This is a transcript of the video:
Hello and welcome, my name is Dr. Jay Michael Bennett and I am an orthopedic sports medicine surgeon specializing in injuries to the shoulders, elbows and knees. Today we’re going to focus on the elbow.
The elbow is a multi-axial joint that has multiple planes of motion. When you bend your elbow this is called flexion and extension. You can see it on the model here: this is flexion, this is extension. We have supination, which is the palm up. And then we have pronation, which is the palm down. There are a number of ligaments and tendons around the elbow and these ligaments and tendons can be injured commonly with any kind of repetitive motion.
We have a common injury and ailment called golfer’s elbow, which occurs in the medial aspect of the elbow, or the inner side. This controls the flexion of the wrist. There are a number of muscles and tendon units that insert right here on this bone which is called the medial epicondyle. Repetitive motion, particularly repetitive flexion – and you can actually get this from other sports aside from golfing – will irritate this group of tendons or this main tendon here at this insertion site. What happens at that point is you get micro-tears; a tendon may split into small fibers and actually may develop small tears that can easily get inflamed and irritated and fill in with degenerative tissue. That tissue can become easily irritated and very painful, and it becomes painful when you try to elicit activity like swinging a golf club or lifting a weight.
This is easily treatable about 95 percent of the time with things like proper exercise, modification of activities, rest, anti-inflammatories, bracing, and occasionally an injection. Appropriate bracing is called a counter-force brace and it actually goes around the forearm and unloads this tendon. Using that for a period of a couple of weeks will usually unload the tendon and allow it to heal. Now occasionally – about five percent of the time – these injuries may not get better. If that’s the case then your physician or surgeon needs to get an MRI to see if the tendon is degenerative or not or how badly torn it is. Occasionally surgery is indicated and we have to go in and repair that tendon.
Now on the other side of the elbow – the lateral side – this over here (he manipulates the elbow model), the outside of the elbow, this is where the common extensors insert, and that allows you to lift your wrist up. And this is where patients will commonly get what’s called lateral epicondylitis, also known as tennis elbow. It was originally most attributed to tennis players because of the types of grip they would use in holding a racket. Same exact thing happens with the lateral side as the medial side; the tendon becomes overloaded, these micro-tears occur, you get degeneration within that tendon and this can lead to chronic pain. Once again you can treat this with bracing, exercise, modification of activities, and occasionally anti-inflammatories and injections, and if it does not respond we tend to obtain an MRI and then operate. With fixing the lateral side, we can do the surgery in one of two ways: We can do it arthroscopically, with two poke holes in either side of the elbow and we put a camera in there and actually debride this area and repair it; or we can make a small incision, about a centimeter and a half or two centimeters big, over the site and repair it with an anchor. Same thing with the medial side. So those are the two common injuries in the lateral and medial aspect of the elbow: medial epicondylitis and lateral epicondylitis, also known as golfer’s elbow and tennis elbow.
Moving on to the central portion of the elbow, supination – which means rotating your hand almost like you are carrying a bowl of soup – is one of the main motions that we use when we reach for change, when we reach out to twist a doorknob, and this is actually controlled – the majority of supination, or the strength of supination, that is – by biceps insertion. This is the biceps muscle here (he points to his own arm) and it inserts right at the radial tuberosity, which is right here (he manipulates the model). So if my hand is pointed downward, this is the position my bones are in. This insertion here, this stump, is the biceps tendon. When you flex your arm and you pull on this tendon here, it supinates the arm. So this is where it inserts on this bone here (again uses the model for reference). Occasionally you can have a tear of this biceps tendon or you can get a tendonitis in this area.
When you have a tear it is usually an audible “pop,” or significant pain with a deformity. If you notice that your arm looks a little abnormal and your biceps swollen, more than likely you have a biceps rupture. And you can have a rupture distally, in the lower part which is where this inserts (manipulates the model), which controls your supination, or you can have it up top – proximally – and you can have a shortened biceps in the opposite direction. The proximal biceps ruptures do not usually get addressed unless the patient has an issue with the cosmesis. The distal biceps ruptures are usually addressed in patients that are very active, or are laborers and depend a lot upon their supination strength and on their flexion strength. Most commonly this is fixed by a small incision over the forearm region and we go in there, find the tendon and tack it back down to the bone with some small anchors. This will usually give you back your strength, allowing you to supinate again.
Check the second segment of Dr. Bennett’s video series on Elbow Injuries.
If you have any questions about elbow treatments or elbow injuries, please call our office at 281-633-8600.
