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Elbow Rehabilitation

Article written by: GEORGIANA TACHE, MD, Medical rehabilitation doctor


Elbow recovery

The elbow articulation is a complex articulation, being composed of three articulations: the humero-ulnar articulation, the humero-radial and the radio-ulnar articulation, all communicating with each other because the capsule is common.

The proximal epiphyses of the radius and ulna also articulate with each other through the articular circumference of the radius and the radial incision of the ulna. The bony components of the elbow are supported by means of joints, represented by:

  • Joint capsule
  • Ulnar collateral ligament
  • Radial collateral ligament
  • Square ligament
  • The annular ligament

The most common pathologies at the elbow are represented by:

1. Elbow bursitis: Normally, the olecranon bursa is flattened with a small amount of fluid. If the bursa becomes inflamed, the amount of fluid encountered at this level will increase, in this case speaking of an elbow bursa. The causes are multiple and include: direct trauma, prolonged pressure on the elbow, infection, rheumatoid arthritis or gout. The symptoms are represented by pain (accentuated by elbow flexion and palpation), the skin being red, at the same time the patient complaining of fever or chills.

2. Lateral epicondylitis: it represents the inflammation of the tendons that are inserted at the level of the lateral humeral epicondyle (also called tennis elbow). Symptoms include pain in the tendon insertion area and tenderness. The diagnosis is a clinical one, completed by a soft tissue ultrasound or magnetic resonance imaging. Treatment consists of rest, NSAIDs, painkillers, cortisone therapy and physiotherapy. Surgical treatment is indicated in less than 5% of cases.

3. Medial epicondylitis:
Also known as the golfer's elbow, this condition involves inflammation of the muscles that insert into the medial epicondyle of the humerus. The treatment is the same as in lateral epicondylitis.

4. Injuries of the ulnar collateral ligament:
through repetitive throwing movements there is wear, stretching or rupture of this ligament. If the force felt by the soft tissues is greater than the tensile strength of the ligament, ruptures may occur in its fibers. The most important symptom is pain, athletes feel pain during the throw, especially during the acceleration phase or when clenching the fist (at this level the flexor muscles of the hand originate). If we talk about a complete rupture, a significant bruising will occur locally. The diagnosis is made following clinical examination and imaging investigations (X-ray, MRI, ultrasound, CT - less often). Conservative treatment has a very high success rate and consists of rest, NSAIDs and painkillers, local ice. If the lesion does not respond to non-surgical treatment, surgery is proposed.

 

5. Brachial biceps muscle rupture: : more than 50% of brachial biceps muscle ruptures occur in the long head. The rupture occurs mainly in middle-aged men, when lifting heavy weights, with the elbow flexed at 90 degrees or when the biceps contracts at an unexpected resistance. The symptoms are pain, local inflammation, bruising and local deformity in the middle of the arm (migrated muscle). The treatment of choice is surgical and consists in reattaching the long head tendon to the insertion site with the help of special anchors.

6. Ulnar canal syndrome: is a pathology that affects the ulnar nerve when it crosses from the anterior lobe of the arm to the anterior lobe of the forearm. A common cause is frequent bending of the elbow (repeated pulling, pushing or lifting various weights). Direct and constant pressure on the elbow can also lead to ulnar canal syndrome. Another cause of production is local trauma (blows to the ulnar canal). Symptoms include numbness on the inside of the forearm, hand and fingers 4 and 5, which over time turn into pain and clumsiness of the hand due to damage to the innervated muscles of this nerve. The diagnosis is made with the help of special tests (nerve conduction velocity test - VCN and electromyogram - EMG). The treatment is primarily conservative and includes rest and analgesic / anti-inflammatory medication. At the same time, the patient should consult a physiotherapist to show him how to perform the current activities without putting extra pressure on the elbow as well as a series of exercises that will strengthen the muscles of the forearm. Surgical treatment involves releasing pressure on the ulnar nerve where it passes through the ulnar canal.
 
7. Radial tunnel syndrome: the symptoms are similar to those of the tennis player's elbow, being also very difficult to diagnose. The preferred treatment is the conservative one (rest, ice, NSAIDs / analgesics), the conservative treatment being considered the last solution. Conservative treatment must be accompanied by a complex medical recovery program consisting of physiotherapy and physical therapy. Physiotherapy aims to reduce inflammation and is recommended from the first symptoms of the condition to reduce pain, inflammation, practically to improve the general condition of the patient. It lasts an average of 10 days, followed by a clinical evaluation. Physiotherapy has the role of restoring function, mobility, muscle tone, ensuring the patient's integration into the family, social and professional environment.