"The most interesting therapeutic advances in this field are arthroscopy and arthroplasties or prostheses".
DR. SANTIAGO AMILLO GARAYOA
SPECIALIST. ORTHOPEDIC SURGERY AND TRAUMATOLOGY DEPARTMENT
The forearm is formed by two bones, the ulna and the radius, which articulate with each other at their upper and lower ends to make prognosupination possible.
The pronosupination movement depends not only on the perfect integrity of the upper and lower radiocubital articulations, but also demands normality in the whole length of both bones, as well as the presence of anatomical incurvations of the radius.
Any incurvation of these elements can alter the rotation of the forearm and cause problems in the elbow.
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Causes of elbow pain
It is an extra-articular condition characterized by pain and exquisite sensitivity of the insertion of the forearm extensor muscles.
The cause can be a repeated effort of the extensor muscles in the practice of tennis, "tennis elbow" or some other sport. It can be included within the so-called insertion tendinopathies or tendinosis.
Although usually called tendinitis, in anatomopathological studies have not been observed inflammatory infiltrations. The injury corresponds to a deterioration of the structure of collagen.
The clinic is characterized by pain in the external face of the elbow irradiated, often, towards the back of the forearm. It is exacerbated by forcing of the extensor muscles keeping the forearm in pronation. At the exploration a painful point can be found at the level of the epicondyle. The mobility is complete and the x-ray does not show any injury.
Treatment: If a favorable evolution does not spontaneously follow, after taking a series of preventive measures, the epicondyle insertion of the extensor muscles can be resorted to infiltrations. If these fail, the origin of these muscles can be disinserted. Rehabilitation is a treatment both pre and post-operative.
It is a lesion equivalent to the insertion of the forearm flexors in the epitroclea.
It can reveal a painful point at this level.
Treatment: will be the local infiltration. Rarely will it be necessary to resort to surgical treatment.
It is not as frequent or as important as at the knee and hip level. It produces little pain, but limits mobility.
It can, by the formation of osteophytes at level of the channel epitrócleocraniano, produce a commitment of the ulnar nerve that requires an operation.
Osteoarthritis can also affect the humerus radial joint and produce alterations at the level of the head of the radius, sometimes related to repeated traumatisms.
The sliding bag located between the olecranon and the skin is not infrequently inflamed, producing an increase of liquid that is called hygroma or bursitis.
The most frequent causes are microtraumas, traumatic bursitis or the student's elbow (formerly, currently computerized).
If there is pain or too much fluid, it will be treated by aspirating the fluid from the inside of the bursa. If it recurs, the olecranial bursa can be removed.
In the elbow, in addition to inflammation of the olecranial sac -bursitis-, it is frequent to have injury of vessels and associated nerves, due to the serious articular deformities that are produced.
The chronic synovitis by deposits of uric acid in the joint produces a deterioration of the cartilage with subchondral geodes and deformity of the articular surface in advanced phases.
Previously, as the only treatment, arthrodesis was proposed. Today, however, there is a greater tendency to synovectomy, in cases that are not very advanced, and the placement of hinge prostheses in serious cases.
Most often the long portion inserted into the supraglenoid tuber of the scapula is affected.
In athletes, partial or total tearing of the glenoid insertion may occur. By arthroscopic techniques, partial lesions can be checked and reinserted.
Tenosynovitis of the long portion of the biceps with chronic inflammation of the synovial sheath that surrounds it within the bicipital sulcus can produce a deterioration of the tendon if the problem is not solved with conservative treatments.
This can produce pain and eventually rupture the tendon, with the sign of the ball falling. Synovitis produces radiating pain to the biceps, which increases with mobilization and palpation.
The treatment can be:
- Medical: with infiltrations of anti-inflammatory-analgesics that in the long run can produce a rupture of the tendon or electrotherapy.
- Surgical: by opening the slide. In the cases in which a deficit of incapacitating force appears by the rupture, it is possible to take advantage of the force of the muscular mass of the long portion reinserting it in the tendon of the short portion or in the bone.
It is possible that for abrupt efforts in flexion of the elbow or for sports distal tears of the tendon of the biceps are produced, producing functional impotence for the active flexion of the elbow.
In this case, it is necessary to perform surgical reinsertion of the distal tendon in the radius. If it is not done, the sign of the ascended ball appears and a significant loss of elbow flexion strength.
Where do we treat it?
IN NAVARRE AND MADRID
OUR MEDICAL TEAM
Specialists from the Department of Orthopedic Surgery and Traumatology
The Department of Orthopedic Surgery and Traumatology covers the full spectrum of congenital or acquired conditions of the musculoskeletal system including trauma and its aftermath.
Since 1986, the Clinica Universidad de Navarra has had an excellent bank of osteotendinous tissue for bone grafting and offers the best therapeutic alternatives.
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- Upper extremity.
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Why at the Clinica?
- Experts in arthroscopic surgery.
- Highly qualified professionals who perform pioneering techniques to solve traumatological injuries.
- One of the centers with the most experience in bone tumors.
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