Lateral Epicondylitis (Tennis Elbow)
The area where tendons attach to bones may become inflamed as a result of overuse. When this occurs on the outside part of the elbow, it is called lateral epicondylitis or “tennis elbow.” It is treated with activity modification, icing and NSAIDs. Injections of biopuncture or platelet-rich plasma (PRP) can be very helpful, as well as massage therapy. Surgery is very successful, but is rarely needed because most cases will resolve with time and treatment.
Tommy John (UCL) Ulnar Collateral Ligament
The UCL is located on the inside of the elbow. It connects the bone of the upper arm (humerus) to a bone in the forearm (ulna). Anyone can get a UCL injury from repetitive stress to the elbow or from trauma, but throwers have the highest risk due to throwing motions that twist and bend the elbow which put extreme stress on the ligament. Over time, the UCL can develop microscopic tears that can develop into one large tear over time. The ligament stretches and lengthens to the point where it can't hold the bones tightly enough during throwing activities. UCL injuries are usually first treated with conservative (non-surgical) therapies. These therapies include rest, ice, and nonsteroidal anti-inflammatory drugs. Next, patients typically undergo physical therapy to help strengthen the muscles around the elbow to compensate for the torn ligament. Some athletes may be candidates to have surgery right away, Tommy John surgery is most commonly recommended for athletes who:
- Don't respond to non-surgical treatments
- Want to resume strenuous overhead or throwing activities
Rehabilitation from Tommy John surgery usually takes about a year. In some cases, up to 2 years are needed for athletes to return to their previous level of ability. Rehabilitation will be closely monitored by the Performance Health team of physicians and physical therapists. The rehabilitation program follows a three-phase process: Phase I immobilizes the elbow and allows the wound to heal. Phase II begins by strengthening the Forearm and Wrist areas, followed by elbow strengthening 6 weeks into therapy. Phase III concentrates on a sport-specific strengthening program, where throwing athletes begin to lightly toss 4-5 months after surgery. At 6 months, the patient is able to begin throwing using a wind-up motion from flat-ground, while slowly continuing to increase throwing distance. At 7 months, baseball pitchers are able to return to the mound. Once the patient has achieved normal strength and range of motion around months 9-12, the patient will be able to begin throwing competitvely.
Ulnar Neuritis (Cubital Tunnel Syndrome)
The ulnar nerve passes along the inside of the elbow, on its way to provide movement to the hand muscle and sensation to the ring finger and pinky. When one strikes his or her elbow, this nerve may cause shooting pain and pins and needles sensations (often referred to as hitting one’s “funny bone”). However, these same sensations can occur when at rest or with normal activities - such as talking on the phone - due to inflammation or entrapment of the ulnar nerve. Physical therapy, NSAIDs and activity modification often lead to resolution. Persistent cases can be cured with a minimally invasive surgery to remove scar tissue or reposition the nerve away from the sites of entrapment.
Medial Epicondylitis (Golfer's Elbow)
The area where tendons attach to bones may become inflamed as a result of overuse. When this occurs on the inside part of the elbow, it is called medial epicondylitis or “golfer’s elbow.” It is treated with activity modification, icing and NSAIDs. Biopuncture injections or platelet-rich plasma (PRP) can be extremely helpful in the rehabilitation process.