torn as result of repetitive over extension of the wrist and elbow.

When is surgery appropriate?

In most cases, the micro tears and inflammation settle down and heal with rest but in some recalcitrant cases surgery is required.

This involves repairing the torn extensor tendons after excising the degenerate segment and performing a tendon release.

Both result in reduced pain and increased grip strength.

A sling is required for comfort post operatively and physiotherapy also.

Advanced arthritis of the elbow can be treated with an elbow replacement (arthroplasty).

Typical symptoms of elbow arthritis include:

• Pain - Generally worse as you rotate the forearm. As the condition progresses pain interrupts sleep during the night
• Swelling (more common with rheumatoid arthritis)
• Instability of the joint
• Inability to extend or flex the elbow
• Locking and stiffness

When is surgery appropriate?

Elbow replacement surgery is usually done if your doctor has assessed your elbow as being badly damaged by osteoarthritis or if the pain is persistent and severe and you cannot use your arm.

Surgery may also be appropriate may for patients with rheumatoid arthritis, a badly broken bone in the upper or lower arm near the elbow, badly damaged or torn elbow tissues, a tumour or a very stiff elbow.

During a total elbow replacement procedure, the damaged parts of the elbow-hinged joint are removed and replaced with artificial components called prostheses.

Replacement options include a hemiarthoplasty where part of the joint is replaced not the olecranon (the bony point of the elbow); a total elbow arthroplasty where the end of the humerus and olecranon is replaced with a metal and plastic hinged joint.

The decision as to which prosthesis is used is dependent on your surgeon, the degree of your arthritis and your age.

As the elbow is a much smaller joint than a knee or a hip there is generally a 3kg lifting restriction applied following surgery to prevent the plastic wearing out too soon.

Elbows can become stiff after injury, immobilisation or arthritis.

Prevention with physiotherapy and early motion after injury will prevent stiffness but when permanent stiffness occurs, surgery may be required.

Arthroscopic or open surgery requires removal of scarred capsule, bone spurs and loose bodies that may be preventing full elbow motion.

Following surgery, a period of continuous elbow range of motion with a continuous passive motion (CPM) machine is required to maintain motion and prevent recurrent scarring.

The CPM machine is used in hospital for around 3 days continuously and for most of the day for up to a month after.

Thus there is a significant time commitment to rehabilitation post-operatively.

There is ongoing medical research into the effects of PRP in healing tendon injuries.

PRP is obtained from the patient’s own blood and spun down to create supraphysiological growth factor concentrations (greater than normally found in the body) which are then injected into the area of tendon damage - potentially accelerating the healing process.

Although somewhat experimental, it has been beneficial in some cases.

Often two or more injections are required and you should discuss your suitability with your doctor.