Warm weather a painful time for elbows

Spring and summer can be a painful time for

elbows.The nicer weather means more people are pitching baseballs, swinging tennis rackets and hitting golf balls. Orthopedic Surgeon Dr. Adam Smith knows that some of those people will end up at his clinic with an elbow injury.

“The elbow is one of the most complex joints,” says Dr. Smith, who practices at West Tennessee Bone & Joint Clinic and who had a fellowship in elbow and shoulder reconstruction at the Mayo Clinic in Rochester, Minnesota. He developed a special interest in the elbow through a mentor in medical school who was an elbow surgeon.

The elbow is complex because three different bones make up the joint, he says. “The elbow’s primary function is to position the hand in space. People with elbow problems suffer because they can’t position or rotate the hand.”

He treats elbow problems in people of all ages, from small children to senior citizens. Common causes of elbow problems include trauma, arthritis, chronic wear and tear and overuse in young athletes.

Throwing injuries
Doctors, parents and coaches are alarmed by the increase in pitching and throwing injuries in young athletes because of overuse of the arm and improper techniques, Dr. Smith says. In response, some leagues, such as Little League, are setting guidelines on pitch counts and how much rest a pitcher needs between games.

“Athletes who throw overhead are particularly stressful on the elbow. Pain on the inside of the elbow can develop over time with repetitive throwing or after a single pitch.”

In younger athletes, Dr. Smith said, this type of injury can represent a stress fracture through one of the growth plates in the elbow. “The force required to throw the ball can exceed the strength of the growth plates, allowing the growth plate to fracture. Older athletes can have similar pain with tearing or stretching of the medial collateral ligament of the elbow.”

Some young people also play on more than one team, making it hard for coaches to know total pitch counts over several days or a week, Dr. Smith says. “I strongly encourage parents to take an active role in managing the throw counts. The vast majority of professional pitchers didn’t pitch in Little League.”

Tennis elbow
One of the most common elbow conditions is known as “tennis elbow,” because it frequently is found in tennis players who experience pain on the outside part of the lead elbow during a backhand swing, Dr. Smith says. “Pain during the backhand is usually due to incorrect form during the backhand stroke. Correct form requires the lead wrist to be locked with no active wrist extension throughout the stroke.”

Though it is called tennis elbow, Dr. Smith notes that most patients with this diagnosis do not play tennis. Pain on the outside or lateral side of the elbow is seen in people who handle heavy pots or pans or who do secretarial and computer work or jobs that require power grasping.

A golfer can have pain on the inside or medial side of the elbow, Dr. Smith says. “Repetitive strain of the flexor muscles of the forearm occurs during the down portion of the swing on the player’s back arm. As the back elbow drops down to deliver the club forward, the wrist is in the extended position, which places significant strain on the flexors of the forearm that attach to the elbow.”

Treatment
Depending on the severity of the elbow problem or injury, Dr. Smith first tries to treat the elbow conservatively. Resting the elbow, using ice packs and taking anti-inflammatory medicine often helps.

If conservative measures fail, arthroscopic elbow surgery may be indicated where he makes small incisions and uses a lighted scope to repair elbow damage, such as arthritis. This minimally invasive surgery results in a more rapid recovery and less pain for the patient than traditional surgery, he says.

Elbow joint replacement is not as reliable as hip and knee joint replacement, he says. But for those with no other option, “it’s a good salvage treatment for patients who want pain relief and ability to do light household tasks.”

Like other bones, elbows also can be fractured. “A fracture can occur any time you fall with your hand outstretched.” It’s a little more difficult to cast an elbow as he would a broken leg, Dr. Smith says, because an elbow placed in a cast is prone to stiffness.

The proper technique in sports, such as tennis, golf and baseball, can help avoid an elbow injury. Parents should pay close attention to young athletes who participate in repetitive motion sports. A little-leaguer, for example, should have a period of rest if he or she experiences elbow pain after throwing.

Most everyone will get elbow pain occasionally, Dr. Smith says. He suggests trying to alleviate the pain with over-the-counter anti-inflammatories. “If the pain persists or if patients develop restricted range of motion, locking of the elbow joint or swelling in the elbow, they should see their doctor