Our orthopedic centre in Friedrichshafen, Germany is famous for its state-of-the-art orthopaedic surgery. Our Center for joint replacement, under the guidance of an experienced Professor of Medicine Eugene Winter, is highly specialised in modern minimally invasive diagnostic and surgical procedures (keyhole surgery), implantation of modular joint prosthetics and complicated replacement of existing prosthetics.
An elbow replacement is most often performed when the joint has been damaged in some kind of accident. Also the rheumatism leads to wearing off the joint tissue. Damage to the joint as a result of tumours can also be an indication for elbow replacement surgery.
When pain occurs in the elbow, the cause is almost always directly in the area of the elbow joint. Elbow pain is rarely a progressive pain that has its origins elsewhere, such as in the shoulder girdle. What are the most common causes of pain in the elbow, which examinations the doctor performs to clarify and what are possible treatments, our expert explain here.
Pain in the elbow may be due to injury or overwork or may be an indication of acute or chronic illness. Important causes of elbow pain are:
Behind elbow pain on the outside is often a so-called epicondylitis radialis, colloquially called "tennis elbow" or "tennis elbow": The affected persons feel pressure pain in the area of the bony protrusion on the outside of the elbow. Often, the pain in the elbow when stretching the forearm noticeable, with the full stretch is usually no longer possible.
The affected hand also has a loss of power: Patients are unable to forcefully close their hands to a fist, hold a cup, or firmly grip when shaking hands. In addition, the stretching of the fingers against resistance is quite painful.
The tennis elbow is a painful irritation of the tendon insertion of the hand and finger extensors in the elbow, which can lead to inflammation. Possible cause is an overload by unilateral activity (playing tennis, ironing, operating the computer mouse, playing an instrument, etc.) or ligament instability at the elbow joint.
In conditions such as rheumatism (rheumatoid arthritis) and gout, inflammation occurs in many joints, associated with joint pain. Elbow joints can also be affected by rheumatism.
Joint wear can affect various joints - including the elbow joint. The affected persons initially experience pain in the elbow when it is loaded. Later, the pain occurs with every movement in the elbow joint - and finally at rest. If joint wear is accompanied by inflammatory processes (activated arthrosis), it can also cause pain in the elbow.
Pain in the elbow and blockages of the joint may be signs of so-called osteochondritis dissecans. This disease causes cartilage and bone damage in the elbow.
This may be due to repeated tiny injuries or strains (such as repeated throwing movements). In this case, small fragments of cartilage and / or bone can be blasted off, which can be trapped as a free joint body in the joint space.
Panner's disease (juvenile osteochondrosis)
Especially in boys between the ages of 6 and 10, elbow pain sometimes occurs, sometimes accompanied by swelling. Panner's disease is characterized by the death of bone tissue in the area of the elbow joint (bone necrosis). It runs in stages and can also be associated with the formation of free joint body.
You should go to the doctor if you experience severe and / or persistent pain in the elbow. This is especially true if additional symptoms such as swelling and overheating of the joint, a malposition of the elbow or a significantly reduced mobility of the forearm.
In such cases, you can seek advice from your family doctor, orthopedist or sports physician.
This is followed by the physical examination. The doctor scans the elbow, paying attention, among other things, to swelling, overheating, articular effusion and pressure pain. He also checks the active and passive mobility of the elbow joint and performs various tests. If necessary, the doctor will also examine other joints.
The physical examination, movement and functional tests, as well as information from the anamnesis interview are in many cases sufficient for the physician to determine the cause of the pain in the elbow. If not, or if there are doubts about the diagnosis, additional clinical or instrumental examinations will be used as needed.
Thus, for example, by means of X-ray examination bony injuries or free joint bodies can be detected as the cause of the pain in the elbow, or exclude. An ultrasound scan of the elbow joint may help diagnose bursitis. Occasionally magnetic resonance imaging (MRI) or computed tomography (CT) may be required to elucidate pain in the elbow.
Nerve damage in the sulcus-ulnaris syndrome can be detected by an electroneurographic examination (ENG).
If it is suspected that inflammation generally causes the pain in the elbow, a measurement of the inflammatory parameters in the blood (erythrocyte sedimentation rate, CRP, leukocytes) can help.
In the case of joint effusions or swelling, the physician can draw liquid collected by means of a puncture in order to have it examined more closely in the laboratory. At the same time, puncturing relieves the joint, so it also has a therapeutic benefit.
Depending on the cause of the elbow pain, the doctor will suggest suitable treatment. Some examples:
A tennis or golfer's elbow is usually treated conservatively by restoring and protecting the joint. Help against pain in the elbow cold (the acute stage) or heat (in the chronic stage) and analgesic drugs.
Injections of an anesthetic with cortisone directly into the joint as well as a shock wave therapy are further treatment options against the elbow pain in epicondylitis. If the pain in the elbow is very persistent and can not be eliminated with conservative therapies, a tennis or golfer's arm is operated on.
Even if a sharp pain in the elbow is caused by bursitis, a conservative treatment is the treatment of choice: It consists in an immobilization of the joint, anti-inflammatory and analgesic drugs and possibly a puncture (in case of severe swelling). Surgery is just the last treatment option.
Pain in the elbow due to dislocation or Chassaignac palsy requires professional dislocation of the "slipped out" structures.
Elbow pain caused by Panner's disease often heals spontaneously. Symptomatic measures such as ointment dressings and the avoidance of joint-burdening sports (such as tennis) support the healing process. Only when free joint body or in joint blockage is operated on. Similarly, the therapy for pain in the elbow due to osteochondritis dissecans (conservative treatment preferred, elbow joint surgery only in advanced stages).
Within the framework of our special consultation hours for shoulder and elbow surgery, a clinical examination takes place, in which your medical history, digital X-rays, MRI and computed tomography (possibly with 3-D images) play a decisive role. This is essential in order to decide on the appropriate form of therapy and for the careful, extensive endoprosthesis planning for your individual case.
In the case of irreparably damaged joints, our Joint Centre in Germany can implant an endoprosthesis, as is done with other joint replacements, e.g. knee, hip, shoulder. Options are:
Today, elbow replacement surgery presents a solution for patients with rheumatoid arthritis or extremely advanced arthritis after injuries to the joint. The prosthetics available are excellent and deliver very good results. Usually, good mobility of the joint with complete absence of pain can be achieved with this procedure.
As is the case with knee endoprosthetics, elbow prosthetics used in replacement surgery are also divided into various categories according to international norms (ISO).
The indications for uncoupled prosthetics in elbow replacement surgery are very limited. The greatest threat here lies in insufficient stability in terms of the ligaments which in turn results in a very high risk of dislocation.
In the case of rheumatic disorders of the joint, it can be presumed that the damage to the bones and ligaments is more considerable, in which case resurfacing of the joint alone is insufficient. In this case, a partially coupled prosthesis or a rigidly coupled prosthesis can be considered. Sufficient integrity of the bone to ensure long-term stability of the endoprosthesis is a prerequisite for the success of this operation. A 14 day stay in the clinic is usually required, followed by in-patient rehabilitation. After the operation, physiotherapy is necessary to restore the strength of the muscles.
A bacterial infection is a contraindication for an endoprosthesis. Such infections must first be brought under control with antibiotics or by other means before a surgical procedure can be considered. In a pre-operative consultation, the patient is thoroughly informed regarding the implantation of the endoprosthesis. For example, people who do heavy work (such as builders) will need to change their jobs or possibly begin training in another field, because the artificial joint will never be as stable as a natural healthy joint, and the amount of weight it can bear is limited.
The prognosis for this type of procedure can be described as good. In the last few decades, surgical techniques have made huge advances and modern prosthetics deliver excellent results. Elbow replacement surgery is becoming a routine orthopaedic procedure. The artificial joint has excellent mobility and a long life-span. However, lifting weights of more than 4-5kg is contraindicated as it can lead to loosening of the prosthesis. For this reason, this procedure is usually only performed in elderly patients, patients suffering from rheumatism and accident victims, and in some cases, for patients who are not likely to burden the joint very much. On making your decision about the efficient joint therapy, please, don't hesitate to call us.
Comments and questions