CONDITIONS & DISEASES - Elbow

Thrower's elbow
Thrower's elbow is a complex group of problems that occur in people who do a lot of throwing, particularly baseball pitchers. It is often related to technique and the amount of throwing repetitively performed, as well as velocity. For that reason, pitchers are more commonly affected than outfielders. Depending on the thrower's age and bodily response, different problems can occur:

• Pain on the inside of the elbow in a thrower is frequently related to valgus overload, or repetitive stretching of the medial collateral ligament. After enough stretching episodes, this ligament can become torn. Most people with this problem, however, don't have tears, they just have a stretched out ligament.
• Pain on the outside of the elbow in a younger teenage pitcher can be due to osteochondritis dissecans. Because of the repetitive loads on the cartilage of the lateral elbow, the cartilage and underlying bone can lose its blood supply and become soft or flake off. Most often this occurs on the capitellum, which is part of the humerus bone.

Treatment usually includes rest from throwing, an exercise program to strengthen the muscles on the inside of the elbow, bracing, and ice/compression of the elbow. Also, careful evaluation of a pitchers throwing mechanics can help. Frequently, these non-operative treatments can bring about a full recovery.

In more severe cases, ligament reconstruction can be performed (i.e., "Tommy John surgery") and/or arthroscopy for osteochondritis. After surgery, ice/compression can also help decrease swelling.

Arthritis
Most arthritis is the elbow is the degenerative type, called osteoarthritis. It usually occurs slowly, over time. Most patients usually notice that they cannot straighten their elbow out fully; this is usually the first sign of arthritis. Often, initially, arthritis in the elbow is not painful, but becomes so over time.

Simple things to treat arthritis include a stretching program to recover lost range of motion and anti-inflammatory medications. We have had good results with glucosamine in treating elbow arthritis; it is much safer to take than chronic NSAIDs. Ice/heat contrast also is beneficial. Patients often find that using heat on the joint prior to activity to "loosen it up" and then icing afterwards can be of great benefit.

Steroid injections, arthroscopic and open surgeries are also options in treating arthritis of the elbow. Elbow replacements are available, but only rarely need to be performed.

Tendonitis
The most common forms of elbow tendonitis are lateral epicondylitis (i.e., "tennis elbow") and medial epicondylitis (i.e., "golfer's elbow"). Lateral epicondylitis involves pain on the outside of your elbow, where all the muscles that allow for wrist and finger extension attach. Medial epicondylitis is associated with pain on the inside of your elbow, where all the flexor muscles attach. In both disorders, patients usually have an aching pain, pain while firmly gripping objects in the hand, and pain to the touch in the areas described above.

Treatment involves rest, avoidance of repetitive gripping (i.e., tennis, golf, raking leaves, screwdriving, etc.), ice/heat, and bracing. Often a simple forerarm brace can help redistribute the muscle forces around the inflamed area and give patients good relief, particularly when they are doing an activity that is known to cause them irritation. Extercises to stretch the tendons and rebalance forearm muscle strength are also helpful. If these treatments fail, steroid injections are often beneficial and in many patients, curative. Finally, there are good surgical options to treat these tendinitis problems of the elbow, that are relatively minimally invasive and are performed on an outpatient basis.