Give praise to the elbow: A bending, twisting marvel

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New Mexico Orthopaedics is a multi-disciplinary orthopedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

What are Hand, Wrist or Elbow Dislocations?

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Article featured on Mercy Health

What are hand, wrist or elbow dislocations?

Hand dislocations occur when one of the eight carpal bones (bones located at the base of the hand) fall out of the joint to cause a hand dislocation. The capitate (largest bone in the hand) or lunate bones are the bones that most frequently dislocate.

Wrist dislocations occur when one of the eight bones of the wrist fall out of socket due to a fall.

Elbow dislocations occur when the joints of the elbows somehow separate. In a partial elbow dislocation, the joint surfaces are not completely separated (also known as subluxation), while in a complete dislocation, the joint surfaces are completely dislocated.

Causes of hand, wrist or elbow dislocations

  • Hand dislocations typically occur when direct, intense force is applied to the wrist and the hand is bent backward.
  • High impact sports such as basketball and football are common causes of hand, wrist or elbow dislocations – football and basketball players can dislocate finger joints when striking the ball, the ground or another player.
  • A hard blow to the joint, for example in a car accident, could cause a hand, wrist or elbow dislocation.

Risk factors of hand, wrist or elbow dislocations

Risk factors of hand, wrist or elbow dislocations are:

  • Participating in high impact, extreme sporting activities, such as football and hockey can put people at higher risk for a hand, wrist or elbow dislocation
  • Sports where falls are common, such as volleyball, gymnastics and downhill skiing put people at a higher risk of hand, wrist or elbow dislocations
  • Some people are born with ligaments and joints that are more prone to injury
  • Patients who are more susceptible to falls (such as the elderly) are at a higher risk for hand, wrist or elbow dislocations

Symptoms of hand, wrist or elbow dislocations

Symptoms of hand, wrist or elbow dislocations include:

  • Visible deformities in the hand, wrist or elbow after trauma
  • Inability to move your hand, wrist or elbow
  • Severe pain in the affected area
  • Swelling in the hands, wrists or elbow
  • Misshaped appearance of the hand, wrist or elbow
  • Numbness

Diagnosis of a hand, wrist or elbow dislocation

If you suspect you have a hand, wrist or elbow dislocation, visit the ER right away. It is crucial to treat a hand, wrist or elbow dislocation right away to avoid developing arthritis or death of bone tissue. When possible, ice the joint and keep it immobile while waiting to see the physician.

Hand, wrist or elbow dislocations are diagnosed in a physical exam and with an x-ray, MRI or CT scan to evaluate the extent of the injury and determine the best course of treatment.

Treatments for hand, wrist or elbow dislocations

Wrist dislocations typically require surgery by a hand or wrist orthopedic surgeon.

The hand surgeon will place the bones back into the correct location as well as repair the ligaments and soft tissue surrounding the injury during the procedure.

After the procedure, the wrist will be immobilized in a cast for eight weeks to ensure proper healing.

New Mexico Orthopaedics is a multi-disciplinary orthopedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Quick Fixes for Aching Elbows

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The elbow is a funny joint. It is home to your funny bone—your ulnar nerve—which hurts if it’s hit a certain way. And the elbow is often overlooked as an important joint to help us maintain our independence. Many older adults may not think much about the elbow, because it’s not a weight-bearing joint and because it doesn’t often develop arthritis or require joint replacement in the older adult population. But elbow pain can keep you from getting dressed, cooking dinner, and anything else that requires the use of your arm. Taking care of this joint helps ensure that you can care for yourself.

Causes of elbow pain

The elbow is made up of bones, muscles, ligaments (which connect bones), and tendons (which connect muscles to bone). The most common cause of elbow pain is inflammation of one or both of the elbow’s two tendons. This is called tendinitis, and it is often the result of overuse. “Repetitive movements from everyday work, household chores, golf, or tennis can affect the muscles above and below the elbow and cause tendinitis,” says Norby. Tendinitis pain travels from the elbow to the upper arm or to the lower arm.

Other causes of elbow pain are fractures from falling onto an outstretched arm; arthritis; sprains, which stretch or tear elbow ligaments; and bursitis, inflammation of the fluid-filled joint cushions called bursae.

Diagnosis and fixes

If you are unable to make your arm completely straight after an injury, Contact your doctor to check for a possible fracture. You’ll likely undergo an x-ray.

If your elbow is just sore, you should consider these fixes before contacting your doctor for help.

  • Rest. Stop overuse of the muscle group you suspect is behind your elbow pain. For example, if you have a hobby or project that requires repetitive wrist flexing or extending, you may be overusing the muscles and tendons of the forearm that connect to the elbow.
  • Heat therapy. Heat can bring blood flow and nutrients to the elbow, which can encourage healing. Protect your skin with a thin cloth, then place a heating pad or hot pack around your elbow.
  • Stretching. Stretching out the muscles of the forearm can offer some relief. Simply straighten your elbow out with the palm of your hand facing the floor, and gently pull your fingers toward the underside of your wrist. You should feel a stretch along the back of your forearm. Hold it for 30 seconds. Then flip your forearm over, with your palm facing the ceiling, and push your fingers toward the floor. Hold for 30 seconds.
  • Bracing. Constantly wearing a brace keeps the muscles still, allowing them time to heal. You can buy various arm braces at most drugstores. Look for one that immobilizes the muscles that may be causing your pain, such as a wrist or forearm brace if you often flex your wrist.

Prevention

Once your elbow has healed, talk to your doctor about physical therapy to strengthen the muscles surrounding the joint. You’ll likely perform exercises such as biceps curls that focus on the muscles in your upper arm. Strengthen your muscles every other day, so they have time to repair and replenish energy stores. You can stretch them daily.

New Mexico Orthopaedics is a multi-disciplinary orthopedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Elbow Pain? Here’s What Might Be Causing It

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Article featured on WebMD

Your elbow lets you throw, lift, swing, and hug, for starters. You can do all this because it’s not a simple joint. And that means there are a lot of ways things can go wrong. Your elbow’s a joint formed where three bones come together — your upper arm bone, called the humerus, and the ulna and the radius, the two bones that make up your forearm. Each bone has cartilage on the end, which helps them slide against each other and absorb shocks. They’re lashed into place with tough tissues called ligaments. And your tendons connect your bones to muscles to allow you to move your arm in different ways. If anything happens to any of these parts, not to mention the nerves and blood vessels around them, it can cause you pain. Here are some of the different ways your elbow can hurt:

One-time Injuries

Some injuries, hopefully, are one-off events, like when you fall or get hit hard while playing a sport.

  • Dislocated elbow. When one of the bones that forms the elbow gets knocked out of place, you have a dislocated elbow. One of the more common causes is when you put your hand out to catch yourself during a fall. It can also happen to toddlers when you swing them by their forearms — that’s called nursemaid’s elbow. If you think you or your child has a dislocated elbow, call your doctor right away.
  • Fractured elbow: If one of your arm bones breaks at the elbow, you have a fracture. Usually, this happens with a sudden blow, as you might get in a contact sport or a car accident. And don’t be fooled if you can still move your elbow afterward. If you’re in pain and it doesn’t look right, it could be broken. You’ll need medical attention.
  • Strains and sprains: File these under, “Oof, I think I pushed it a little too far.” When muscles get stretched or torn, it’s called a strain. When it’s ligaments, it’s a sprain.
You can get a strain when you put too much pressure on your elbow muscles, like when you lift heavy objects or overdo it with sports. Elbow sprains are common in athletes who throw, use racquets, or play contact sports. Both are treated with rest, ice and — once the pain is gone — stretching and strength exercises.

Wear-and-Tear Injuries

Other injuries occur over time, as you repeat certain actions and put wear and tear on your elbow. You can injure yourself playing sports or in any number of work settings, from a factory to an office.

  • Bursitis: Often caused by repeating the same motion over and over, you can also get bursitis from an accident or infection. Bursa are small sacs with fluid in them. You have them in your joints to help cushion your bones, tendons, and muscles. They also help skin slide over bone. But they can get swollen and cause you pain. Often, bursitis is simply treated with pain medicine and starts to get better within a few weeks.
  • Tennis elbow and golfer’s elbow: These are both types of tendinopathy or tendinosis, which means you have damage in the tendons around your elbow from overuse. Despite the names, the injuries aren’t limited to golfers or tennis players. You’re just more likely to get them based on the arm motions used in those sports. The main difference between the two is that tennis elbow affects the outside of your elbow, while golfer’s elbow affects the inside.
  • Trapped nerves: You might be familiar with carpal tunnel syndrome, where a nerve that passes through your wrist gets squeezed and causes some wrist and arm issues. You can have similar problems in your elbow.
  • If you have radial tunnel syndrome, you have a similar issue with the radial nerve as it passes through the radial tunnel near the outside of your elbow. You may have burning or numbness on your outside forearm and elbow.
  • Stress fractures: With a stress fracture, you have a small crack in one of your arm bones, usually from overuse. They’re more common in the lower legs and feet, but athletes who throw a lot, such as baseball pitchers, can get them in the elbow, too. The pain is usually worse when throwing.

Diseases

Several diseases can also cause elbow pain, though it’s usually not the main symptom.

  • Arthritis: Many types of arthritis can affect your elbow, but the main ones are rheumatoid arthritis and osteoarthritis.
    • Rheumatoid arthritis is the most common type of arthritis in the elbow. When you have it, your immune system attacks your body’s healthy tissue and causes swelling in your joints. You get osteoarthritis when your elbow cartilage breaks down over time, which means the bones rub together and cause pain and stiffness.
  • Osteochondritis dissecans: Children and teenagers mostly get this condition, where a piece of bone near the elbow dies. The bone piece and some cartilage then break off, which causes pain during physical activity. It’s more common in the knees, but can happen in the elbow, as well.
  • Gout: This is actually a type of arthritis. Uric acid, normally a waste product to be sent out of your body, builds up as crystals in your tissues. If the buildup happens in your elbow, it can be very painful.
  • Lupus: This is another illness where your immune system attacks healthy parts of your body, including your joints and organs. It more commonly affects your hands and feet, but it can cause problems in your elbow.
  • Lyme disease: Carried by ticks, Lyme disease can cause serious problems if not treated early. You may have issues with your nervous system and pain in your joints, like your elbow.

When to Call Your Doctor

If you think you’ve fractured or dislocated your elbow — it hurts and doesn’t look right — go to the emergency room.
Call your doctor if you have:

  • Elbow pain that doesn’t go away with rest and ice, or pain that doesn’t go away even when you’re not using your arm
  • Intense pain, swelling, and bruising around your elbow
  • Pain, swelling, or redness that gets worse, especially if you have a fever, too
  • Problems using your elbow, such as difficulty bending your arm

New Mexico Orthopaedics is a multi-disciplinary orthopedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.
New Mexico Orthopaedics offers a full spectrum of services related to orthopedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.
Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopedic condition, and offer related support services, such as physical therapy, WorkLink and much more.
If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

14 Common Causes of Elbow Pain

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Article featured on WebMD.

Your elbow lets you throw, lift, swing, and hug, for starters. You can do all this because it’s not a simple joint. And that means there are a lot of ways things can go wrong.

Your elbow’s a joint formed where three bones come together — your upper arm bone, called the humerus, and the ulna and the radius, the two bones that make up your forearm.

Each bone has cartilage on the end, which helps them slide against each other and absorb shocks. They’re lashed into place with tough tissues called ligaments. And your tendons connect your bones to muscles to allow you to move your arm in different ways.

If anything happens to any of these parts, not to mention the nerves and blood vessels around them, it can cause you pain.

Here are some of the different ways your elbow can hurt:

One-time Injuries

Some injuries, hopefully, are one-off events, like when you fall or get hit hard while playing a sport.

  • Dislocated elbow: When one of the bones that forms the elbow gets knocked out of place, you have a dislocated elbow. One of the more common causes is when you put your hand out to catch yourself during a fall. It can also happen to toddlers when you swing them by their forearms — that’s called nursemaid’s elbow. If you think you or your child has a dislocated elbow, call your doctor right away.
  • Fractured elbow: If one of your arm bones breaks at the elbow, you have a fracture. Usually, this happens with a sudden blow, as you might get in a contact sport or a car accident. And don’t be fooled if you can still move your elbow afterward. If you’re in pain and it doesn’t look right, it could be broken. You’ll need medical attention.
  • Strains and sprains: File these under, “Oof, I think I pushed it a little too far.” When muscles get stretched or torn, it’s called a strain. When it’s ligaments, it’s a sprain.

You can get a strain when you put too much pressure on your elbow muscles, like when you lift heavy objects or overdo it with sports.

Elbow sprains are common in athletes who throw, use racquets, or play contact sports.

Both are treated with rest, ice and — once the pain is gone — stretching and strength exercises.

Wear-and-Tear Injuries

Other injuries occur over time, as you repeat certain actions and put wear and tear on your elbow. You can injure yourself playing sports or in any number of work settings, from a factory to an office.

  • Bursitis: Often caused by repeating the same motion over and over, you can also get bursitis from an accident or infection. Bursa are small sacs with fluid in them. You have them in your joints to help cushion your bones, tendons, and muscles. They also help skin slide over bone. But they can get swollen and cause you pain. Often, bursitis is simply treated with pain medicine and starts to get better within a few weeks.
  • Tennis elbow and golfer’s elbow: These are both types of tendinopathy or tendinosis, which means you have damage in the tendons around your elbow from overuse. Despite the names, the injuries aren’t limited to golfers or tennis players. You’re just more likely to get them based on the arm motions used in those sports. The main difference between the two is that tennis elbow affects the outside of your elbow, while golfer’s elbow affects the inside.
  • Trapped nerves: You might be familiar with carpal tunnel syndrome, where a nerve that passes through your wrist gets squeezed and causes some wrist and arm issues. You can have similar problems in your elbow.
  • If you have cubital tunnel syndrome, one of the main nerves in your arm (the ulnar nerve) gets squeezed as it runs along the inside of your elbow and passes through tissue called the cubital tunnel. You may have burning or numbness in your hand, arm, and fingers.
  • If you have radial tunnel syndrome, you have a similar issue with the radial nerve as it passes through the radial tunnel near the outside of your elbow. You may have burning or numbness on your outside forearm and elbow.
  • Stress fractures: With a stress fracture, you have a small crack in one of your arm bones, usually from overuse. They’re more common in the lower legs and feet, but athletes who throw a lot, such as baseball pitchers, can get them in the elbow, too. The pain is usually worse when throwing.

Diseases

Several diseases can also cause elbow pain, though it’s usually not the main symptom.

  • Arthritis: Many types of arthritis can affect your elbow, but the main ones are rheumatoid arthritis and osteoarthritis.
    • Rheumatoid arthritis is the most common type of arthritis in the elbow. When you have it, your immune system attacks your body’s healthy tissue and causes swelling in your joints. You get osteoarthritis when your elbow cartilage breaks down over time, which means the bones rub together and cause pain and stiffness.
    • Osteochondritis dissecans: Children and teenagers mostly get this condition, where a piece of bone near the elbow dies. The bone piece and some cartilage then break off, which causes pain during physical activity. It’s more common in the knees, but can happen in the elbow, as well.
  • Gout: This is actually a type of arthritis. Uric acid, normally a waste product to be sent out of your body, builds up as crystals in your tissues. If the buildup happens in your elbow, it can be very painful.
  • Lupus: This is another illness where your immune system attacks healthy parts of your body, including your joints and organs. It more commonly affects your hands and feet, but it can cause problems in your elbow.
  • Lyme disease: Carried by ticks, Lyme disease can cause serious problems if not treated early. You may have issues with your nervous system and pain in your joints, like your elbow.

When to Call Your Doctor

If you think you’ve fractured or dislocated your elbow — it hurts and doesn’t look right — go to the emergency room.

Call your doctor if you have:

  • Elbow pain that doesn’t go away with rest and ice, or pain that doesn’t go away even when you’re not using your arm
  • Intense pain, swelling, and bruising around your elbow
  • Pain, swelling, or redness that gets worse, especially if you have a fever, too
  • Problems using your elbow, such as difficulty bending your arm

New Mexico Orthopaedics is a multi-disciplinary orthopedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.
New Mexico Orthopaedics offers a full spectrum of services related to orthopedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.
Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopedic condition, and offer related support services, such as physical therapy, WorkLink and much more.
If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

What a Dislocated Elbow Means

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Article featured on the Cleveland Clinic.
The elbow is composed of three bones. A dislocation happens when any of these bones become separated or knocked out of place. If you think you have dislocated your elbow, you should get immediate medical help.

What is a dislocated elbow?

A dislocated elbow occurs when any of the three bones in the elbow joint become separated or knocked out of their normal positions.
Dislocation can be very painful, causing the elbow to become unstable and sometimes unable to move. Dislocation damages the ligaments of the elbow and can also damage the surrounding muscles, nerves and tendons (tissues that connect the bones at a joint).
You should seek immediate medical treatment if you think you have an elbow dislocation. Treatment reduces the risk of irreversible damage.

How common is a dislocated elbow?

The incidence of the injury has been estimated at 2.9 events per 100,000 people over the age of 16. In children, dislocations can happen when someone yanks on the child’s arm.

SYMPTOMS AND CAUSES

What causes a dislocated elbow?

There can be various causes of a dislocated elbow.

  • Most elbow dislocations occur when people try to stop a fall with their outstretched hand.
  • Car accidents can cause dislocated elbows when people reach out to brace themselves against impact.
  • Sports injuries can cause dislocations.
  • Overuse can also be a cause.
  • In some cases, a joint disorder such as Ehlers-Danlos syndrome causes dislocations. Ehlers-Danlos makes joints unusually loose and flexible.

What are the signs and symptoms of a dislocated elbow?

A dislocated elbow can be partial or complete. A complete elbow dislocation involves a total separation and is called a luxation. When the elbow joint is partially dislocated, it is called a subluxation.
Doctors also classify elbow dislocations according to the extent of the damage and where it occurs. The 3 types include:

  • Simple: No major injury to the bone
  • Complex: Severe injuries to the bone and ligament
  • Severe: Damage to the nerves and blood vessels around the elbow

The signs and symptoms of a dislocated elbow vary depending on the severity of the injury and the bones involved. They include:

  • Bruising
  • Deformed-looking arm (bone looks out of place)
  • Weakness in the joint
  • Loss of ability to move the elbow
  • Pain
  • Swelling

DIAGNOSIS AND TESTS

How is dislocated elbow diagnosed?

A doctor diagnoses a dislocated elbow by looking at the arm and moving the joint.
In many cases, doctors use an imaging test called an X-ray to see if the bone is injured. Occasionally, doctors use tests called MRI or CT scans to look for damage to the surrounding muscles and tendons.

MANAGEMENT AND TREATMENT

How is a dislocated elbow condition managed or treated?

Some dislocated elbows return to their usual position on their own. More severe cases need a doctor to return the bones to their proper position.
Treatment for a dislocated elbow varies according to the severity of the injury. Steps you can take to reduce pain while you wait to see a doctor include:

  • Rest
  • Apply ice
  • Keep the elbow elevated

Treatments for an elbow dislocation include:

  • Manipulation: A doctor returns the bones to their normal positions, called a joint reduction.
  • Medication: Your doctor may recommend over-the-counter medicine to reduce pain.
  • Rest: Once the joint is back in place, you may need to keep it immobile and protect it. Using a sling can help the elbow joint heal.
  • Physical therapy: You may need to do exercises to strengthen the muscles and tendons in the elbow to help support it after it heals.
  • Surgery: You may need surgery if:
    • Your doctor is unable to return the bones to their proper positions through manipulation.
    • Dislocation damaged nerves or blood vessels in the elbow.
    • Torn tendons or muscles need repair.

PREVENTION

Can dislocated elbow be prevented?

Caution can help reduce your risk of a dislocated elbow. Be careful on slippery surfaces and stairs to avoid falls. Avoid overtraining in sports to avoid overuse injuries.

What are the risk factors for dislocated elbow?

People at higher risk for a dislocated elbow include those who:

  • Are over age 65 (because they are more prone to falls)
  • Overtrain in sports, especially activities involving throwing
  • Have inherited joint disorders such as Ehlers-Danlos syndrome

OUTLOOK/PROGNOSIS

What is the prognosis (outlook) for people with dislocated elbow?

Recovery times vary according to the severity of the elbow dislocation. Many dislocated elbows do not cause any further problems once they heal. They usually feel better as soon as a doctor puts the joint back in place.

LIVING WITH

When should I call the doctor?

Contact your doctor if you have the symptoms of a dislocated elbow. Do not try to push a dislocated elbow back into place yourself. This effort could damage the surrounding tissue and tendons and lead to complications. If you have a dislocated elbow, let your doctor know if you think you are not healing correctly or continue to have problems.

What questions should I ask my doctor?

If you have a dislocated elbow, you may want to ask your doctor:

  • How serious is the dislocation?
  • Will I need surgery or other treatment?
  • What signs of complications should I look out for?
  • Do I need a follow-up visit, and if so, when?

When can I go back to my regular activities?

Healing time for a dislocated elbow varies depending on the severity of the injury. Most people with a dislocated elbow can return to their usual activities once a doctor has returned the joint to its normal position.
A sling can help protect the elbow joint so you can return to your usual activities while the joint heals. Your doctor will let you know when you can resume more physical activities such as sports or lifting heavy objects.

New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.
New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.
Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.
If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Potential Causes of Elbow and Arm Pain

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Article features on News Medical Life Sciences
There are various possible causes of elbow pain or arm pain. These include injury to the arm, compression of the nerves that serve the arm, arthritis, and various other health conditions.
elbow pain

Injury

A sprain can occur when a movement of the arm has caused damage to the connective tissues in the area. This can present as arm or elbow pain. This damage is usually acute and temporary, and the pain will improve with time as the tissues are repaired.
A fracture or dislocation of a bone in the arm or elbow may also be responsible for causing elbow pain. Most patients are able to pinpoint the cause of the pain or trace it to a certain incident that caused the damage.
Repetitive strain injury (RSI) can also cause elbow pain. It is due to the performance of repetitive tasks that involve movements of the elbows. As such, it commonly affects office workers who use computers frequently throughout the day, and other individuals whose job comprises repetitive manual work.
Tennis elbow or golfer’s elbow can cause elbow pain, and occurs due to the overuse of the muscles and tendons in the joint. It is so named because it is most common in individuals who plan tennis or golf, due to the arm movements that are involved in these sports.

Nerve compression

The joints and bones of an individual show wear and tear as part of the natural aging process. This can lead to the squashing or trapping of nerves, which in turn can cause pain in various areas of the body. In this case, the nerves around the elbow may be pinched, causing pain. Other sensations, such as numbness or tingling, may also be experienced.
cubital tunnel syndrome
Cervical spondylosis is a condition that involves compression of the spinal nerves in the neck region. Some of these nerves are responsible for the sensory messages of pain carried to and from the arm. Damage to them can hence lead to arm pain. Sometimes the compressed nerve may be located in the arm.
A cervical rib is a musculoskeletal abnormality that involves the presence of an additional rib above the normal first rib. This extra bone can interfere with the free passage of nerves in the region, which may lead to elbow pain.

Arthritis

Osteoarthritis or rheumatoid arthritis that affects the elbow joint can lead to stiffness, pain and inflammation of the elbow and arm.
Osteoarthritis involves damage to the cartilage at the ends of the bones that help to prevent friction between the bones that take part in the joint, often due to overuse of or injury to the joint. This leads to rubbing of the bones against each other, which provokes the symptoms of arthritis.
Rheumatoid arthritis involves an autoimmune response of the body that leads to damage to the synovial membrane that lines the joints in the body, including the elbow. In this condition, both elbows are usually affected.

Other health conditions that cause elbow pain

Angina is a health condition that involves reduced blood flow to the heart muscles as a result of narrowing of the blood vessels. Individuals with angina may experience a dull, throbbing pain in the chest, neck, and left arm as a symptom of the condition, particularly during physical activity or when they undergo stress.
Gout is another health condition characterized by the formation of sharp crystals at various locations around the body, including inside the elbow joints. This is due to a high concentration of uric acid in the body. This can cause severe elbow pain during a gout attack.
Olecranon bursitis is the build up of fluid inside the fold of smooth synovial membrane that cushions the olecranon (the bony tip of the elbow joint). This can cause pain and inflammation.

New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.
New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.
Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.
If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Elbow Injuries in the Throwing Athlete

Elbow Injuries in the Throwing Athlete

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Article Featured on Orthoinfo.com

Overhand throwing places extremely high stresses on the elbow. In baseball pitchers and other throwing athletes, these high stresses are repeated many times and can lead to serious overuse injury.

Unlike an acute injury that results from a fall or collision with another player, an overuse injury occurs gradually over time. In many cases, overuse injuries develop when an athletic movement is repeated often during single periods of play, and when these periods of play — games, practices — are so frequent that the body does not have enough time to rest and heal.

Although throwing injuries in the elbow most commonly occur in pitchers, they can be seen in any athlete who participates in repetitive overhand throwing.

Anatomy

normal elbow anatomy

The normal anatomy of the elbow joint shown from the side closest to the body. The bones, major nerves, and ligaments are highlighted.

Your elbow joint is where three bones in your arm meet: your upper arm bone (humerus) and the two bones in your forearm (radius and ulna). It is a combination hinge and pivot joint. The hinge part of the joint lets the arm bend and straighten; the pivot part lets the lower arm twist and rotate.

At the upper end of the ulna is the olecranon, the bony point of the elbow that can easily be felt beneath the skin.

On the inner and outer sides of the elbow, thicker ligaments (collateral ligaments) hold the elbow joint together and prevent dislocation. The ligament on the inside of the elbow is the ulnar collateral ligament (UCL). It runs from the inner side of the humerus to the inner side of the ulna, and must withstand extreme stresses as it stabilizes the elbow during overhand throwing.

Several muscles, nerves, and tendons (connective tissues between muscles and bones) cross at the elbow.The flexor/pronator muscles of the forearm and wrist begin at the elbow, and are also important stabilizers of the elbow during throwing.

The ulnar nerve crosses behind the elbow. It controls the muscles of the hand and provides sensation to the small and ring fingers.

bones, tendons, ligaments of the elbow

(Left) The bones of the elbow and forearm, and the path of the ulnar nerve when the palm is facing forward. (Center) Several muscles and tendons control movement of the elbow and forearm. Shown here are the flexor muscles of the wrist that begin at the inside of the elbow and attach at the wrist bones. (Right) The ligaments of the elbow.

Reproduced and adapted with permission from J Bernstein, ed: Musculoskeletal Medicine. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2003.

Common Throwing Injuries of the Elbow

When athletes throw repeatedly at high speed, the repetitive stresses can lead to a wide range of overuse injuries. Problems most often occur at the inside of the elbow because considerable force is concentrated over the inner elbow during throwing.
baseball pitcher

Reproduced with permission from Ahmad CS, ElAttrache NS: Elbow valgus instability in throwing athletes. Orthopaedic Knowledge Online Journal 2004. Accessed December 2012.

Flexor Tendinitis

Repetitive throwing can irritate and inflame the flexor/pronator tendons where they attach to the humerus bone on the inner side of the elbow. Athletes will have pain on the inside of the elbow when throwing, and if the tendinitis is severe, pain will also occur during rest.

Ulnar Collateral Ligament (UCL) Injury

The ulnar collateral ligament (UCL) is the most commonly injured ligament in throwers. Injuries of the UCL can range from minor damage and inflammation to a complete tear of the ligament. Athletes will have pain on the inside of the elbow, and frequently notice decreased throwing velocity.

Valgus Extension Overload (VEO)

During the throwing motion, the olecranon and humerus bones are twisted and forced against each other. Over time, this can lead to valgus extension overload (VEO), a condition in which the protective cartilage on the olecranon is worn away and abnormal overgrowth of bone — called bone spurs or osteophytes — develop. Athletes with VEO experience swelling and pain at the site of maximum contact between the bones.

Valgus Extension Overload (VEO)

The abnormal bone growth of VEO is apparent in these illustrations of the back of the elbow and inner side of the elbow. Reproduced with permission from Miller CD, Savoie FH III: Valgus extension injuries of the elbow in the throwing athlete. J Am Acad Orthop Surg 1994; 2:261-269.

Olecranon Stress Fracture

Stress fractures occur when muscles become fatigued and are unable to absorb added shock. Eventually, the fatigued muscle transfers the overload of stress to the bone, causing a tiny crack called a stress fracture.

The olecranon is the most common location for stress fractures in throwers. Athletes will notice aching pain over the surface of the olecranon on the underside of the elbow. This pain is worst during throwing or other strenuous activity, and occasionally occurs during rest.

Ulnar Neuritis

When the elbow is bent, the ulnar nerve stretches around the bony bump at the end of the humerus. In throwing athletes, the ulnar nerve is stretched repeatedly, and can even slip out of place, causing painful snapping. This stretching or snapping leads to irritation of the nerve, a condition called ulnar neuritis.

Throwers with ulnar neuritis will notice pain that resembles electric shocks starting at the inner elbow (often called the “funny bone”) and running along the nerve as it passes into the forearm. Numbness, tingling, or pain in the small and ring fingers may occur during or immediately after throwing, and may also persist during periods of rest.

Ulnar neuritis can also occur in non-throwers, who frequently notice these same symptoms when first waking up in the morning, or when holding the elbow in a bent position for prolonged periods.

Cause

Elbow injuries in throwers are usually the result of overuse and repetitive high stresses. In many cases, pain will resolve when the athlete stops throwing. It is uncommon for many of these injuries to occur in non-throwers.

In baseball pitchers, rate of injury is highly related to the number of pitches thrown, the number of innings pitched, and the number of months spent pitching each year. Taller and heavier pitchers, pitchers who throw with higher velocity, and those who participate in showcases are also at higher risk of injury. Pitchers who throw with arm pain or while fatigued have the highest rate of injury.

Symptoms

Most of these conditions initially cause pain during or after throwing. They will often limit the ability to throw or decrease throwing velocity. In the case of ulnar neuritis, the athlete will frequently experience numbness and tingling of the elbow, forearm, or hand as described above.

Doctor Examination

Medical History

The medical history portion of the initial doctor visit includes discussion about the athlete’s general medical health, symptoms and when they first began, and the nature and frequency of athletic participation.

Physical Examination

valgus stress test

The valgus stress test.

Reproduced with permission from JF Sarwark, ed: Essentials of Musculoskeletal Care, ed 4. Rosemont, IL, American Academy of Orthopaedic Surgeons, 2010.

During the physical examination, the doctor will check the range of motion, strength, and stability of the elbow. He or she may also evaluate the athlete’s shoulder.

The doctor will assess elbow range of motion, muscle bulk, and appearance, and will compare the injured elbow with the opposite side. In some cases, sensation and individual muscle strength will be assessed.

The doctor will ask the athlete to identify the area of greatest pain, and will frequently use direct pressure over several distinct areas to try to pinpoint the exact location of the pain.

To recreate the stresses placed on the elbow during throwing, the doctor will perform the valgus stress test. During this test, the doctor holds the arm still and applies pressure against the side of the elbow. If the elbow is loose or if this test causes pain, it is considered a positive test. Other specialized physical examination maneuvers may be necessary, as well.

The results of these tests help the doctor decide if additional testing or imaging of the elbow is necessary.

Imaging Tests

X-rays. This imaging test creates clear pictures of dense structures, like bone. X-rays will often show stress fractures, bone spurs, and other abnormalities.

Computed tomography (CT) scans. These scans are not typically used to help diagnose problems in throwers’ elbows. CT scans provide a three-dimensional image of bony structures, and can be very helpful in defining bone spurs or other bony disorders that may limit motion or cause pain.

Magnetic resonance imaging (MRI) scans. This test provides an excellent view of the soft tissues of the elbow, and can help your doctor distinguish between ligament and tendon disorders that often cause the same symptoms and physical examination findings. MRI scans can also help determine the severity of an injury, such as whether a ligament is mildly damaged or completely torn. MRI is also useful in identifying a stress fracture that is not visible in an x-ray image.

Treatment

Nonsurgical Treatment

In most cases, treatment for throwing injuries in the elbow begins with a short period of rest.

Additional treatment options may include:

Physical therapy. Specific exercises can restore flexibility and strength. A rehabilitation program directed by your doctor or physical therapist will include a gradual return to throwing.

Change of position. Throwing mechanics can be evaluated in order to correct body positioning that puts excessive stress on the elbow. Although a change of position or even a change in sport can eliminate repetitive stresses on the elbow and provide lasting relief, this is often undesirable, especially in high level athletes.

Anti-inflammatory medications. Drugs like ibuprofen and naproxen reduce pain and swelling, and can be provided in prescription-strength form. If symptoms persist, a prolonged period of rest may be necessary.

Surgical Treatment

If painful symptoms are not relieved by nonsurgical methods, and the athlete desires to continue throwing, surgical treatment may be considered.

Arthroscopy. Bone spurs on the olecranon and any loose fragments of bone or cartilage within the elbow joint can be removed arthroscopically.

During arthroscopy, the surgeon inserts a small camera, called an arthroscope, into the elbow joint. The camera displays pictures on a television screen, and the surgeon uses these images to guide miniature surgical instruments.

Because the arthroscope and surgical instruments are thin, the surgeon can use very small incisions (cuts), rather than the larger incision needed for standard, open surgery.

UCL reconstruction. Athletes who have an unstable or torn UCL, and who do not respond to nonsurgical treatment, are candidates for surgical ligament reconstruction.

Most ligament tears cannot be sutured (stitched) back together. To surgically repair the UCL and restore elbow strength and stability, the ligament must be reconstructed. During the procedure, the doctor replaces the torn ligament with a tissue graft. This graft acts as a scaffolding for a new ligament to grow on. In most cases of UCL injury, the ligament can be reconstructed using one of the patient’s own tendons.

This surgical procedure is referred to as “Tommy John surgery” by the general public, named after the former major league pitcher who had the first successful surgery in 1974. Today, UCL reconstruction has become a common procedure, helping professional and college athletes continue to compete in a range of sports.

Ulnar nerve anterior transposition. In cases of ulnar neuritis, the nerve can be moved to the front of the elbow to prevent stretching or snapping. This is called an anterior transposition of the ulnar nerve.

Recovery

If nonsurgical treatment is effective, the athlete can often return to throwing in 6 to 9 weeks. If surgery is required, recovery will be very different depending upon the procedure performed. If UCL reconstruction is performed, it may take 6 to 9 months or more to return to competitive throwing.

Prevention

Recent research has focused on indentifying risk factors for elbow injury and strategies for injury prevention. Proper conditioning, technique, and recovery time can help to prevent throwing injuries in the elbow.

In the case of younger athletes, pitching guidelines regarding number of pitches per game and week, as well as type of pitches thrown, have been developed to protect children from injury.

New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.

Pinched Nerve in the Elbow or Arm

Pinched Nerve in the Elbow or Arm

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A pinched nerve happens when too much pressure is placed against a nerve by bones, tendons, muscles, or cartilage.

It can start in several places throughout your body, usually in the joints. When a pinched nerve is in your elbow, it’s called “ulnar nerve entrapment.” It can leave your arm and hand feeling sore, numb, or weak.

Causes

The ulnar nerve runs the entire length of your arm. It helps control the muscles in the forearm and hand. Sensations affecting your ring finger and little finger also travel though the ulnar nerve. Its most vulnerable point is at the elbow.

If you’ve ever hit your elbow, or “funny bone,” hard and felt a tingling down to your fingers, you’ve compressed your ulnar nerve.

Leaning on your elbow for a long time can also irritate the nerve. Whenever you bend your elbow, you’re forcing the nerve to stretch around the bones in the joint. If you sleep with your elbows bent, for instance, or you keep your elbows bent for a long time, you’re putting more pressure on your ulnar nerve.

A buildup of fluid in the elbow, caused by a condition such as bursitis, for instance, can also entrap the nerve.

Symptoms

One of the first signs that you may have a pinched nerve in the elbow is weakness in your hand. You may not be able to grip things as tightly as you used to or lift heavy things the way you once did.

Your hand may be more tender, more easily hurt, too. The ring finger and little finger may not be as strong and flexible as they used to be.

Other symptoms of ulnar nerve entrapment include:

  • tingling or numbness in the hand, especially the ring and little fingers
  • cold sensitivity in the affected arm or hand
  • tenderness at the elbow

These symptoms tend to come and go at first. You may notice them more when your elbow is bent. You may even wake up in the middle of the night with a tingling feeling in your fingers.

Who Tends to Get This?

Reasons for compression of the ulnar nerve in the elbow aren’t always known. You may not recall injuring your elbow or bending your elbow too much. Your chances of getting ulnar nerve entrapment are higher, though, if your elbow:

  • has arthritis
  • has been fractured
  • was dislocated
  • has been repeatedly injured

When Do I Call a Doctor?

If a pinched nerve in the elbow goes untreated for a long time, there could be permanent damage. Muscles controlled by the nerve may begin to get smaller and shorter. This is called muscle wasting, and it can’t always be reversed.

To avoid this problem, see a doctor quickly if you start to have severe pain, weakness, or tingling in your arm or hand. Even if your discomfort doesn’t feel serious, call your doctor if it’s been with you for at least 6 weeks.

Diagnosis and Tests

To get a proper diagnosis, you should see an orthopedist. Try to find someone who specializes in elbows and wrists.

If you have arthritis and you see a rheumatologist, you may want to start with that doctor. She may later recommend you to an orthopedist. What you might expect:

Medical review: Diagnosing the problem usually starts with a review of your medical history and your lifestyle. If you do a lot of heavy lifting or play contact sports, these would be helpful details to pass along.

Physical exam: Your doctor will likely do a physical exam of your arm, tapping the spot where the nerve crosses the bone in your elbow. The doctor may also want to see whether the nerve itself slides out of its proper position when your elbow bends.

You may be asked to put your arms in different positions and turn your neck from side to side to see whether that causes any pain or numbness. Your doctor may check the strength in your fingers and hand, and test for feeling in those areas.

X-ray: You might have an X-ray taken so your doctor can look for bone spurs or arthritis. These may be placing pressure on your nerve. Nerve conduction study: In this test, the doctor stimulates your ulnar nerve in various places. An area that takes longer to respond may be where the nerve is compressed.

This test is also helpful in diagnosing muscle wasting caused by nerve problems.

Treatment

Once you’ve been diagnosed with ulnar nerve entrapment, it will be time to decide how to treat the problem. The severity of the condition will help you and your doctor decide whether surgery or a less-invasive strategy is best.

Nonsurgical treatments include:

Nonsteroidal anti-inflammatory drugs: NSAIDs can reduce pain and inflammation.

A splint or brace: These can keep your elbow straight, especially while you’re sleeping.

An elbow pad: This helps reduce pressure on the joint.

Occupational and physical therapy: This will improve the strength and flexibility of your arm and hand.

Nerve-gliding exercise: Do this to help guide the nerve through the proper “tunnels” in the wrist and elbow. If nonsurgical options haven’t eased your symptoms or there is obvious muscle damage, surgery may be necessary. The goal of surgery is to remove pressure from the nerve. In some cases, the nerve is moved as part of the operation.

Some surgical treatment options include:

Ulnar nerve anterior transposition: This moves the ulnar nerve so that it doesn’t stretch over the bony parts of the elbow joint.

Medial epicondylectomy: This removes the bump on the inside of the elbow joint, which takes pressure off the ulnar nerve.

Cubital tunnel release: This removes part of the compressed tube through which the nerve passes in the elbow.

Self-care at Home

If you have surgery, physical therapy to regain your arm and hand strength will likely be advised. You might need a splint for a few weeks to help make sure the elbow heals properly.

Ongoing care for your elbow should include steps to avoid injuring or irritating the nerve further. You should be careful to avoid trauma to your elbow. You may also need to learn, with occupational therapy, how to hold your arm differently, stretch, or take frequent breaks when doing everyday activities such as working on your computer.

New Mexico Orthopaedics is a multi-disciplinary orthopaedic clinic located in Albuquerque New Mexico. We have multiple physical therapy clinics located throughout the Albuquerque metro area.

New Mexico Orthopaedics offers a full spectrum of services related to orthopaedic care and our expertise ranges from acute conditions such as sports injuries and fractures to prolonged, chronic care diagnoses, including total joint replacement and spinal disorders.

Because our team of highly-trained physicians specialize in various aspects of the musculoskeletal system, our practice has the capacity to treat any orthopaedic condition, and offer related support services, such as physical therapy, WorkLink and much more.

If you need orthopedic care in Albuquerque New Mexico contact New Mexico Orthopaedics at 505-724-4300.