When dealing with an elbow injury it’s important to consider the mechanism of the injury. This can be in the form of an overuse injury, a trauma, a fall onto an outstretched arm, or some symptoms that occur gradually over time.
The location of pain with elbow injuries is very important as the site of the pain often but not always, indicates the site of the injury.
Sounds such as a popping or snapping can indicate injuries such as a rupture. An osteopath will also look for any symptoms such as pins and needles and numbness to see if there is any indication of nerve involvement or colour or pulse changes to indicate vascular involvement.
An osteopath will conduct a full examination of the elbow. This will include an observation to look for any obvious deformities, swelling, signs of trauma etc as well as the landmarks associated with injury. Your osteopath will also take the joint through full range of movement as well as applying some stress to the joint to test for the integrity of the supporting ligaments. Muscle specific tests can also be utilised to identify individual muscle and tendon involvement.
X-rays are the most common imaging tool with elbow pain, especially if it’s been traumatic in onset. MRI scans are also used in the event of there being signs of ligament or tendon injuries, loose bodies or osteochondral injuries.
This depends on what type of injury has occurred. In an acute setting for injuries such as soft tissue injuries, early mobilisation can be beneficial and should be encouraged as soon as the patient can. In the case of an injury such as a fracture or where surgery may be indicated, the injury should be fixed in an internal fixation position.
Rehab focusses on a few concepts. Control inflammation, initiate early range of motion and promote functional use of the upper body.
There are a number of really common elbow injuries that I will discuss.
This joint is the second most dislocated joint in the upper body with the type of dislocation being determined by which direction the trauma occurred. A dislocation will often occur when the person has fallen onto their outstretched arm. Pain, a popping sensation and visual deformity are common findings. Once the dislocation has been addressed it’s important to assess for any secondary injury to structures like nerves and ligaments etc. Additionally, x-rays are required in all cases of dislocation. Treatment involves an early reduction of the dislocation and a short period of immobilisation. Depending on the severity, a return to activity will be between 7 days and 6 weeks.
Common extensor origin tendinopathy and common flexor tendon origin tendinopathy, or as they are more commonly known as, tennis and golfers elbow are another common injury to the elbow joint. A tendinopathy is often related to overload from an increase in activity. It is described as activity related pain that has often developed over time. At its worse, the patient can feel pain at rest too. There will often be tenderness at the site of the injury with muscle testing also provoking pain. Osteopaths will often make this diagnosis in the clinic but they can be aided by the use of MRI’s and ultrasound scanners. Your osteopath will approach your tendinopathy with a few simple measures. Education, load management and strengthening.
A rupture of the various tendons at the elbow is another common injury. These often follow a trauma and the patient will hear a popping noise followed by significant bruising. With a rupture the tendon may not always be palpable. Muscle weakness will be apparent though. In the event of a rupture, surgery is often indicated followed by a period of immobilisation before rehabilitation begins.
Like ruptures, a fracture will often occur from a traumatic event, often a fall. The presentation will likely include local tenderness and significant swelling. Treatment wise, a period of immobilisation is needed.
An osteopath will be able to assess and develop their clinical diagnosis and help you decide on the appropriate course of action. Rehabilitation is essential in the injuries we have discussed and your osteopath will be able to come up with a plan that will optimise your recovery.