Elbow Injuries and Treatments in New Jersey

The elbow is an exceptionally complex joint.

NJ Elbow Doctors and Elbow Surgery

The elbow is made up of the humerous (upper arm bone), the ulna (larger of the lower arm bones), and the radius (the smaller bone in the lower arm), along with a an array of muscles, tendons and ligaments. There are three main types of elbow injuries causing elbow pain:

  • Overuse injuries (microtrauma) – including tendonitis, medial and lateral epicondylitis (medial epicondylitis is also known as golfer’s elbow, baseball elbow, and forehand tennis elbow), and lateral epicondylitis  (also known as tennis elbow)
  • Chronic conditions – such as osteoarthritis, bursitis, etc.
  • Traumatic injuries – including fractures, dislocations, tendon/ligament ruptures, etc.

Conditions of the elbow that can be treated by arthroscopy include fractures, tennis elbow, stiffness, arthritis, and tears in the ligaments and cartilage. Arthroscopy can also be used for removal of loose bodies (bone fragments) or to shave bone spurs in the elbow.

Common Conditions

Procedures

Arthroscopy

Arthroscopy can be very useful for conditions of the elbow. Conditions of the elbow that can be treated by arthroscopy include fractures, tennis elbow, stiffness, arthritis, and tears in the ligaments and cartilage. Arthroscopy can also be used for removal of loose bodies (bone fragments), to shave bone spurs in the elbow (seen in arthritis or VEO), treat cartilage lesions, visualize fracture reduction, debride tendons affected by tennis elbow, release contractures, and examine joint problems which provide a most accurate diagnosis and treatment plan.

Tommy John Surgery

Tommy John surgery repairs an injured elbow ligament. Tommy John surgery is also called UCL reconstruction, short for Ulnar Collateral Ligament. The UCL is located on the inside of the elbow. It connects the bone of the upper arm (humerus) to a bone in the forearm (ulna). During this surgery, the injured UCL is replaced with a tendon taken from somewhere else in the patient’s body.

Historically, Tommy John surgery is most commonly done on college and pro athletes, especially baseball pitches. USA Today had reported that in the 2002 and 2003 seasons, 75 of the almost 700 major league pitchers were Tommy John surgery survivors. That is approximately one in every nine pitchers. Unfortunately, today this surgery is becoming required in younger and younger patients, and is a focus of injury prevention by educating youth athletes.

The surgery is named after former Los Angeles Dodgers pitcher Tommy John. In 1974, he underwent the first surgery of this type by Dr. Frank Jobe. This procedure was modified and mastered by Dr. James Andrews, who maintains the largest reported series of this procedure with high return to the same or higher level of performance. It is this technique that is utilized by the surgeons at NJOI.

UCL injury can be incurred by anyone who experiences repetitive stress to the elbow or from trauma. However “throwing” athletes have the highest risk, due to the extreme stress placed on the ligament by throwing motions that twist and bend the elbow.

Over time, the UCL can develop microscopic or large tears. The ligament stretches and lengthens to the point where it can no longer hold the bones securely and tightly enough during throwing activities. While most sports-related UCL injuries occur in baseball players, other sports are sometimes linked to UCL injuries, such as javelin, tennis, wrestling and gymnastics.

Elbow Arthroscopy-loose bodies, bone spurs, Valgus Extension Overload (VEO)

The unique anatomy of the elbow joint allows it to pass through a broad range of motion. The elbow joint is a hinged joint in which the upper arm bone (humerus) meets the two forearm bones (ulna and radius). The main stabilizing structure of the elbow joint is the ligament along the inner aspect of the elbow (medial collateral ligament.) During repetitive overhead and lifting sports and tasks or jobs, the elbow experiences tremendous stress. This may lead to the formation of small fragments of cartilage or bone (loose bodies) or elbow joint spurs.

Arthroscopic surgery, performed by the experts at NJOI, is often the ideal choice for treating certain elbow conditions. An injury or arthritis can damage the ends of the bones and cause bone spurs. These spurs can be painful and make it hard to move the elbow. After the spurs have been removed by our surgeons, the elbow moves more easily and with less pain.

In addition to injury or overuse causing the need for surgery, elbow arthroscopy can be performed in early stages of elbow rheumatoid arthritis and osteoarthritis to improve motion and provide pain relief.

Valgus extension overload (VEO) is a group of problems and pains within the elbow due to overuse and repetitive throwing forces, largely seen in an athlete who performs overhead motion. It is also known as posterior elbow impingement, or posteromedial elbow impingement. Athletes in many sports may experience VEO and other common pathologies related to the high repetitive stresses generated by the overhead throwing motion. VEO is characterized by reproducible pain that is elicited by repeatedly forcing the elbow into terminal extension while applying a valgus stress* to the elbow. Pain at the posteromedial tip of the olecranon (bone at tip of elbow) is characteristic of the condition.

*(The valgus stress test is used to assess the integrity of the medial collateral ligament, also known as the ulnar collateral ligament. Valgus is a bending or twisting which denotes a deformity).

Arthroscopic surgery permits removal of loose bodies and debris (bone or cartilage) and shaving of any bone spurs that have formed. 

Tendon Repair-Golfer’s Elbow and Tennis Elbow

Golfer’s Elbow Surgery (Medial Epicondylectomy & Ulnar Nerve Release)
Golfer’s elbow, or medial epicondylitis, is a condition that causes pain on the inner side of the elbow, where the tendons of the forearm muscles attach to the bony bump on the inside of the elbow. The pain may also spread into the forearm and wrist. It causes the tendons to become inflamed and stressed due to general injury or overuse.

Golfer’s elbow is similar to tennis elbow, but it occurs on the inside, rather than the outside, of the elbow. It is also not limited to golfers. Tennis players and others who repeatedly use their wrists or clench their fingers can also develop golfer’s elbow.

Golfer’s elbow surgery (called medial epicondylectomy and ulnar nerve release) involves an incision along the inner side of the elbow in order to access and remove the medial epicondyle (the bony bump located on the inner side of the elbow) that is exerting pressure on the blocked ulnar nerve. Once removed, the ulnar nerve is able to glide freely whether the elbow is bent or in use.

Tennis Elbow Surgery (Lateral Epicondylitis Debridement)
Tennis elbow is a condition in which there is inflammation of the tendons (tendinitis) attached to the outside, or lateral side, of the elbow at a bony prominence of the arm bone (humerus). This bony prominence is called the lateral epicondyle, hence this condition is also called “lateral epicondylitis.” Muscles that work the wrist and fingers lead to a tendon which attaches to this area. Overuse can also cause this inflammation to become a tendon tear.

Patients with tennis elbow experience pain at the lateral aspect of the elbow that can radiate or travel into the forearm and, occasionally, the hand. The pain occurs with grasping activities and may be accompanied by a sense of weakness. An achy type of discomfort may also be present at rest or at nighttime after activity. Once the tendons get inflamed, it can be difficult to eradicate because those tendons are used every time the hand grips or squeezes.

Tennis elbow surgery (called lateral epicondylitis debridement) involves creating small incisions around the elbow and accessing the diseased bones, cartilage, ligaments, or tendons via an arthroscopic camera, which allows the surgeon to view the procedure on a monitor. Once diagnosed, the surgeon uses arthroscopic tools to carefully repair and/or remove any damage.  

Fracture Repair

The elbow is a complex joint due to its intricate functional anatomy. The ulna, radius and humerus articulate in such a way as to form four distinctive joints. Fractures associated with elbow instability often require surgery.

Elbow fractures may result from falling onto an outstretched arm, a direct impact to the elbow, or a twisting stress or injury. Sprain, strains, or dislocations may simultaneously occur with a fracture.

While there are various types of elbow fractures, fractures that cause instability or are displaced are more likely to need surgery. This is to stabilize the fragments, or sometimes remove those bone fragments, and ideally allow for rapid return of motion.

When the joint surfaces of an elbow are separated, the elbow is dislocated. Elbow dislocations can be complete or partial. In a complete dislocation, the joint surfaces are completely separated. In a partial dislocation, the joint surfaces are only partly separated. A partial dislocation is also called a subluxation. Whenever a fracture is open (broken skin over the fracture), urgent surgery is needed to clean out the tract and bone in order to minimize the risk of deep infection.

NJ Elbow Doctors and Surgeons

The NJ elbow pain specialists at The New Jersey Orthopaedic Institute are experienced in both surgical and non-surgical interventions of elbow injuries and conditions including biceps tendonitis, dislocation, fractures, tennis/golf elbow and many others. Contact us today to schedule an appointment. Serving patients in Wayne, Clifton, Butler, Bridgewater, Morristown and surrounding areas in New Jersey.