Elbow Injury Specialists Scottsbluff NE
Physical Medicine and Rehabilitation
Horizons West Medical Group
Family Practice, Hematology / Oncology, Medical Oncology
A New Shot for Tennis Elbow
You don't have to play tennis to have a common elbow problem called "tennis elbow." This painful condition involves the outside "bump" or epicondyle of the elbow. It is typically caused by injury (strain) or repetitive stresses to the tendons that attach to the epicondyle.
Tennis elbow has long been treated as a form of tendonitis with inflammation as the problem. Treatments have included ice massage, steroid injections, splinting, and medication.
Researchers studying the muscle and tendon tissue have learned that chronic tennis elbow isn't a problem of inflammation. Instead, there's damage to the cells that form the tendons, a condition called tendonosis. The problem is compounded by a loss of blood supply to the damaged tendon.
The doctors in this study injected blood into the painful area of the elbows of 28 adults. The patients donated their own blood for this treatment. Eighty percent of the patients got complete relief of pain after one injection. A smaller number of patients needed two or even three injections.
It took about three weeks for the first injection to take effect. This matches the time needed for a healing process to take place. Repeated injections worked faster (one to two weeks). The authors think this is because the first injection started the steps toward healing.
The doctors say they can't know for sure if the blood was what worked. It may be that the injection itself caused a small injury to the area that produced the healing...
Best Treatment for Elbow Fractures in Children
In this study, orthopedic surgeons compared three ways to treat elbow fractures in children. The specific type of fracture was a lateral condylar fracture of the distal humerus. The distal humerus is at the bottom of the upper arm.
The humerus flares at the bottom on both sides forming a part of the bone called the condyle. The lateral condyle is the bony projection along the outside of the elbow (side farthest away from the body). Fractures of the lateral condyle are fairly common in children. Finding the most effective treatment with the fewest complications is an important goal.
The choices in treatment include: putting the arm in a cast from the hand to the top of the upper arm. That's called a long arm cast. Casting without surgery is possible when the break is intact and hasn't separated or displaced.
A second treatment alternative is called closed reduction and internal fixation or CRIF. With CRIF, the break can be lined up (reset) without an incision to cut through the skin and open the arm up. And for fractures that have separated too much and/or shifted so the broken ends no longer line up, the third procedure used is called an open reduction and internal fixation (ORIF). With the open reduction, the surgeon makes an incision down to the bone. The bone is put back together and held in place with wires, plates, and/or screws. The arm is placed in a long arm cast until sufficient healing takes place.
Each of these treatment approaches have their pros and cons. Putting a cast on without wiring or screwing the bones back together has a risk of the bones drifting too far apart. Closed reduction and internal fixation may not bring the bones back as close together as needed. The result can be deformity and change in the carrying angle of the arm. Open reduction with internal fixation (ORIF) is really the most accurate treatment but it is also the most invasive.
A wide range of complications can occur from the treatment of lateral condylar fractures. There can be infections, loss of blood supply to the bone, failure of the bones to knit back together (malunion), or just a very slow process of healing (delayed union).
Sometimes the bones shift even with surgery (CRIF or ORIF). If too much shifting occurs, an elbow deformity can develop that affects the carrying angle of the arm. There are cases where growth is stopped or the opposite (too much bone growth) occurs. Stiffness, loss of motion, weakness, and loss of function are all possible problems that can develop.
So, which one of these treatments works best? Which one has the fewest complications? How can surgeons optimize motion, strength, and function and help the patients get back to as normal as possible? Let's see what this study of 175 children revealed. Please note: all 175 children were treated by the same surgeon and given the same follow-up care and rehab.
Fourteen patients of the 39 who were put in a long arm cast without surgery ended up with...
Elbow Pain in Young Boys: Panner Disease or Osteochondritis Dissecans?
What do we know these days about osteochondritis dissecans of the elbow in young athletes? What causes this condition? Can it be cured? These are some of the questions answered in this review article written by sports medicine orthopedic surgeons from Rush University in Chicago, Illinois.
Osteochondritis dissecans (OCD) is a problem encountered most often by male adolescents (teens) involved in repetitive overhead throwing activities. Young girls participating in gymnastics are the second group affected most often. Gymnasts can spend quite a bit of time engaged in activities that require repeated weight-bearing on the arms leading to OCD.
What is OCD and what causes it? In this condition, repetitive microtrauma from repeated motions of the elbow causes the articular cartilage that lines the elbow joint to separate and break into pieces. When the cartilage pulls away from the joint, it takes a layer of subchondral bone with it. Subchondral just means "under the cartilage," which describes the first layer of bone next to the articular cartilage.
Any bone within the elbow can be affected. But the most commonly involved bone is the capitellum. Here's a quick review of elbow anatomy to help you picture the capitellum. The elbow is the connection of the humerus (upper arm bone) and the two bones of the forearm (the ulna and the radius).
The joint where the humerus meets the radius is called the humeroradial joint. This joint is formed by a knob and a shallow cup. The knob on the end of the humerus is called the capitellum. The capitellum fits into the cup-shaped end of the radius, also called the head of the radius.
When the head of the radius spins on the capitellum, the forearm rotates so that the palm faces up toward the ceiling (supination) or down toward the floor (pronation). The joint also hinges as the elbow bends and straightens.
When making the diagnosis, the orthopedic surgeon must distinguish between OCD and another problem called Panner disease. Although these two conditions are considered separate problems, some experts view them as two stages of the same thing.
Both affect the capitellum but Panner disease causes fragmentation of the entire capitellum. OCD is usually more of an isolated lesion that breaks away from the main bone causing a loose body to float inside the joint.
Panner disease tends to develop in young boys between the ages of 5 and 10 who aren't involved in repetitive motions that cause trauma to the joint. For unknown reasons, normal growth in the outer edge of the elbow is disrupted, which causes the small area of bone to flatten out.
Symptoms of diffuse elbow pain are common with both Panner disease and OCD. Diffuse means throughout the entire elbow. Pain can occur along the outside or lateral aspect of the elbow. The pain is present with activity and there's a loss of extension. The child cannot straighten the elbow all the way. There may be stiffness, swelling...