Elbow injury

General information

The elbow joint is a unique union of three bones: the humerus, radius, and ulna. It is a complex composite joint that includes three simple joints: the humeral head, the humeral head, and the proximal radius. They are all united by a common capsule and articular pouch. Synovial fluid is constantly produced inside the articular bag, which serves as a lubricant for the rubbing joint surfaces and nutrition for the anatomical parts. The ends of the bones are covered by a layer of periosteum, which helps protect and renew the bone tissues and also helps nutrients from the synovial fluid. All joint surfaces are covered by articular cartilage. The elbow joint is firmly reinforced by ligaments and protected by a good muscular framework. These features allow four types of movements: extension and flexion, supination (rotation of the forearm in the elbow joint, in which it is possible to turn the hand palm up), and pronation (rotation of the forearm in the elbow joint, in which it is possible to turn the hand palm down). It is worth noting that the end of the ulna from above has an ulnar process that resembles a hook in shape. The triceps muscle of the shoulder attaches to it. A fracture of this process is a fairly common injury.

Types of injury

The elbow joint injury is characterized by the following categories:

• Traumatic
• Contusions. Most common are contusions of the ulna, periarticular tissues, the condyles of the shoulder, and the ulnar nerve
• Stretches of the ligamentous apparatus
• Dislocations. 
• Elbow bone fractures can be categorized by the nature of the injury into:
• intra-articular;
• periarticular;
• closed;
• open;
• with no displacement;
• Displacement of bone fragments (displacement of bone fragments most often occurs in ulnar fractures)
• Inflammatory
• Epicondylitis (“tennis elbow”) is an inflammatory degenerative disease that affects the tendons in the elbow joint area due to chronic overloading of the forearm muscles.
• Styloiditis is a dystrophic and inflammatory process where the tendon attaches to the ulna.
• Bursitis is inflammation of the joint bag on the elbow’s back surface.
• Neuritis – ailments resulting from pinched nerve endings
• Elbow tendonitis- inflammation in the tendon area of the elbow end of the triceps muscle
• Arthritis – an acute inflammatory process in the articular cartilage and capsule without gross structural changes in the joint
• Osteoarthritis
• Osteoarthritis is a dystrophic-degenerative disease of the cartilage and bone of a joint.

Symptoms

The main symptom of elbow disorders is pain.

The traumatic group of injuries is characterized by the following features:

• Piercing pain at the time of injury
• Swelling and hematoma in the elbow joint area
• Elbow deformity
• Limitations in arm movement, partial or complete loss of limb function
• Or abnormal mobility and the possibility of atypical elbow movements
• Numbness or tingling in the area of the forearm, wrist, and hand
• Squeaking or clicking when you move your elbow
• Any discoloration of the skin in the area of the injury
• Palpable protrusion of bone fragments beneath the skin surface

If any of the above symptoms occur, you should seek immediate care at a trauma unit.

Diagnosis

Diagnostic measures include:

• Medical examination (palpation of the elbow joint)
• Collection of medical history
• Clinical and biochemical blood tests
• General urinalysis
• Ultrasound of the joints of the elbow
• X-ray of the hand (two projections)
• Computed tomography
• MRI

Treatment

Treatment depends largely on the type and nature of the fracture in the elbow joint. Fractures without displacement can be treated conservatively by applying a fixation plaster cast for several weeks. If there is displacement of the joint, then the question of surgical intervention is decided. To do this, repositioning of the fragments is performed (closed or open). In open repositioning, surgical fixation of the fragments is mandatory; this operation is called osteosynthesis. Osteosynthesis is the joining of bone fragments with the help of special fixation means (bone grafts or metal structures). If the fractures of the articular part of the humerus are fragmented, it is possible to replace the elbow joint with a prosthesis.

Osteotomy is currently performed to restore elbow joint function in deforming osteoarthritis, as well as in congenital and acquired deformities and contractures of other etiologies. Osteotomy is a surgical procedure that helps to correct elbow joint deformity or improve musculoskeletal function by artificial fracture with further fixation to give a functionally favorable position. After any surgical intervention, the patient is prescribed rehabilitation measures that the attending physician individually tailors.

All these treatment options are available in more than 920 hospitals worldwide (https://doctor.global/results/diseases/elbow-injury). For example, Arthroscopic elbow debridement can be done in 46 clinics across Germany for an approximate price of $3,2K (https://doctor.global/results/europe/germany/all-cities/all-specializations/procedures/arthroscopic-elbow-debridement). 

Rehabilitation and prevention of elbow injuries

After the acute period is over, rehabilitation specialists begin working with the patient from the first days of an injury or diagnosed disease. Their goal is to prevent contractures in the elbow joint from developing, maintain the tone of the shoulder and forearm muscles, and, if possible, preserve the volume of active movements in the joint. Therapeutic massage and physiotherapeutic procedures accompany the patient’s treatment both in inpatient and outpatient treatment and at home.

Since pathological conditions in the elbow joint often result from various types of injuries, the simplest preventive measures include observing safety precautions during sports training and being attentive to the increased risk of injury due to seasonal factors or loads. Moderate physical activity, such as swimming, contributes to the strengthening of muscles. If the pain syndrome is chronic, it is necessary to seek advice and get information from a doctor about measures to protect against exacerbations and medications to alleviate the condition. People of any age at risk for the prevention of joint pain can undergo a course of spa treatment, which strengthens the body and has a beneficial effect on the local problem.

As with any disease or traumatic injury of the musculoskeletal system, any pathological changes in the elbow joint—pain, limited movement, swelling, redness, abnormal mobility—should be referred to a specialist traumatologist or surgeon as soon as possible. Do not self-medicate. Seemingly insignificant pathological processes can later turn into a chronic state with the involvement of neighboring tissues in inflammation and end with loss of function of the elbow joint and upper extremity, expensive and lengthy treatment, and even endoprosthesis.