The biceps muscle is present on the front side of your upper arm and functions to help you bend and rotate your arm.
The biceps tendon is a tough band of connective fibrous tissue that attaches your biceps muscle to the bones in your shoulder on one side and the elbow on the other side.
Osteochondritis Dissecans of the Capitellum
Ulnar neuritis, also called cubital tunnel syndrome, is the inflammation of the ulnar nerve that is characterized by weakness and numbness in the hand. The ulnar nerve travels from the neck down into your hand. It is responsible for sensations in the little finger and half of the ring finger as well as helping with grip strength and fine motor movements of the hand.
Medial/Lateral Epicondylitis of the Elbow
Golfer’s elbow, also called Medial Epicondylitis, is a painful condition occurring from repeated muscle contractions in the forearm that leads to inflammation and microtears in the tendons that attach to the medial epicondyle. The medial epicondyle is the bony prominence that is felt on the inside of the elbow.
Three bones, humerus, radius and ulna make up the elbow joint. The bones are held together by ligaments thus providing stability to the joint. Muscles and tendons around the bones coordinate the movements and help in performing various activities. Elbow fractures may occur from trauma resulting from a variety of reasons, some of them being a fall on an outstretched arm, a direct blow to the elbow, or an abnormal twist to the joint beyond its functional limit.
Radial Head Fracture
The elbow is a junction between the forearm and the upper arm. The elbow joint is made up of 3 bones namely the humerus bone in the upper arm which joins with the radius and ulna bones in the forearm. The elbow joint is essential for the movement of your arms and to perform daily activities.
Ulnar Collateral Ligament Reconstruction
Ulnar collateral ligament (UCL) reconstruction surgery involves replacing a torn ulnar collateral ligament with a tendon from elsewhere in the body. It is also referred to as tommy john surgery. The UCL, also called medial collateral ligament, is located on the inside of the elbow and connects the ulna bone to the humerus bone. It is one of the main stabilizing ligaments in the elbow especially with overhead activities such as throwing and pitching. When this ligament is injured, it can end a professional athlete’s career unless surgery is performed.
The common symptoms associated with a UCL injury are pain on inner side of the elbow, unstable elbow joint, numbness in the little finger or ring finger and decreased performance in activities such as throwing baseballs or other objects.
Ulnar collateral ligament injury is usually caused by repetitive overhead throwing such as in baseball. The stress of repeated throwing on the elbow causes microscopic tissue tears and inflammation. With continued repetition, eventually the UCL can tear preventing the athlete from throwing with significant speed. If untreated, it can end an athlete’s professional career. UCL injury may also be caused by direct trauma such as with a fall, car accident, or work injury. Other causes include any activity that requires repetitive overhead motion of the arm such as tennis, pitching sports, fencing, and painting.
UCL injury should be evaluated by an orthopedic specialist for proper diagnosis and treatment. Your physician will perform the following:
- Medical history
- Physical examination including a valgus stress test to assess for elbow instability
Other tests such as X-rays and MRI scans may be ordered to confirm the diagnosis.
Your physician will recommend conservative treatment options to treat the symptoms associated with UCL injury unless you are a professional or collegiate athlete. In these cases, if the patient wants to continue in their sport, surgical reconstruction is performed.
Conservative treatment options that are commonly recommended for non-athletes include activity restrictions, orthotics, ice compression, medications, physical therapy, pulsed ultrasound to increase blood flow to the injured ligament and promote healing and professional instruction.
If conservative treatment options fail to resolve the condition and symptoms persist for 6-12 months, your surgeon may recommend ulnar collateral ligament reconstruction surgery. UCL reconstruction surgery repairs the UCL by reconstructing it with a tendon from the patient’s own body (autograft) or from a cadaver (allograft). The most frequently used tissue is the palmaris longus tendon in the forearm. The basic steps for UCL reconstruction surgery include the following:
- The surgery is performed in an operating room under regional or general anesthesia
- Your surgeon will make an incision over the medial epicondyle area
- Care is taken to move muscles, tendons, and nerves out of the way
- The donor tendon is harvested from either the forearm or below the knee
- Your surgeon drills holes into the ulna and humerus bones
- The donor tendon is then inserted through the drilled holes in a figure 8 pattern
- The tendon is attached to the bone surfaces with special sutures
- The incision is closed and covered with sterile dressings
Finally, a splint is applied with the elbow flexed at 90 degrees.
After surgery your surgeon will give you guidelines to follow, depending on the type of repair performed and the surgeon’s preference. Common post-operative guidelines include:
- Elevate your arm above heart level to reduce swelling
- Wear an immobilizing splint or cast for 1-3 weeks
- Apply ice packs to the surgical area to reduce swelling
- Keep the surgical incision clean and dry. Cover the area with plastic wrap when bathing or showering
- Physical therapy will be ordered for strengthening and stretching exercises after the removal of the splint or cast
- Professional athletes can expect a strenuous strengthening and range of motion rehabilitation program for 6-12 months before returning to their sport
- Eating a healthy diet and not smoking will promote healing
As with any major surgery there are potential risks involved. The majority of patients suffer from no complications following UCL reconstruction surgery; however, complications can occur following elbow surgery and include infection, limited range of motion, nerve damage causing numbness, tingling, burning or loss of feeling in the hand and forearm area, cubital tunnel syndrome and elbow instability.