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WHAT IS THE ELBOW?

Your elbows are responsible for simple movements, but the joint itself is quite complex. It is referred to as a hinge joint because it primarily moves in two ways, flexing the lower arm up and extending it down. However, it is also responsible for the rotation that occurs at the wrist. This motion is called pronation when the palm rotates down, and supination when it rotates up. 

Why do I care about pronation and supination? Because these rotational movements occur hundreds of times in our daily lives and, unfortunately, are also the cause of most injuries occurring at the elbow.

As your daily lifestyle and workouts increase cumulative elbow activity, the number of repetitions and load put on the elbow also increases the chances of injury. Over a lifetime, it is estimated roughly 70% of people will experience acute (short term) or chronic (long term) elbow pain. ElbowAthlete is here to provide step-by-step information and helpful tools so you can become more educated about your elbow pain, the common types of injuries, and how to alleviate pain while continuing to live the active life you want. 

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ELBOW ANATOMY

BONES

The elbow is made up of 3 bones:

           1) Humerus

           2) Ulna

           3) Radius


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MUSCLES

Muscles are what give the body movement. They attach to bones and when they contract they pull fibers together creating movements. They work concurrently or even antagonistically to provide different types of actions and stability during motion. This is all dependent on whether we need fast movement, slow movements, stability, or control.

The muscles of the elbow include: 
Triceps
Bicep and Brachialis
Brachioradialis
Wrist Extensors
Wrist Flexors
Pronator Teres
Supinator

TENDONS


Tendons are what attach muscles to the bones. When the muscle fibers contract and overlap, they pull on the tendon which is anchored to the bone. Once there is enough tension on the tendon it causes the bone to move.  When tendons are unable to handle those forces and stressors, it leads to tearing of the tissue. If the tearing becomes too severe this is what can create a tendon injury, also known as tendinopathy. This can be caused from a single event or by too many repetitions. Below are the two primary locations where tendon injuries occur in the elbow.

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LIGAMENTS

Ligaments are what connect bone to bone within the body. They supply structure and primarily function is providing support. They, along with tendons, help provide stability with movement. When an injury occurs it often leaves a long lasting “looseness” to joints unless surgery is performed. An injury to ligaments occurs primarily by a blunt force or trauma such as a FOOSH (Falling On Outstretched Shoulder). Although they will never fully heal themselves, with proper recovery and rehabilitation steps a ligament can regain its strength. Unfortunately, there is always a risk of the injury returning. Ie. the ankle sprain.  

The primary ligaments of the elbow are: 
Ulnar (medial) collateral ligament 
Radial (lateral) Collateral Ligament
Annular Ligament

CARTILAGE

Lubrication for Elbow

Cartilage is responsible for keeping bones together during action by providing lubrication and suctional force. Cartilage has minimal to no blood flow due to the friction between the bones as the body moves. Consequently, it has a slow healing rate.


There are three main types of cartilage hyaline, elastic, and fibrocartilage. Hyaline is used for support, but is the most flexible of the three types of cartilage, IE the nose and space between the rib cage. Elastic cartilage is similar to Hyaline but has a little more support. Fibrocartilage is the strongest of the three with the least amount of flexibility. Its primarily goal is to provide extra support to areas of the body, ie. the spine. 


The significance of cartilage is for joints to move easily and without pain, healthy cartilage is needed. If cartilage becomes injured,  it can affect the whole joint by decreasing the congruency between the bones and decreasing the efficiency of the movement. This can often feel like a “clicking” or “catching” when a joint is moving. If cartilage continues to experience excessive wear and tear, it can lead to a long term injury. This injury is often referred to as arthritis

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NERVES

Brain to Elbow Communications

Nerves are fibers which look like cables running throughout the body. They use electrical and chemical signals of communication to provide the body with sensory (feeling) and motor (movement). These signals allow for the body to react to stimulus that is created in its environment, send it to the brain, and the brain then decides what response is necessary. In terms of the elbow, the nerves supply sensation to the skin of the arm and hand, and helps the muscles move the arm and wrist. The elbows' primary nerves are the medial nerve, radial nerve, and ulnar nerve. They all start in the cervical spine (upper neck) and travel down to the fingertips by branching off as they go.


Another way to understand this process is to think of the Brain as an electrical switch. It sends “electricity” through the wires (nerves) and the light bulb (muscle) turns on. 

At the elbow these nerves are very superficial, which is why one feels a “lightning bolt” or “shock” sensation when they hit their funny bone. Sometimes these fibers can become impinged when tendons or muscles get too tight. Another reason can also be due to the increased amount of inflammation to the area like in bursitis. This can cause a temporary loss of function, sensation or even strength. At Elbow Athlete part of our rehabilitation program places emphasis on mobility routines and proper strength training to reduce these symptoms from happening. 

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VASCULARIZATION

What is it? And why is it important for my elbow recovery?

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Vascularization simply means blood flow. It is important because the bloodstream is the primary way nutrients and oxygen are sent throughout the body to aid in the healing process.


Muscles, for example, have high vascularization. In joints, there is reduced vascularization so the healing response can be limited in comparison. Due to the limited vascularization of the elbow, it is necessary to focus on passive, or light, active movement during injury to improve healing to damaged tissue. As light movement occurs, new fluid brings nutrients to the joint and creates a healing response. However, it is important to not overload the injured area so recovery can maximize. This is where Elbow Athletes' expertise comes in. We have spent years learning and assessing the most efficient ways to recover from elbow injuries. 

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COMMON ELBOW INJURIES

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Tendinopathy

The most common type of elbow injury is called tendinopathy. It is also referred to as tendonitis in acute conditions and tendinosis in more chronic cases. The simple breakdown of this injury is the tendon, which attaches muscles to bones, has become inflamed due to the amount of stress or force placed on it over time. This can be a result of a single action or the repetition of the same action.  The tendon has experienced micro-tearing, which is normal, however, when the area becomes overly fatigued it leads to increased swelling, tenderness, pain, and a decrease in function.

Below is a list of some of the common signs and symptoms of tendinopathy: 

-        Tenderness to touch (palpation)

-        Pain with passive movement 

-        Pain following exercise

-        Minimal pain with actions without load 

-        Swelling in the joint

-        Decreased grip strength 

Two types of tendinopathies that you have probably heard of before are Golfer’s Elbow and Tennis Elbow. Below is information to help you differentiate the two and identify if your elbow pain is being caused by one of these two common elbow injuries. Keep in mind, these are guidelines and there are many other possible types of injury. Accurate diagnosis is imperative for proper rehabilitation.  


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Golfer’s Elbow

See below for a list of some of the common signs and symptoms of Golfer's Elbow - as well as common causes: 


Signs and Symptoms 

-     Tenderness and pain occurring on the inside of the elbow 

-     Pain radiating to the anterior aspect of the forearm 

-     Pain increases with gripping or excessive movements of the elbow 

-     Pain diminishes with activity but increases following activity 


Common causes 

-     Excessive or repeated movements of overloading the wrist flexors and supinator.  

-     Muscular strain from overuse of gripping

-     Muscular strain from lifting too much weight

 -     Is often an overuse injury but can be caused by blunt force or trauma

Activities 

-     Throwing a baseball 

-     Golfing

-     Combative sports

-     Excessive use of handyman tools

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Tennis Elbow 

See below for a list of some of the common signs and symptoms of Tennis Elbow - as well as common causes: 


Signs and Symptoms 

-     Tenderness and pain on the outside of the elbow 

-     Pain that radiates to the outside or back of the forearm as well 

-     Pain from gripping and movements of twisting 

-     Decreased grip strength and endurance 


Common causes

-     Excessive/repeated movements of overloading the wrist extensors and supinators

-     Muscular strain from overuse of gripping 

-     Muscular strain from lifting to much weight 

-     Is often an overuse injury, but can be caused by a blunt force or trauma 


Activities 

-     Playing racquet sports, excessive hits using the backhand 

-     Rowing

-     Excessive use of powers tools, gripping, like the screwdriver 

-     Typing at a keyboard 

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How do you treat a tendinopathy injury? 

Treating a tendinopathy injury is an extensive process that requires self-awareness, education, and natural progressions of exercises to return to full health. Elbow Athlete provides you with a self-guided circuit to optimize your recovery and progress your performance. Continue to Step 1: Recovery for the next step. 

Other options not included are surgical interventions, which may be required if a full tendon tear has taken place due to blunt force or acute trauma. If this is the case seek medical advice and visit your primary healthcare provider. A full tendon rupture should require surgery and is time-sensitive.

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Olecranon bursitis

Olecranon Bursitis 

Olecranon Bursitis is inflammation or excessive buildup of fluid in a bursa, which is a fluid-filled sac that provides cushion to the elbow joint in the body at the olecranon. 

What are the common signs and symptoms of bursitis? 

-        A swollen, golf ball-sized, fluid buildup on the posterior aspect of the elbow 

-        An achy or stiff joint when it is moved passively or actively

-        It hurts when is pressed on or palpated

-        Often looks swollen and red 


How is it caused? 

It is commonly caused by the irritation and pressure occurring from excessive movements. One example is the rubbing and pressure a tendon can put on the bursae during movement. This can be due to tightness of the muscle or movement dysfunction. 

Another cause of bursitis can be blunt trauma or force directly to the joint. This causes abnormal swelling of the bursae. For example, sliding into second base or army crawls under barbed wire. 

What are the common treatments for bursitis? 

The best way to treat bursitis is the combination of the R.I.C.E method. For more information See Phase 1: Recover. An emphasis should be placed on compression, as this will help reduced the fluid in the joint space. Other treatment options include medication, injection, physical therapy, and assistive devices. Surgery is not common but in severe cases may be utilized to help drain the fluid. 


What is the prognosis for Bursitis? 

If treated correctly, the outcome of bursitis is very good. People usually return to their normal day-to-day life within a few weeks. Often bursitis does not reoccur and is a one-time injury if treated properly. 

Some preventative measures to bursitis include proper load management, proper movement, and technique in the sport of activity, reduction of excessive repeated movements, longer warm-ups to exercise, strength training, and continuation of the recovery. 

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Degenerative Arthritis

What is degenerative arthritis? 

Often diagnosed as osteoarthritis, degenerative arthritis is the buildup of inflammation because of loss of cartilage in the joint. 

How is arthritis caused? 

It is caused by the natural wear and tear of the elbow joint. It is the 4th most common cause of elbow pain but is often overlooked as arthritis is more common in weight-bearing joints. Those who have performed excessive movements in their job or have a history of elbow injuries have an increased chance of arthritis. 

What are the signs and symptoms? 

Signs and symptoms can include but are not limited to: 

-        Pain and stiffness in the joint 

-        Swelling

-        Limited range of motion both passive and active

-        A feeling of it “catching” or locking” during movement 

Who is commonly diagnosed? 

The most common individuals diagnosed are those over the age of 50. This is due to the natural breakdown that occurs in the joint. As individuals get older, there is a natural reduction in physiological function. Individuals who have had previous elbow injuries like fractures and dislocations are also at higher risk. 

What treatments are available? 

The best treatment options for those who have been diagnosed with arthritis include physical therapy, medications, and activity modification. However, arthritis does not go away, therefore, education is the best tool in handling this type of injury. At Elbow Athlete you can find the information needed to self-manage arthritis by developing a routine that works for you. It is important to reach out to your health care provider or contact us at Elbow Athlete for a consultation and more information. But in the meantime, continue to Phase 1: Recovery to learn what steps you can take for holistic pain relief. 

In severe cases, an individual can develop ossifications or bone spurs. Surgery may be necessary to reduce pain, improve range of motion and increase functionality.

What is the prognosis? 

Due to the degenerative nature of arthritis, it is chronic and progressive but can be managed with a combination of education and modification in exercise or activity levels. 

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DO I HAVE ELBOW TENDONITIS?

Are you feeling pain or tenderness on the inside or outside portion of your elbow? 

Are you an athlete, weightlifter, golfer, tennis player? Or someone who grips and lifts objects on a regular basis?

You might be experiencing the frustrating telltale signs of golfer's elbow (medial epicondylitis) if the pain is in the inner elbow, or tennis elbow (lateral epicondylitis) if the pain is on the outside of your elbow. 


Begin Phase  1 of our relief and recovery process to see how we recovered from elbow tendonitis pain.

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Are you ready to learn how we recovered from elbow tendonitis? Click below to see Step 1 in our treatment process:

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