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INJURIES OF THE ELBOW

Possible diagnoses:

Olecranon Bursitis
Triceps Tendinitis
Tennis Elbow
Golfer's Elbow

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1. Olecranon Bursitis (Scholar's Elbow) The olecranon is the bone at the sharp tip of the elbow which is protected from direct trauma by a fluid filled sac called the olecranon bursa. The bursa also allows the skin to move freely over the tip of the elbow.

Mechanism of injury	Symptoms	Management
Repetitive friction or direct trauma to the tip of the elbow are the most common causes of swelling of the bursa. Common in wrestling and judo and other collision sports.	Swelling over the tip of the elbow. Pain over the tip of the elbow which can be very severe with pressure. Movement of the elbow is not normally affected.	Rest, ice, compression and elevation. Anti-inflammatory medication. The excess fluid may need to be drained out by your doctor. If pain and swelling persists for extended periods, cortico-steroid injections may be indicated.

2. Triceps Tendinitis The triceps is the large muscle situated on the posterior surface of the upper arm (opposite the biceps).

Mechanism of injury	Symptoms	Management
This is an overload injury after repetitive use of the muscle. Common in weightlifting and throwing sports e.g. shot-putting. Repetitive overloading causes degeneration of the triceps tendon with resultant inflammation.	Pain on and just above the tip of the elbow. Tenderness over the tip of the elbow. The pain is aggravated by exercise. The triceps may also show signs of weakness.	Rest from aggravating activity, icing and anti-inflammatory medication. Cortico-steroid injections should be considered as a last resort.

3. Tennis Elbow (Lateral Epicondylitis)

Mechanism of injury	Symptoms	Management
This is an overuse injury to the extensor muscles of the forearm where they attach onto the prominent bone on the outside of the elbow. This is an area of poor blood supply which, when combined with excessive use, may lead to degenerative changes in the tendon. With continued use, these degenerative changes may result in the development of microscopic tears and scarring in the tendon. Occurs not only in tennis players but also squash or any activity where repetitive backward movement of the wrist is excessive e.g. bricklaying, carpentry and even knitting.	Pain in the outer, upper part of the forearm and specifically over the lateral bone of the elbow. Pain is aggravated by overloading the affected muscles e.g. lifting heavy objects.	Firstly, it is important to treat the initial cause of the injury: reduce aggravating activity, correct biomechanics (e.g. lighter tennis racquet, or change size of grip), strengthen and stretch muscles as pain subsides. Secondly, treat the inflammation: rest, icing, physiotherapy and anti-inflammatory medication.

4. Golfer's Elbow (Medial Epicondylitis)

Mechanism of injury	Symptoms	Management
This is an overuse injury to the flexor muscles of the forearm where they attach onto the prominent bone on the inside of the elbow. Usually brought on by racquet sports, golf and weightlifting. This is commonly a repetitive overuse injury.	Pain on the bony prominence on the inside of the elbow when gripping something and tender to touch. Stiffness in the morning or after prolonged immobilisation. Stress test: pain on the inner side of the elbow on pressing palms together firmly.	Reduce aggravating activity. Icing, specific muscle strengthening and anti- inflammatory medication. It may help to change to lighter golf clubs or racquet once pain has subsided. If there is no improvement, cortico-steroid injections may be necessary.