Elbow pain is frequent patient complaint seen by a physician. Pain from overuse activities at work or from recreation is most commonly seen. Inflammatory causes account for majority of elbow pains. Most of elbow pains are self limiting and can be treated after clinical diagnosis.
But quite few of inflammatory diseases require further investigations to ascertain the diagnosis.
Major inflammatory causes of elbow pain with exclusion of rheumatoid arthritis are as follow
Lateral Epicondylitis/ Medial Epicondylitis
Lateral epicondylitis is commonly referred to as “tennis elbow”, although it is frequenly seen in other activities such as prolonged use of a computer keyboard, lifteing a heavy briefcase or suitcase, or any activity that puts strain on the elbow.
It also may be seen in the left arm of right-handed golfers, although golfers also may have a distinct syndrome known as “golfer’s elbow” or medial epicondylitis. This is thought to occur because of improper swing mechanics.
With lateral epicondylitis, patients complain of pain at the lateral aspect of the elbow; with medial epicondylitis they complain of medial-elbow pain.
Physical examination in lateral epicondylitis reveals tenderness to palpation overlying the lateral epicondyle, which is the origin of the wrist and finger extensor musculature. With medial epicondylitis, tenderness occurs overlying the medial epicondyle.
Treatment should include rest, icing, and the use of nonsteroidal anti-inflammatory drugs ( along with a gentle wrist-stretching program. Physical therapy with ionto-or phonophoresis may help reduce inflammation.
These modalities use corticosteroid topical preparations and either electrical current (iontophoresis) or ultrasound (phonophoresis) to provide transcutaneous dispersion.
For recalcitrant cases, the physician may perform one or two direct corticosteroid injections overlying the inflamed tendinous origin. Direct tendon injection should be avoided as this may lead to tendon rupture. Once the inflammation and pain have resolved, a gentle wrist-extensor strengthening program is indicated.
The vast majority of these patients will respond to nonoperative treatment. If this is not successful, surgery to excise the inflamed tissue and a limited epicondylectomy are indicated.
Is is important to determine the etiology of this overuse syndrome so that the behavior can be modified. Tennis players and golfers should have a professional evaluate their swing; computer workers may benefit from an ergonomics evaluation of their workstation.
Noninfectious Bursitis
Noninfectious bursitis is caused by inflammation of the olecranon bursa, which overlies the posterior aspect of the elbow. It may be seen in computer workers who rest their elbows on hard surfaces for prolonged time periods (e.g., hard arm rests on chairs) or in those whose occupations require repetitive elbow flexion or crawling (such as coal miners or construction workers).
Alcoholics may develop this from spending many hours at the bar leaning on their elbows.
Physical examination reveals a swollen, slightly tender olecranon bursa without erythema and with minimal warmth. Patients are afebrile. These findings are very different in patients with septic bursitis, which is characterized by fever, erythema, and severe tenderness to palpation overlying the bursa. Radiographs may infrequently reveal an olecranon osteophyte.
Inflammatory bursitis typically responds slowly to rest, icing, NSAIDs, compression wrapping of the elbow, and avoidance of the instigating behavior. A direct bursal corticosteroid injection may be useful for patients who do not get the relief they seek. Chronic cases may require a surgical approach with bursal excision and osteophyte removal, if present.
Popularity: 1% [?]
Related posts:
Join Discussions