Anatomy
The elbow joint is the joint connection between the humerus and the two bones of the forearm: the radius and ulna. The three major nerves: radial, ulnar and median can all be injured around the elbow. The ligaments on the outside and inside of the elbow (ligamentum collaterale laterale and mediale) and many muscles around the elbow help stabilise the joint.
Cause
Repeated high-intensity loading of the elbow, primarily when throwing with the arm above head height (baseball, handball, tennis), can cause overuse injuries to the various structures. Thus, there can be several different causes for the pain during throwing movements:
1) When the elbow is overstretched with great force, the tip of the elbow (olecranon) can strike the humerus, causing osteophytes to form on the olecranon, which can break off and affect the articular cartilage.
2) When the elbow is twisted during the throw, the medial collateral ligament (medial collateral ligament) is overstretched and can become loose, making the elbow unstable.
3) Cartilage lesions can occur externally (laterally) in the elbow joint.
4) Affected articular cartilage, bone remodelling (osteophytes) and free joint mice (bone tears in the joint) can cause an increase in boxing of the elbow joint.
5) Nerve impingement (ulnar nerve) due to multiple overstretching of the nerve during throwing movements.
Symptoms
Symptoms is:
1) Pain when the elbow is overstretched, such as when the ball is just released when throwing overhand. There is often pressure tenderness on the edges of the elbow tip (olecranon).
2) Pain when applying pressure to the inner lateral ligaments with aggravation when the ligaments are stress-tested (valgus loading), e.g. just before the ball is released when throwing overhand.
3) Pain on the outside (lateral) of the elbow with aggravation when the lateral joint surfaces of the humerus and radius are pressed together (valgus loading).
4) Diffuse tenderness and a tense sensation in the elbow joint, often with restricted mobility and possible locking.
5) Tingling, prickling and sleeping sensation towards the little finger, where symptoms can be triggered by tapping the nerve behind the medial humeral epicondyle with a finger
Examination
The diagnosis is usually made through a general clinical examination by a relevant professional, possibly supplemented by X-rays, ultrasound scans and MRI scans.
Treatment
Reduction of the cause of the pain (strain, throwing the arm above the head) as well as stretching and slowly increasing strength training of the muscles around the elbow within the pain threshold. If the discomfort does not subside with relief and gentle rehabilitation, treatment can sometimes be supplemented with medical treatment in the form of arthritis pills (NSAID) or injection of adrenal cortex hormone as part of slowly increasing rehabilitation within the pain threshold over several months before maximum load is allowed.
Surgical treatment may be indicated if there is no improvement within 6 months despite offloading, rehabilitation and possibly injections. The surgical treatment targets the changes that can be detected in the elbow.
Complications
If no progress is made, you should reconsider the correctness of the diagnosis and ensure re-examination by a specialist to ensure correct diagnosis and rule out others.
In particular, the following should be considered:
- Inflammation of the bursa at the elbow
- Rheumatoid arthritis in the elbow joint
- Ligament ruptures on the inside or outside of the elbow
- Damage to the ulnar and median nerves
- Osteoarthritis in the elbow
- Loose bone fragments in elbow
- Muscle rupture
