Different elbow problems have a tendency to occur at different ages.
As a Shoulder and Elbow Consultant, I commonly see tennis elbow or golfer’s elbow in those aged 30–50. These painful conditions can be caused directly from injury or from repetitive overuse or gripping activities. They are degenerative conditions and essentially result from a mismatch between our wear and tear processes and repair mechanisms. As we age the repair mechanisms in our body lag behind the wear and tear processes.
In older individuals, elbow arthritis is more common. Any elbow injury can lead to post-traumatic stiffness and pain, and consequently, elbow arthritis makes up a significant proportion of referrals to elbow clinics.
With more people spending longer working at computers, iPads and on smartphones, ulnar nerve problems are also common. The ulnar nerve runs through the inner part of your elbow. It can become inflamed and irritated when your elbows remain bent for extended periods of time. Symptoms include pins and needles, and tingling in your fingers.
Managing common elbow problems often starts with taking anti-inflammatory drugs (eg ibuprofen) and resting your elbow, specifically avoiding the movement that causes your pain. Steroid injections are not recommended if the cause of the problem is degenerative and not inflammatory — steroids help treat inflammation and in the case of degenerative conditions can actually prolong the disease.
A thorough history and examination is key to making the correct diagnosis and recommending effective management for elbow problems.
Ulnar nerve problems
Avoid bending your elbow by wrapping a towel around it to prevent you from flexing it. This is especially important at night when you may inadvertently bend your elbow and then wake up with pins and needles.
If your ulnar nerve problems persist, you may start to experience weakness and muscle wasting in your hand. In this case, you will need decompression surgery to remove the pressure on your ulnar nerve.
Tennis elbow and golfer’s elbow
Non-steroidal anti-inflammatory drugs are helpful initially and are generally prescribed by GPs. You may also benefit from wearing a brace. Physiotherapy is also helpful and involves strengthening the muscles in and around your elbows with daily exercises.
If your tennis elbow or golfer’s elbow symptoms persist, your doctor may recommend injections of platelet-rich plasma (PRP). PRP is collected from your own blood and has proven to be highly successful in treating tennis elbow and golfer’s elbow, and preventing the need for surgery.
However, in cases where surgery is needed, a minimally invasive, keyhole procedure called an elbow arthroscopy can be performed to remove the damaged part of your tendon.
Elbow arthritis is first treated with a variety of non-surgical options, including rest, changing your activities, physiotherapy, taking non-steroidal anti-inflammatory drugs (eg ibuprofen) and painkillers, applying heat or cold packs, and steroid injections.
If these treatments aren’t enough to relieve your symptoms, your doctor may recommend an osteocapsular arthroplasty to reshape your elbow joint bones, remove loose tissue and restore your range of movement. In severe cases, they may recommend elbow replacement surgery.
Elbow pain and stiffness after injury
After an elbow injury where you wear a sling for several weeks, your elbow may become stiff through underuse. Stiffness can become so bad that it is painful to move your elbow. Surgery to remove scar tissue can help but must be followed by physiotherapy to strengthen your elbow joint and avoid the vicious cycle of underuse leading to stiffness.
The time it takes to recover from elbow surgery varies according to the underlying condition and whether you have keyhole or open surgery. In general, keyhole surgery offers shorter recovery times, usually around a few weeks, while recovering from open surgery takes longer.
Recovering from surgery to treat tennis elbow or keyhole surgery to treat elbow arthritis takes around three weeks. This includes performing daily physiotherapy exercises to restore your range of movement. When your range of movement returns will determine when you can start driving again.
Whatever type of elbow surgery you have, it is important to mobilise your joint as soon as possible, following the guidance of your surgeon and physiotherapist. This will help prevent stiffness setting in and help restore full range of movement.
Mr Jagwant Singh is a Shoulder and Elbow, Upper Limb Consultant at Spire London East Hospital specialising in sports injuries, arthroscopy, and elbow and shoulder surgery. He is also actively involved in research, has been involved in numerous clinical trials and has published his research extensively in peer-reviewed journals.