Elbow Surgery

The elbow is an intricate and powerful joint that facilitates nearly every advanced motion we humans have evolved to make. From twisting and lifting to basic gestures, the elbow is an essential tool in most people’s active lives. If pain flares up or the joint’s movement is diminished in any way, the consequences can be debilitating. We usually don’t think about our elbows until they hurt, but they are an important part of the body. They allow the hands to side to side and to and from the body. The elbow allows the arms to lengthen and shorten to the space the hand is needed to be at any given time. When we have elbow pain, even something small like lifting a glass or opening a door can be painful. If your elbow is causing pain, it is time to seek medical attention. If you would like to schedule a hand or wrist surgery consultation, please contact us to learn about your options

Here at San Diego Orthopedic Surgeon, we offer a comprehensive approach to elbow pain and elbow surgery. Rather than simply focus on a single point source of patient distress, our advanced imaging and diagnostic tools analyze the full joint for anything amiss. Ligaments, tendons, muscles and bones all play a role in the proper function of the elbow, and even systemic issues such as circulation can play a role. This holistic approach incorporates the full breadth of our understanding of pain and biomechanics.
Dr. Robert Afra is widely renowned as one of the foremost orthopedic surgeons in the nation, and his experience leads an expert team of technicians and medical professionals in every elbow surgery procedure we offer. Our focus is on the total patient, so we consistently exhaust all nonsurgical optionsbefore considering a more permanent approach such as elbow surgery. This includes a variety of minimally invasive options such as therapy and non-operative treatment.
If elbow surgery is necessary, we offer a diverse selection of procedures to relieve all major issues, including:

  • Lateral epicondylitis

  • Medial epicondylitis

  • Elbow osteoarthritis

  • Osteochondritis dessicans

  • Elbow instability

  • Cubital tunnel syndrome

The Elbow:

The elbow is a synovia joint, which is a common joint in the body that allows movement. It is also a hinge joint as it only allows movement in one plane (it bends one way only). The elbow is located between the ulna and radius (long bones in the forearm) and the humerus (the long bone in the upper arm). The tip of the elbow is called the olecranon, which is commonly referred to as the “funny bone” (although there’s nothing funny about the pain that occurs when it is bumped). There are three joints in the elbow; the humeroulnar, humeroradial, and superior radioulnar joints. The humeroulnar joint is a hinge joint located at the junction between the ulna and the humerus. It enables the elbow to flex and extend. The humeroradial joint is a ball and socket joint located between the top of the radius to the smooth part of the humerus. The superior radioulnar joint is located at the top of the radius to the notch of the ulna. This allows the arm to be rotated inwards and outward.

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Warning Signs of Elbow Injury:

  • Pain in elbow

  • Pain in elbow that runs to lower or upper arms

  • Tenderness in the outside knob of elbow

  • Weakness or pain when lifting, making a fist, raising hand

  • Swelling or heat of the elbow joint

  • Lack of mobility

Elbow conditions can cause pain in the hands, wrist, lower, and upper arms. While home remedies such as rest, splints, or ice may ease the symptoms, elbow conditions still need medical intervention. Lack of proper care can lead to disability and damage.

Elbow Injuries and Conditions:

Elbow surgery at San Diego Orthopedic Surgery has helped reduce pain and gain mobility to the following conditions:

  • Lateral Epicondylitis (Tennis Elbow)

  • Medial Epicondylitis (Golfer’s Elbow)

  • Elbow osteoarthritis

  • Osteochondritis dissecans

  • Elbow instability

  • Cubital tunnel syndrome

Lateral Epicondylitis:

Lateral epicondylitis is a common elbow condition caused by repetitive motions and overuse. Aptly nicknamed “tennis elbow” due to the possible damage racquet type sports can do to the elbow, you don’t have to play tennis to acquire this condition. Painting, cooking, construction, and other activities that are repetitive over time can cause this condition. The tendons in our forearms, called extensors, are what attaches the muscles of the forearm to the bone. These are attached to the lateral epicondyle which is attached by a tendon to a forearm muscle called the Extensor Carpi Radialis Brevis, or ECRB. The ECRB keeps the wrist stable when we straighten the elbow. When the ECRB becomes overused, tears form in the tendon that is attached to the lateral epicondyle. Symptoms of lateral epicondylitis are weakness in the hands while gripping, and pain and burning on the outer elbow area. Doctors can diagnose this condition through recreational history and a physical examination.

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Medial Epicondylitis:

Medial epicondylitis is also known as “Golfer’s Elbow”, although, like “Tennis Elbow” one does not have to be a golfer to have this condition. Repetitive activities such as computer work, cooking, gardening, and chopping wood can affect this area of the elbow. The medial epicondyle is a bump on the inside of the elbow. The muscles that pull the hand forward, the flexors, are attached to the main tendon, called the common flexor tendon, on the medial epicondyle. When you move your wrist, hand, or forearm, the muscles contract and pull on the flexor tendon. Repeated activities over time can cause wear, pressure, and strain on the muscles and tendons in this area. This causes the inflammation around the medical epicondyle. Symptoms of medial epicondylitis is pain, weakness, and soreness of the bump inside the elbow. Medial epicondylitis is diagnosed through medical history, recreational history, and a physical examination. X-rays can also be ordered to look for calcium deposits.

Elbow Osteoarthritis:

Arthritis is a gradual disease that occurs when the cartilage in the joints wear down. Cartilage is a cushion between the joints that allow them to move freely. When cartilage begins to wear away, the bones begin to rub together which can cause pain, bone spurs, and possible deformity. Arthritis can occur in any of the hand and finger joints, but most often are seen in the base of the thumb, the joints closest to fingernails, and the middle join of the finger. Symptoms of arthritis can include pain, stiffness, and swelling. A crunching or grinding feeling in the joints, and lowered range of motion can also occur. Arthritis is diagnosed by the patient’s medical history and a physical exam. X-rays and bone scans can also be used.

Osteochondritis Dissecans:

Osteochondritis dissecans (OCD) is a condition in which bone and its cartilage separate inside the joint. This happens when a section of cartilage and the layer of bone underneath loses their blood supply and begin to die. While any joint can be affected, the knees and elbows are among the most common areas for this condition. Young men ages 9-18 are affected most by osteochondritis dissecans, and it usually occurs after an injury, but it is still unclear exactly what causes OCD. Untreated joints can result in a piece of bone coming loose and become caught in between other parts of the joint. Symptoms of OCD include pain during movement, stiffness, the feeling of something moving inside the joint, swelling, and occasionally the joint will lock. Osteochondritis dissecans is diagnosed by a physical examination and an MRI.

Elbow Instability:

Elbow instability usually occurs after an injury, and causes the elbow to feel loose, or that it may slip out of place. Elbow instability can be caused to trauma, a fall on an outstretched hand, repetitive motion, and activities that use the overhand motion, such as a pitcher. Elbow instability, if not treated, can cause damage to the bone and ligaments of the elbow. The elbow has collateral ligaments that keep the joint in place to prevent instability. The most important are the outside ligament (radial) and the inside ligament (ulnar). They work together with the muscles to keep the elbow joint stable. An injury to the any of the collateral ligaments can cause the elbow to slide in and out of the joint. Symptoms of elbow instability include: a feeling your elbow may pop out of place, locking, clicking, and sometimes pain. A diagnosis of elbow instability is through past medical history and a physical examination.

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Cubital Tunnel Syndrome:

Cubital tunnel syndrome occurs when the ulnar nerve becomes compressed in the elbow. The ulnar nerve is the largest nerve in the body that is not protected by bones or muscle, leaving it vulnerable to injury. The cubital tunnel is a passageway the ulnar nerve travels through, all the way to the pinky and ring fingers. It goes under the medial epicondyle, which is the bump on the inside of the elbow. This bump is referred to as the “funny bone”, which when hit causes what feels like electrical shock to the area. Because the cubital tunnel is narrow, compression of the ulnar nerve can happen many ways: bending the elbow, leaning on the elbow, trauma to the area, and fluid buildup. Symptoms of cubital tunnel syndrome actually occur in the fingers than the actual elbow, due to where the ulnar nerve travels. Numbness and prickling sensations in the pinky and ring finger when the elbow is bent, weakness in grip, and difficulty moving the fingers are common symptoms. A diagnosis of cubital tunnel syndrome is by medical history, physical examination, x-rays, and occasionally nerve conduction tests.

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