What is Elbow Impingement?
Elbow impingement is a medical condition characterized by compression and injury of soft tissue structures, such as bone and cartilage, at the back of the elbow and less commonly the front of the elbow. It can occur due to degenerative conditions such as arthritis or from athletic overuse conditions such as valgus extension overload syndrome - also known as pitcher’s elbow. Valgus-extension overload generally occurs in athletes participating in overhead-throwing sports like baseball, football, volleyball, and tennis. It can also result less commonly from gymnastics and aggressive weight-lifting.
Anatomy of the Elbow
The elbow is a complex hinge joint formed by the articulation of three bones: the humerus, radius, and ulna. The upper arm bone or humerus connects the shoulder to the elbow, forming the upper portion of the hinge joint. The lower arm consists of two bones, the radius and the ulna. These connect the elbow to the wrist to form the lower portion of the hinge joint. A joint capsule surrounds the elbow joint, which contains synovial fluid for lubrication. The elbow is held in place with the support of various soft tissues such as cartilage, tendons, ligaments, muscles, nerves, blood vessels, and bursae.
Causes of Elbow Impingement
When the elbow is fully flexed or extended, the soft tissue structures at the back or the front of the joint may become compressed. This may lead to pain when the elbow is fully straightened or bent.
Some of the conditions that can cause elbow impingement include:
- Bone spurs or abnormal bony projections along the ends of bones
- Cartilage or other soft tissue masses (“loose bodies”)
- Synovitis or inflammation of the synovium, a membrane that lines the joints. When the swelling of the synovium is significant, this is known as a plica.
Signs and Symptoms
Some of the sign and symptoms of elbow impingement include:
- Pain and tenderness at the elbow
- Joint stiffness
- Locking and catching of the elbow
- Abnormal popping or crackling sound
- Joint effusion (abnormal fluid build-up)
- Decreased range of motion
- Swelling and bruising of the elbow
Your doctor will review your symptoms and medical history and perform a physical examination to check for range of motion, stability, and strength in your elbow. If necessary, your doctor will order certain imaging tests such as X-ray, MRI or CT scan to confirm the diagnosis and eliminate the possibility of other problems.
Treatment for elbow impingement can involve surgical and non-surgical options. Your doctor will decide the best option based on the condition of your elbow.
Nonsurgical treatment options may include:
- Ice: Application of ice packs on the elbow to decrease swelling and pain following heavy activity
- Activity Modification: Avoiding activities that trigger symptoms and changing one’s habits (e.g. avoid fully straightening or “locking out” the elbow during weightlifting, decreasing number of pitches thrown in a baseball game, etc)
- Physical Therapy: Regular exercise regimen to improve range of motion and strengthen elbow muscles
- Anti-inflammatory Medication: Medications like naproxen and ibuprofen to relieve inflammation and pain.
- Cortisone Injection: If physical therapy, medications, rest, and activity modification do not yield the desired results, a cortisone injection may be temporarily helpful.
Surgical treatment options may include:
- Arthroscopy: Your doctor will be able to repair damage to soft tissues of the elbow by using this technique. Arthroscopy is a minimally invasive surgical procedure that involves making small keyhole incisions to pass a fiber-optic tube with a tiny camera called an arthroscope and miniature instruments into the elbow joint. The camera displays pictures of the affected region on a monitor and the doctor is guided by these images to carry out the necessary repair.
- Open Surgery: A traditional open surgery approach would require a larger surgical incision to be made to repair the affected region if the injury is large and complex. Open surgery has been utilized for joint debridement (removal of damaged cartilage or bone) or removal of osteophytes (bone spurs) in more complex cases.