The elbow is formed at the articulation of three separate bones, the humerus, radius and ulna. A relatively simple hinge joint is formed by the humerus (or upper arm bone) and the ulna and radius of the lower arm. This joint only allows flexion and extension of the joint.
The elbow, however, is actually composed of 3 joints. A second joint between the radius and humerus allows flexion and extension, but is involved in the more complex motion of rotation of the lower arm. The third is a pivot joint formed by the radius and ulna, which also supports the rotating motion of the lower arm.
The elbow joint is supported by ligaments and tendons that provide stability to the joint. Ligaments are firm, fibrous tissues that connect bones to other bones. The elbow joint is strongly supported on both the inner (medial) and outer (lateral) sides by these fibrous tissues. The front and back of the elbow, however, are less supported, making it vulnerable to hyperextension and dislocation.
Tendons are bands of connective tissue fibers that connect muscle to bone. The most common injury to the elbow is from repetitive motion that causes the tendons that attach the working muscles to the skeletal system to become damaged from overuse.
Because ligaments, tendons, and cartilage, have poor blood supply, they are slow to heal and often heal incompletely. Procedures in Regenerative Medicine, such as injection of the patient's own stem cells or PRP injections can accelerate the speed at which they heal and ensure a more complete recovery.
Common conditions of the elbow include:
- Tendinopathy of the elbow When the tendon that attaches the muscle to the bone becomes damaged, it can become tender and often develop micro-tears. Because blood supply to tendons is poor, healing can take a long time and is often incomplete.
"Tennis Elbow", or lateral epicondylitis. Activities such as tennis, painting, typing, and gardening can cause the tendon attaching the muscle to the bony prominence on the outside of the elbow (lateral epicondyle) to become inflamed. Patients with tennis elbow experience pain or burning that gradually worsens and results in a weakened grip. It is a painful condition that leads to inflammation and micro tears in the tendons that attach to the lateral epicondyle.
"Golfer's Elbow" or medial epicondylitis. This condition is commonly seen in golfers, hence the name. Other common causes include activities that require repetitive motion of the forearm. As in tennis elbow, the pain may radiate down to the wrist and make it hard to lift a cup or turn a doorknob. Swelling around the elbow may occur and difficulty straightening the arm.
- Olecranon bursitis. Bursitis is an inflammation of small sacs of fluid (bursae) that help joints move smoothly. The olecranon bursae are located on the back of the elbow. The causes of elbow bursitis may include trauma or a hard blow, excessive leaning on the elbow, infection through puncture wounds or insect bites, or conditions such as gout and rheumatoid arthritis.
- Biceps tendinitis. The biceps muscle extends from the shoulder to the elbow on the front of the upper arm. When the main tendon that attaches the biceps to the shoulder becomes inflamed, the front and top of the shoulder will begin to ache. The sheath covering the tendon gradually starts to thicken. It may occasionally tear, leading to a bulge in the upper arm.
Biceps tendinitis can occur with sports and job-related activities that involve repetitive overhead arm movements. Wear and tear of the tendon can also accumulate with age.
- Ulna and radial collateral ligament sprains. These 2 ligaments are the main source of stability for the elbow. Damage to these ligaments from injury or repetitive use will cause pain along the inside of the elbow. Closing the hand and clenching the fist will also be painful.
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