Ask the Expert: Dr. Joshua Dines, Orthopedic Surgeon, Answers Your Questions About Elbow Injuries
Q1. What is tennis elbow and what are my treatment options?
Tennis elbow, or lateral epicondylitis, is often caused by overuse and affects the side of the elbow, causing pain when extending and rotating the elbow. In most cases, initial treatment is to modify your activity or to rest the elbow. Anti-inflammatory medications can help too and it is best to consult with your treating physician to find out if this is an option. Physical therapy can be one of the best ways to treat the problem. Cortisone injections, Platelet Rich Plasma (PRP) therapy—a procedure involving the injection of your own concentrated blood-platelets into the abnormal tissue that may promote tendon healing—and surgery can be used to treat more resistant cases.
Q2. My elbow gets tight and the range of motion is limited what might be causing this?
Limited range of motion can be due to a variety of causes, and may sometimes be painless—similar to what may be seen in professional baseball pitchers. It may be a sign of an injury in the elbow. Arthritis, tendonitis, inflammation of the capsule (or capsulitis), bone spurs, amongst other conditions can cause tightness and limited motion. It is important to see a professional who can make the diagnosis as the treatment may vary based on the cause of the symptoms.
Q3. I was told that I may have an adhesion in my elbow, can you explain what that means?
Elbow adhesions refer to an abnormal joining together of structures in the elbow, typically affecting the soft tissues. There are a variety of causes and it can cause pain and decreased range of motion. In most cases, treatment consists of physical therapy and occasionally a cortisone injection. If the condition doesn’t improve, a possible treatment is arthroscopic surgery to physically break up the adhesions. During this minimally invasive procedure, a tiny camera and small instruments are inserted through small incisions in the elbow in order to correct the adhesion.
Q4. My elbow feels like it gets caught and then will get loose again. What could the problem be?
Several problems in the elbow joint may cause the sensation of the elbow getting “caught” and then “loose again.” Most commonly, loose bodies—fragments of bone or cartilage that break loose causing pain that may result from arthritis, previous trauma or other cartilage disorder—can float around in the joint and cause the catching or locking sensation. Some patients have plica bands, which are inflamed bands of synovial tissue—membranes in the joint—that can cause similar symptoms. These may be particularly symptomatic in athletes.
Q5. Can elbow surgery damage the ulnar nerves and cause permanent nerve damage?
The ulnar nerve courses along the inner side of the elbow. Depending on how the elbow problem being treated, the ulnar may be at risk for injury during surgery, but the risk of permanent damage is low. Choosing a surgeon who specializes in elbow problems can help decrease this risk.
Dr. Joshua Dines is an orthopedic surgeon and a member of the Sports Medicine and Shoulder Service at Hospital for Special Surgery. He was the team doctor for the U.S. Davis cup tennis team, and currently serves as an assistant team physician for the New York Mets and a sports medicine orthopedic consultant for the NY Rangers.