Elbow joint is a complicated connective element of shoulder, elbow and radial bone. Complex movable structure allows a human to perform all basic kinds of movements: bending and unbending, rotation of the forearm.
The structure of the elbow joint has unique anatomy, because it’s connection of three simple articulations:
- humero-ulnar (block-shaped with one axe);
- humeroredial (spherical with a vertical and frontal axe);
- radioulnar (cylindrical with vertical axe).
General joint capsule combines and fixes independent joints surface of which is covered with cartilaginous tissue. The front and the back parts are pretty thin, so they aren’t protected from damage. The lateral part of the capsule is protected with ligaments. Basic fixture is located in the shoulder bone reaching the forearm.
Synovial membrane consists of creases and bursa that make movements smoother and protect joints without cartilaginous tissue located in the joint. Inflammatory processes and damage of this area can cause development of a disease - bursitis of the elbow.
Connective tissues of the elbow joint fix the connection and consist of:
- elbow and radial collateral band;
- anular radial bone;
- interosseous membrane of forearm;
- quadrate ligament.
Muscular frame consists of different tissues of evertors and extensor muscles. Smooth works of such muscles makes up for the possibility of making precise elbow movements.
Methods of Diagnostics
There are some diagnostic methods to reveal pathologies in the area of elbow joint. Only a doctor can evaluate patient’s state and define whether instrumental examination is required.
Basic methods of diagnosis include:
- Visual analysis, palpation. Reddening, swelling and tension of skin covering, heat in the zone of connection can be the signs of the pathology. Any deformations and knot formations can be the symptoms of some disturbances and abnormalities. Palpation of the zone in relaxed state will help to define swelling, integrity and form of connection, crunch and painful sensations during movement.
- X-ray examination. This method is one of the most widespread ways to define the state of the elbow joint. X-ray imaging should be performed in two projections: it allows revealing pathological changes in muscle components of the elbow. However, X-ray imaging doesn’t allow revealing inflammatory processes in elbow components.
- Tomography. Examination with the help of computer, magnetic-resonance tomography allows defining and visualizing all pathological changes, processes in bone structure and muscle tissues of the elbow.
- Ultrasound examination. Ultrasound method of examination is highly safe, gives fast results and a high level of informational value. Thanks to superficial placement of the elbow joint, examination allows defining early stages of pathology.
- Arthroscopy. The principle of this method presupposes making invasion with the help of a special camera put inside a small incision in the area of elbow connection. The image is broadcast on the monitor where it can be zoomed. Arthroscopy allows making the inner examination of joint and revealing structural damages.
- Puncture. If exudate has collected in the elbow joint, it will be closely inspected to find out the reason of the inflammation. Puncture allows performing diagnosis and removing extra exudate, or injecting medications with anti-inflammatory and antibacterial effects.
Timely diagnosis will help to reveal the disease, define past medical history and start corresponding therapy. High-quality examination at early stages also helps to prevent further development of disease and its complications.
Diseases of Elbow Joint
Painful sensations in the area of elbow joint can be the reason to visit a doctor. Pain in elbow and acute symptoms can gradually become chronic and be accompanies with problems of joint functioning and irreversible pathological changes.
High-risk group of elbow osteoarthrosis includes people whose profession is connected with frequent injuries, loading on connective tissues, endocrine and metabolic dysfunction, surgeries on the joint and arthritis. Osteoarthrosis affects elbow joint less frequently than knee and pelvic joints.
Typical symptoms include:
- periodic dull pain (appears after loading on a joint);
- crunch and flicks during activity of the joint;
- restriction of function in elbow joint (ankylosis, lower amplitude of movements).
Diagnostic measures for revealing the disease depend on the symptoms. Doctors apply X-ray examination, MRI, arthroscopy. Therapy of disease is based on complex approach and combine medications and physical therapy.
Arthritis is an inflammation of elbow joint. The main reason of this pathology is allergic reactions, various kinds of infections (viral, bacterial and fungal). The disease can develop into an acute or chronic stage.
Symptoms of the disease are similar regardless of etiology:
- intense pain sensations;
- hyperemia of skin covering;
- restriction of function of elbow joint.
One of the most widespread pathologies is rhematoid damage. The symptom is symmetric damage of joints in both hands, restriction of movements, swelling near the connection. The disease has cyclical pattern – remission is changed by recrudescence.
Pain in elbow abarticulation can be the sign of epicondylitis. High-risk group includes people whose profession is connected with physical loading, the need to perform rotating movements and carry heavy things.
The disease can be of two types: lateral and medial. The main symptom of epicondylitis is pain in the area where the epicondylus is damaged. Pain at the early stages of disease can occur after movement and carrying heavy stuff, and it subsides with the time being. Further on, acute pain can appear because of minor actions and movements.
Pathologies of inflammatory character can affect connection of ligaments in elbow joint. The disease is characterized by pain during movement of abarticulation, hyperemia and painful sensations during palpation of the joint.
Inflammatory process is revealed locally in fascia of muscles in the elbow joint. The main symptoms of disease is pulling pain, low tonus, weakness of muscles and skin covering.
Inflammation of nerve endings can be caused by impaction because of injuries. Periodic acute pain can appear without any reasons, and may not be connected with activity of elbow joint. Symptomatic signs of neurite are numbing of skin covering, sensation of tingling in the area of abarticulation, or on the skin of the forearm.
This disease is characterized by acute inflammatory processes in the area of joint capsule. Most often, the pathological process appears after injury of the back part of the elbow joint. Bursitis is characterized by acute and painful symptoms:
- pulsating pain;
- swelling, hyperemia of skin covering;
- restriction of movements;
- development of swelling on the back part of the elbow;
- high temperature;
- general weakness and poor well-being.
Absence of timely treatment can lead to complications and difficult outcomes (apostem and phlegmon). purulent exudate should be instantly removed from the bursa – it will prevent development of inflammatory process.
Pathological states of the elbow joint can be caused by injuries. The most widespread traumas are:
- bruise(damage depends on the power of hit);
- dislocation of bones in the abarticulation;
- distortion or tearing of ligaments;
- breaking (intra-articular injury);
- breaking of joint capsule;
- damage of muscle tissues in elbow.
The consequences of late therapy of trauma can lead to post-traumatic contractures, development of ossificates. Incorrect treatment can cause ankylosis – full immobility of elbow joint. Inadequate treatment of inflammatory processes in the area of abartoculation can also cause purulent damage (lymphangitis, aposteme, purulent arthritis).
Elbow joint has a very complicated but rigid anatomical structure. Physical loading, injuries, and infections can destroy functionality of the joint. Pain and restriction of movements in elbow joint require visiting a hospital immediately.
Treatment of Elbow Joint Diseases
What can be done, if some of the above mentioned diseases have developed, or you have symptoms of it?
First and foremost, a person should consult a neurologist or a traumatologist who can make a precise diagnosis. Besides, some examinations should be performed to define the state of the joint. Only when the results of the examinations are ready, corresponding treatment can be started.
The complex of treatment measures includes non-medication methods, medication therapy and surgeries. Non-medication methods include physical therapy, a set of warm-up exercises, diet, as well as treatment of elbow joints with traditional methods.
The diet presupposes refusing form spicy food and alcohol. The ration should include the products rich in calcium and Omega-3 fatty acids. These components promote regeneration of damaged joints.
Exercises allow reducing the load on elbows and preparing them for work. This way, you can also prevent injuries.
Medications are mainly used to treat pain syndromes and inflammatory processes in joints. First and foremost, non-steroid anti-inflammatory products are widely used for treating pathologies. These products make inflammation of joints subside, and also have pain killing effects.
Treatment of elbow joint with such products should better be accompanies by strict control over gastrointestinal tract. It’s obligatory, if a person uses medication on a long-term basis: omeprazole should necessarily be taken. This medication protects the gastric mucosa from development of gastropathy caused by intake of NSAIDs (non-steroidal anti-inflammatory drugs).
If a person has developed epicondylitis, treatment should better be started with usage of antibiotics, because tearing of tendons can be complicated with bursitis, peritendinitis or abscess development. Injection medications are administered in the cavity of the joint in case of arthritis and arthrosis. Thanks to a high concentration of the medication in joint cavity, optimal pain killing effect can be achieved.
As a rule, surgical invasion is performed in case of traumatic damage of joints. Surgical invasion is obligatory, when comminuted fracture of elbow-forming bones takes place. In this case, a surgeon makes prosection of the joint, matches its fragments and fixes them. Otherwise, if bones reconnect in a wrong way, movement in the joint can be obstructed and complicated, or its functionality can be lost.
Surgical methods also include forcible reduction of severe deformity. It is performed under general anesthesia. After the procedure, a splint or a plaster split is put on the zone: it immobilizes the joint and helps to accelerate the process of its recovery.
Open reposition of chips in case of ruptures
This operation is made for ruptures and ruptures accompanied by dislocations, when closed reposition cannot be performed for some reasons. It’s aimed at restoring the location of bone chips and fixing them to make the ruptured tissues reconnect.
Bone chips can be fixed with the help of wires and screws. Such type of fixation is called osteosynthesis. The operation can last from 12 to 14 hours. It depends on the type of rupture, quantity of bone chips and accompanying damages. Pretty often, such operations require simultaneous stitching of ligaments and performance of arthroplastics.
Stitching of tendons
This operation requires high precision, because correctly put stitches guarantee that the outcomes after such operation will be minimal. Even the smallest tendon is crucial for overall functioning of the joint. Today, such operations allow restoring functionality of limbs by up to 99%, even if traumatic amputation took place, and, in fact, the hand has been reconnected again (such operations should be performed within one hour after the injury; the disconnected limb should be placed in a pack with ice, and an arterial constrictor should be put on the shoulder).
This operation is made to eliminate the defects on hyaline articulation surface. For this purpose, special pastes and liquids are used to fill up the gaps formed by defects an d harden. After setting, such mixtures have very high reliability and resistance to wearing. Today, special plates are also used to cover the surface of joint. They cover it fully and totally replicate its form. Such plates can be produced from medical alloys and polymers. Arthroplastics is also performed by cutting ossified areas of the cartilaginous tissue.
Endoprosthetics of elbow joint
This kind of invasion is performed to replace the joint by a specially prepared implant. Either the articular head of bones is implanted, or the entire joint. It can be necessary when bones are ruptured severely, physiological osteosynthesis is interrupted, bones are damaged with purulent substances during osteomyelitis. Just like plates for cartilaginous surface of joints, endoprostheses are produced from alloys and polymers (most often, medical titanium is used).
This is an instrumental method of diagnosis and surgery on joints. The vast majority of operations are performed with the help of endoscopic equipment: arthroplastics, stitching of ligaments, reposition of bone chips during minor ruptures, for instance, rupture of olecranon. This method requires less invasion, it’s less traumatic than open operations.
The vast majority of operations are performed under general (inhalant endotracheal) anesthesia. It allows using miorelaxants (medications to relax muscles) to ease access to the joint. Puncture, arthroscopic arthroplastics can be used with block anesthesia.
Replacement of Elbow Joint
If non-surgical and minimally invasive methods are helpless in elbow joint treatment (e.i. in case of severe injuries), the endoprosthesis replacement is required. Because of complex anatomy, endoprosthesis replacement of elbow joint is considered as complicated and long-lasting surgery that is conducted with either general or local anaesthesia; its duration could be 1-2 hours. The German orthopaedic centers achieved excellent results in the replacement of all kinds of human joints.
Apart from other joints subject to large load applied, most often pain in elbow joint proves to be the result of inflammation. Non-surgical methods are predominant for elbow treatment. But if surgery is needed, world-renowned doctors employed by our clinics, (orthopaedic clinics of OrthoLiga, in particular) offer full range surgical treatment including endoprosthesis replacement of elbow joint.
Physiologically the elbow joint is very vulnerable to different injuries that may be caused by incorrectly put or extensive load as well as falling down and blows.
Different factors define the type of endoprosthesis to be used: age, habitude, health conditions, bone tissue conditions and chronic diseases, if any.
Prior to surgery
Prior to surgery surgeon in charge would colloquize with the patient, study the clinical chart thoroughly and arrange all required preliminary examinations including X-ray and ultrasonography. Besides, magnetic resonance examination or computer aided tomography might be assigned. On the basis of examinations having been carried out, the surgeon can detect the scope of deformity and wear of the elbow joint, and also to evaluate bone tissue conditions. The main purpose of the examination is to confirm the surgery necessity. It helps also to make a right choice for the type of prosthesis and specific endoprosthesis to be used as well as to plan the surgery itself.
In the course of surgery the patients may lie on the back or sidelong depending of the surgical method chosen. After anaesthesia has taken effect the surgeon makes a cut in the joint area. To avoid unnecessary injuries the muscles are taken apart carefully and then damaged portions of the joint are removed. The next stage consists in polishing and drilling; these operations are preparatory for endoprosthesis placement. At first the trial prosthesis is installed to check fit, stability and mobility of the elbow joint. In case all parameters meet the requirements for fit, stability and mobility, the permanent endoprosthesis is placed and fixed with bone cement. After final testing of endoprosthesis the muscles are returned back into their original position and the cut is stitched. At last the bandage is laid and the hand is fixed with the splint.
After the surgery
Remedial treatment after endoprosthesis replacement of elbow joint takes about 3 months; it begins as early as patient’s one-two weeks’ stay at the hospital. As a rule, on the second day after the surgery some passive exercises is prescribed (physiotherapist moves the patient’s hand in a certain range). Later the patient starts doing exercises without assistance under physiotherapist’s supervision. To avoid suggillation and bleeding as well as to sustain the recovery, right after the surgery a drainage is inserted and analgetics are injected.
Complications After Surgery on Elbow Joint
One of the worst outcomes connected with incorrect surgery performance is lowering or disruption of joint functionality. This problem often requires secondary operation to eliminate the cause of the problem.