Elbow

The Elbow

Please select from the following:

Clinic Appointment		Diagnosis
Office Injections		Treatment

CLINIC APPOINTMENT

You are welcome to bring a relative or friend with you. A nurse can be made available as a chaperone if you wish - please ask at outpatient reception when you arrive. You will meet your doctor and have an opportunity to explain your complaint before being examined. The consultant will want to review a recent xray of your elbow.

By this time the diagnosis has usually been made. Occasionally further tests are required such as nerve conduction studies, ultrasound scan, Magnetic Resonance Imaging (MRI), Computerised Tomography (CT) or blood tests, but your doctor will explain whether these are necessary and why.

^ Top ^

DIAGNOSIS

These are some of the most common elbow conditions. The problems can overlap.

Stiffness. Some people find their elbow is very stiff. Often it doesn't cause a problem until quite severe. If bending the elbow up (flexion) is particularly bad it may be impossible to do up top buttons, ties, necklaces, earrings, wash and brush the back of your head or even get a fork to your mouth. If straightening the elbow out (extension) is the main problem then it may not be possible to get your hand into your back pocket or even take care of personal hygiene. In young people stiffness is usually a consequence of an elbow injury. In middle aged and older people the problem may also be arthritis.
Locking. This is a catching within the elbow which stops you straightening the joint until you have done some wriggling about after which the elbow will straighten normally. This problem is due to loose bits of bone or cartilage floating about within the joint.
Arthritis. This is pain felt all over the elbow joint at all times and made worse by using the joint. It may be associated with stiffness and locking. Often there has been an injury to the joint in the past.
Tennis elbow. This is responsible for pain on the outside of your elbow and is worse after carrying heavy bags etc. Most sufferers have never played tennis.
Ulnar neuritis. This is due to the ulnar nerve becoming irritated behind the inside of your elbow (on the funny bone).Tingling and pins and needles affect the ring and little fingers only. Typically this occurs at night and during activities which require you to keep your elbow bent.

^ Top ^

OFFICE INJECTIONS

Injections containing a mixture of local anaesthetic and cortisone (locally acting steroid) are frequently used in the treatment of painful musculoskeletal problems. They are safe, can help with diagnosis, and often cure the underlying problem. Occasionally they need to be repeated for maximum effect. You would not usually have more than 3 or 4 injections into one area.

After the skin has been cleaned the injection itself is felt as the sharp scratch of the needle followed by an intense hot or burning sensation which lasts only a few seconds. The injection takes only a few seconds to perform. Sometimes the pain, for which the injection was given, gets worse that night and we would suggest you take simple painkillers eg paracetamol, before going to bed. It does not mean anything has gone wrong. Occasionally the injection takes several days to take effect and the good effects may last from between a few hours to several months. A small sticking plaster will be applied afterwards and can be taken off next day. Your doctor will tell you whether you need to restrict any activity after the injection.
You will be able to drive after the injection.
If you are diabetic the cortisone in the injection can upset your blood sugar levels, usually tending to make them rise for about 48 hours. You should monitor your blood sugar levels more carefully than usual and be prepared to give yourself more insulin if necessary.

Injections can cause thinning and whitening (depigmentation) of the skin over the injection point.

^ Top ^

TREATMENT

Many elbow problems can be treated by simple means eg.

modification of your daily activities ie changing a mouse to a tracker ball, using your other hand
seeking advice from your sports professional ie modifying your golf swing or changing the tennis racquet handle grip
taking regular anti-inflammatory drugs ie brufen, nurofen
physiotherapy
acupuncture

Sometimes a cortisone injection into the elbow is helpful. Your GP may already have tried this.
Occasionally the problem is best dealt with by surgery. You will have the opportunity to discuss this with your consultant if it is advised.

^ Top ^