Elbow injury (orthopaedics)

The orthopaedic surgeon always first makes a diagnosis through a thorough examination with imaging (radiology) if necessary. Based on the diagnosis made, the specialized doctor prescribes treatment, which may include medication and/or physical therapy. At some point or with certain injuries, surgery will be necessary.

Plan your appointment

Association orthopaedics 011 33 42 86 dr. Peter Bollars 011 69 96 60

The elbow or elbow joint is the joint that forms the connection between the upper arm and forearm. It is a special joint because it connects one bone in the upper arm with two bones in the forearm. The elbow joint ensures the bending of the forearm in relation to the upper arm and turning the two bones in the forearm in relation to each other.

The elbow consists of the following elements.

Bones and joints

The elbow joint is composed of three bones: the upper arm, radius bone and ulna. In addition to their mutual joint formation, radius head and ulna each form a joint with the upper arm. Thus one can speak of three joints within the one elbow joint. This complex structure allows the arm to extend, flex and rotate about its longitudinal axis. The surrounding capsule and ligaments provide much of the stability of the joint. These are indispensable.

‍Muscles

A joint cannot actively move without the proper muscles. The biceps muscle takes care of bending the arm at the level of the elbow, while the triceps muscle is responsible for stretching. Also important are protrusions, both on the inside and outside of the upper arm where respectively the flexors and extensors of the fingers attach. These attachments are known in proper order as sites for golfer's elbow and tennis elbow. At the posterior protrusion of the ulna, the extensor muscle attaches to the elbow, namely the triceps tendon.

Zenes

The muscles mentioned above must be stimulated by nerves. On the inner side of the arm, there is a groove in the upper arm through which runs the ulnar nerve, which causes tingling in the ring finger and the little finger during an elbow strike. The radialis nerve runs under the muscles along the outside to the forearm, while the median nerve runs along the front to the forearm.

‍Blood vessels

‍The last important structures in the elbow are the veins and arteries, which are responsible for the survival of the tissues in the arm. Among other things, they irrigate the muscles and bones. The superficial veins are an ideal place to draw blood, while the deep veins and arteries run together, safely protected by the surrounding muscle.

Hand and wrist problems

A tennis elbow (also known as epicondylitis lateralis)is caused by an overuse of the muscles and tendons of the forearm that attach to the outside of the elbow (lateral epicondyle). The inflammation occurs at the muscles and tendons that provide stretching of the wrist and fingers. The inflammation results from chronic overuse and often as a result of repetitive movements, both at work and recreationally.  In a later stage, very small tears (microtears) may develop in the tendon and in a final stage, the tears may expand further.

Symptoms

People with tennis elbow also experience discomfort during daily activities. Wringing movements, in particular, but also lifting objects becomes more difficult and painful.

Diagnosis

The diagnosis is made partly clinically at the consultation on the basis of specific symptoms (pain at the outer tubercle of the elbow and pain when stretching the wrist against resistance). If necessary, additional imaging (RX, ultrasound, MRI) will be taken to confirm the diagnosis.

G‍eneral treatment

Treatment is initially non-surgical with local ice application, rest, anti-inflammatories and kinesitherapy. Optionally, a brace can help improve pain symptoms.

Since it is an overexertion, adjustment of work or sports environment is important to achieve healing and avoid a relapse.

If improvement is insufficient, a cortisone injection around the tendon can be used to suppress local inflammation. However, the number of cortisone injections are limited to 2 to 3 per year.

More and more, cortisone injections are being replaced by PRP (Platelet Rich Plasma) injection.  

This involves taking a blood sample from the patient, centrifuging it at high speed which separates the plasma from the rest of the blood. That plasma contains many platelets and growth factors that can provide healing for the diseased tendon. The obtained plasma is then injected into and around the inflamed tendon. Usually 2 PRP injections are given, about 2 weeks apart. The success rate is around 50-70%.

ESWT (extra corporeal shock wave) is also a possible treatment for tennis elbow. This involves stimulating blood flow to the tendon through shock waves to promote healing. This treatment is done at the Department of Physical Medicine.

If the previous treatments do not bring sufficient improvement, an operation is an option. During surgery, the diseased part of the tendon will be removed and the tendon will be anchored back to the bone.

The surgery is possible via day hospitalization. After surgery, the elbow is sometimes immobilized for a short period of time. The healing process may take 3 to 4 months.‍

Golfers' elbow (medial epicondylitis) is an inflammation of the muscles and tendons of the forearm that attach to the inside of the elbow (medial epicondyle). 

Most often inflammation is caused by localized overuse due to repetitive movements at work or recreationally. The symptoms can also develop after a trauma.                     

The affected muscles and tendons provide flexion of the wrist and fingers. As the inflammation progresses, (micro)tears in the tendon can occur.

Symptoms

People with golfers' elbow have pain at the bony tubercle on the inside of the elbow. They also experience loss of strength and pain during day-to-day activities, such as wringing or cleaning windows.

Diagnosis

The diagnosis is made partly clinically at the consultation based on specific symptoms (pain at the inner tubercle of the elbow and pain when bending the wrist against resistance). If necessary, additional imaging (RX,ultrasound, MRI) will be taken to confirm the diagnosis.

‍General treatment

Treatment is initially non-surgical with local ice application, rest, anti-inflammatories and physical therapy. Optionally, a brace can help improve pain symptoms.

Since it is an overexertion, adjustment of work or sport is important to achieve healing and avoid relapse.

If there is insufficient improvement, a cortisone injection may be used around the tendon to suppress local inflammation. However, the number of cortisone injections are limited to 2 to 3 per year.

More and more, cortisone injections are being replaced by PRP (Platelet Rich Plasma) injection. This involves taking a blood sample from the patient, centrifuging it at high speed, separating the plasma from the rest of the blood.

In that plasma there are many platelets and growth factors that can provide healing for the diseased tendon. The obtained plasma is then injected into and around the inflamed tendon. Usually 2 PRP injections are given, about 2 weeks apart. The success rate is around 50-70%.

ESWT (extra corporeal shock wave) is also a possible treatment for golfers' elbow. This involves stimulating blood flow to the tendon through shock waves to promote healing. This treatment is done at the Department of Physical Medicine.

If the previous treatments do not bring sufficient improvement, operation may be an option. During  surgery, the diseased part of the tendon will be removed and the tendon will be anchored back to the bone.

The surgery is done via day hospitalization. After surgery, the elbow is sometimes immobilized for a short period of time. The healing process may take 3 to 4 months.

 

The Ulnar nerve is a nerve that runs in a tunnel (cubital tunnel) on the inside of the elbow, just behind the bony protusion. When the tunnel is narrowed, the nerve becomes pinched and symptoms arise.

Several factors can cause narrowing of the canal and entrapment of the nerve: certain prolonged posture, local pressure on the nerve, trauma, osteoarthritis or inflammation of the elbow joint, instability of the nerve, scarring, ...

Symptoms

Injury of the Ulnaris nerve causes lividity and tingling in the little and ring fingers. Sometimes it is also accompanied by loss of strength.

Diagnosis

The diagnosis can be made after clinical examination at the consultation with the doctor. In addition, a nerve examination (EMG) is usually requested to confirm the diagnosis. If necessary and to rule out other causes, imaging (RX, Ultrasound, MRI) is sometimes indicated.

‍General treatment

The non-operative treatment consists of anti-inflammatories or analgesics. Local pressure on the nerve on the inside of the elbow should be avoided as much as possible. If necessary, a brace can be worn at night to avoid prolonged flexion of the elbow.

If this does not improve enough, surgery can be performed. During surgery the nerve is released so that there is no longer entrapment at the level of the tunnel on the inside of the elbow. If the nerve does not stay in place nicely after release, the nerve is moved more forward (anterior transposition). The procedure is performed via day hospitalization. It is the intention to move the elbow quickly after the operation. Only if the nerve is moved forward during the operation will a plaster cast be applied for a short period after the operation. It can take up to a year for the symptoms to completely disappear. 

Orthopaedic surgeons specialised in elbow injuries

dr. Ramzi Haraké

dr. Ramzi Haraké

orthopaedic surgeon
Read more

Treatments

Conservative treatment tennis elbow and golfer's elbow

  • The treatment is initially non-surgical, but with local ice application, rest, anti-inflammatories and physical therapy. Optionally, a brace can help improve pain symptoms.
  • Since it is an overexertion, adjustment of work or sports environment is important to achieve healing and avoid relapses.
  • If the above treatments prove insufficient, then a cortisone injection around the tendon with the aim of suppressing local inflammation may be opted for. The number of cortisone injections is limited to 2 to 3 per year.

ESWT (extra corporeal shock wave)

ESWT (extra corporeal shock wave) is a possible treatment for golfer's elbow. This involves stimulating blood flow to the tendon through shock waves to promote healing. This treatment is done in the physical medicine department.

PRP (platelet rich plasma) injection

More and more cortisone injections are being replaced by PRP (platelet rich plasma) injection. This involves taking a blood sample from the patient, centrifuging it at high speed which separates the plasma from the rest of the blood. That plasma contains a lot of platelets and growth factors that can provide healing for the diseased tendon.

The obtained plasma is then injected into and around the inflamed tendon. Usually 2 PRP injections are given, with about two weeks in between. The success rate is around 50-70%.

Operative treatment of tennis elbow and golfer's elbow

If previous treatments do not bring sufficient improvement, surgery may be opted for. During the surgery we remove the diseased part of the tendon and anchor the tendon back to the bone.

The surgery is done via day admission. After surgery, the elbow is sometimes immobilized for a short period of time. The healing process may take 3 to 4 months.

Operative treatment of ulnar nerve entrapment

During surgery, the nerve is released so that there is no longer entrapment at the level of the tunnel on the inside of the elbow. If the nerve does not remain in place nicely after the release, the nerve will be moved forward (anterior transposition). The procedure is done via day hospitalization. It is the intention to move the elbow quickly after the operation. Only if the nerve is moved forward during the operation will a plaster cast be applied for a short period after the operation. It can take up to a year before the symptoms disappear completely.

Departments

For diagnosis and treatment, you can visit our orthopaedic surgeons. As part of certain treatments or after any surgery, you can visit our rehabilitation center.
Orthopaedics

Plan your appointment

Association orthopaedics 011 33 42 86 dr. Peter Bollars 011 69 96 60