Elbow Impingement

What is Elbow Impingement?

Elbow impingement is a medical condition characterised by compression and injury of soft tissue structures, such as cartilage, at the back of the elbow or within the elbow joint. It is a condition caused by repetitive forced extensions and overuse of the elbow. It can either occur in isolation or as valgus extension overload syndrome - also known as pitcher’s elbow - commonly noted in athletes in overhead-throwing sports like baseball, football, volleyball, and tennis. It can also result from gymnastics and aggressive weightlifting.

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 extended fully, the soft tissue structures at the back of the joint become compressed. When these compressive forces become excessive, it may result in inflammation and damage to the soft tissue and/or cartilage at the back of the joint. This is what is termed impingement. Sometimes, bony spurs may also develop inside the joint contributing to further exacerbation of the condition.

Some of the conditions that can trigger elbow impingement include:

• Synovitis or inflammation of the synovium, a membrane that lines the joints
• Bursitis or inflammation of the bursae, fluid-filled sacs that cushion the joints
• Bone spurs or abnormal bony projections along the ends of bones
• Inflammation of the joints
• Rupture of cartilage or other soft tissues
• Stiffening of the ligaments, muscles, and tendons

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
• Visible deformity and loss of elbow function

Diagnosis

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, CT scan, or ultrasound to confirm the diagnosis and narrow down any associated problems.

Treatment

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
• Activity Modification: Avoiding activities that trigger symptoms and changing one’s habits
• Physiotherapy: 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 physiotherapy, medications, rest, and activity modification do not yield the desired results, a cortisone injection may be helpful. Cortisone is a very effective anti-inflammatory medicine for bursitis and long-term pain reliever for tears and structural damage.

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 fibre-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 large surgical incision to be made to repair the affected region if the injury is large and complex. Open surgery has been utilised for joint debridement (removal of damaged cartilage or bone) or removal of osteophytes (bone spurs).