Expert treatment for problems and injuries of the elbow.
The elbow is a complex ‘hinge’ joint that is susceptible to injury, and wear and tear. It allows for two types of movement: bending and straightening the arm (hinging) and forearm rotation, which is the ability to rotate the palm face up and face down. We need our elbow to position our hand in space. Having the full range of motion in your elbow is essential for everyday activities; when that motion is limited, it can negatively impact your day-to-day life.
Elbow conditions can affect the bones of the joint, the soft tissues or the nerves. These might be injuries or trauma, such as fractures, dislocations and biceps tendon rupture. Degenerative conditions such as tennis elbow, golfer’s elbow and arthritis are also common elbow problems.
You might require elbow surgery when pain, stiffness and instability persist, and therapies such as physiotherapy have not helped.
This article will explain when elbow surgery is recommended and explore the options for elbow surgery at Circle Health Group’s The Blackheath Hospital in southeast London.
The surfaces where the bones meet are covered with a thin layer of protective cartilage.
The elbow joint is held together and kept stable by the bony structures of these three bones as well as:
You also have three major nerves: the ulnar, median and radial nerves, which pass in close proximity to the elbow joint.
If you have a problem with any of these components, you might experience elbow pain, stiffness and instability or nerve symptoms like tingling, numbness and weakness.
Most elbow injuries respond well to non-surgical treatments, including pain relief medication, physiotherapy, injections or activity modification.
When these options have been exhausted and there is still pain and stiffness, your consultant might recommend surgery. You would make this decision after discussing the risks and benefits with your orthopaedic surgeon at The Blackheath Hospital.
Elbow injuries that frequently require elbow surgery fit into three broad categories:
Anyone of any age can suffer from a traumatic elbow injury. They can result from a fall, direct impact to the arm, sports injury or a car crash.
Fractures can affect any one of the three bones of the elbow joint: the humerus, the ulnar or the radius. Often, more than one bone is broken, which is called a complex fracture.
Simple fractures might not require surgery, but complex fractures in which your bones are misaligned or there is loose material in the joint are best treated with surgery. Stabilisation of the elbow is achieved with plates and screws in the bone.
Dislocations are frequent elbow injuries, with the elbow being the second most commonly dislocated joint. Dislocations affect the bones as well as the soft tissues of the elbow — the ligaments that hold the joint in place. An elbow fracture-dislocation is a complex injury in which the joint is dislocated and one or more bones are fractured.
Although simple dislocations might not require surgery, complex dislocations and fracture-dislocations are best treated surgically to restore the alignment of the bones and repair the ligaments.
Another common elbow injury is a biceps tendon rupture. This is a serious injury in which the tendon that connects your front upper arm muscle (biceps) to the elbow is partially torn or completely detached (ruptured).
Tears and ruptures can be caused by trying to lift a very heavy weight or sudden injury. Biceps tendon ruptures of the elbow require medical attention if you want to preserve the full range of motion of your arm and your full arm strength.
Biceps tendon repair surgery should be done within 2–3 weeks of the injury to prevent the tendon from shrinking and scarring. Your orthopaedic surgeon will reattach the tendon to the bone using a small metal device called a button.
Biceps tendon repair surgeries take 2–3 months to heal properly. You can do light activities during this time, but you should restrict any heavy lifting or activity until your consultant has cleared you.
With traumatic injuries, it is essential to ensure a stable elbow that can move as quickly as possible. The quicker you move the elbow after an injury, the less chance of developing post-injury stiffness.
One of the key goals of elbow fracture repair surgery and complex dislocation surgery is stabilisation to allow early mobilisation.
Mr Jagwant Singh, Consultant Orthopaedic, Trauma & Specialist Upper Limb Surgeon at The Blackheath Hospital, explains the importance of getting prompt surgical treatment for traumatic injuries:
“At Blackheath Hospital, we are very caring about the trauma patients because we know the time factor is there. These patients would have an X-ray as soon as possible and, if need be, a CT scan or further imaging like an MRI scan. In traumatic cases, these will be done in the most efficient and timely manner.”
The key to post-operative success is in early mobilisation and physiotherapy. At The Blackheath Hospital, the physiotherapy team will review your individual case and provide a detailed overview of the exercises you should do.
One to two weeks after your operation, you will be seen again by your consultant, who will examine your wound and remove your stitches. You’ll also meet with a physiotherapist for supervised exercises. Your physiotherapy programme will be personalised to you, so the duration will vary depending on your condition.
Elbow stiffness is not only uncomfortable, but it can prevent you from doing your everyday activities as you would like.
For those patients who have explored physiotherapy and other treatments and are still unable to achieve a full range of movement, a surgical procedure to release the stiff elbow might be recommended by your consultant.
Elbow release surgery (also called arthrolysis) is a last-resort treatment that can help you regain full movement in your elbow again. Some surgeries are done as arthroscopic (keyhole) procedures, but often, you will need open surgery. Your consultant will discuss the benefits and risks of each type of surgery with you.
Different methods of performing a stiff elbow release depend on the cause of the stiffness. In arthroscopic surgery, small incisions are made, and the loose bodies can be removed and tissues released. In other cases, scar tissue and bony growths (bone spurs) may need to be removed via open surgery to improve elbow mobility.
As with most surgeries, physiotherapy plays a crucial role in rehabilitation. Your multidisciplinary team at The Blackheath Hospital will include physiotherapists who will provide you with a personalised regime of exercises to help you recover after your elbow release surgery.
You don’t need to play tennis or golf to suffer from these conditions. They are typically caused by overuse or forceful motions such as lifting, carrying or doing repetitive arm movements.
Mr Singh explains, “When we get into our 30s and early 40s, our tendons get poorer with regard to their repair potential. So it is, simply speaking, an imbalance of the wear and tear and the repair. When we were young, the repair process was efficient enough, and it tidied up any wear and tear. As we grow into our 30s and 40s, the repair process lags behind, but the wear and tear keeps going on. For those who take up sports like racquet sports or for manual labourers who do lifting or any repetitive movements, they have more wear and tear and their repair process lags behind. This manifests as tennis or golfer's elbow.”
Tennis elbow is felt as pain and tenderness on the outside of the arm that may travel down the forearm. Golfer’s elbow is experienced on the inside of the arm.
Both are associated with weak grip and difficulty performing movements such as picking up objects. It is essential to rule out chronic elbow instability, so your consultant will clinically assess you to rule out any signs of instability and perform scans to confirm the diagnosis.
In most cases, tennis elbow and golfer’s elbow will improve with non-surgical treatment. Self-treatment measures include ice, rest, painkillers and avoiding painful activities.
If your pain does not improve after a few weeks, you can make an appointment with a specialist at The Blackheath Hospital to explore additional treatments. This might include bracing, physiotherapy and platelet-rich plasma (PRP) injections.
In most cases, physiotherapy and PRP injections are highly effective in treating tennis elbow and golfer’s elbow.
In those rare cases where physiotherapy has failed, tennis elbow release surgery or golfer’s elbow release surgery is a last-resort option for relieving pain. If your elbow scans have confirmed instability, you would require elbow stabilisation surgery to repair or reconstruct your elbow ligaments.
When tennis elbow causes severe and persistent pain that has not responded to other treatments, surgery to remove the damaged part of the tendon is an effective method of relieving pain. Tennis elbow surgery can be done as a traditional open surgery or keyhole surgery, depending on your orthopaedic surgeon’s recommendations and your preference.
During the surgery, the orthopaedic surgeon removes the damaged part of the tendon, repairs the tendon and ligaments (if necessary) and treats any other associated pathologies in the joint.
Like surgery for tennis elbow, surgery for golfer’s elbow is only recommended after all other treatment options have been tried and failed.
Golfer’s elbow release is most commonly performed as a traditional open surgery in which your orthopaedic surgeon will remove damaged portions of the tendon, remove any bone spurs and re-attach the tendon to the bone.
Your recovery process will vary depending on your surgery. Two weeks after your surgery, you will return to The Blackheath Hospital to see your orthopaedic surgeon, who will remove your stitches and assess your recovery.
There are additional follow-up appointments with your orthopaedic surgeon at six weeks and twelve weeks. Most patients can return to activities after four to six months.
Undergoing physiotherapy is a critical part of post-operative rehabilitation. Your physiotherapist will provide a personalised programme that will maximise the success of your operation and help you achieve movement as soon as possible.
Osteoarthritis (OA) is the most common form of arthritis, and it affects the articular cartilage that covers the surfaces of the three bones of the elbow joint. Although OA is not as common in elbows as in weight-bearing joints like your knees and hips, it can sometimes develop in the elbow due to a previous injury.
For older patients who experience pain, loss of motion, stiffness or a feeling of ‘grating’ or locking, osteoarthritis is typically the cause. Treatment for the early stages of OA includes painkillers, physiotherapy and steroid injections.
For patients whose arthritis has progressed, arthroscopic surgery (arthrolysis) might be recommended.
Arthritis surgery involves removing any loose bodies or inflamed tissues, smoothing irregular surfaces and removing bony spurs.
For patients whose joint surfaces have worn away completely, a total elbow replacement surgery might be recommended. Your consultant will assess you and decide which treatment best suits you based on your lifestyle, job and symptoms.
Symptoms of cubital tunnel syndrome are similar to the feeling you get when you hit your ‘funny bone’, which is actually your ulnar nerve. They might include:
Non-surgical treatment for cubital tunnel syndrome includes activity modification, sleeping with a splint or brace to keep your elbow straight at night, anti-inflammatory painkillers and physiotherapy.
However, if these treatments have not worked for you, or you have muscle weakness or damage, then surgery will be recommended.
Cubital tunnel release surgery is when pressure is relieved from the ulnar nerve by increasing the size of the cubital tunnel where the ulnar nerve passes. A surgery called ulnar nerve anterior transposition is when the ulnar nerve is moved from its place behind the medial epicondyle (the bony bump of the elbow) to a new home in front of it.
Surgeries for cubital tunnel syndrome are performed as day cases. You will have general anaesthesia and painkillers for the first four to five days after the surgery.
Typically, you will not need physiotherapy after the surgery, and you will be encouraged to move your elbow almost immediately after the operation.
For the first few nights after surgery, we recommend that you sleep with your arm elevated above the level of your heart to prevent swelling in your hands and fingers.
For most types of elbow surgery, physiotherapy is a crucial part of the rehabilitation process. Mr Singh describes how The Blackheath Hospital employs a multidisciplinary approach:
“Your surgeon and the physiotherapist work in close coordination to help you improve your range of movements. A set of exercises is prescribed, and you are guided through your rehabilitation.”
Recovery times will vary depending on your surgery and your condition. Your consultant will advise you when you can return to your everyday activities, including driving. You cannot safely drive until your bandages and sling have been removed, and you may need to wait additional time until your arm is strong enough to control the steering wheel.
If you suffer from elbow pain and instability and have exhausted all available non-surgical treatments, elbow surgery at The Blackheath Hospital can provide the relief you deserve.
The benefits of choosing The Blackheath Hospital for elbow surgery include:
The Blackheath Hospital can be found at 40-42 Lee Terrace, Blackheath, London, SE3 9UD. It is easily accessible by road, bus and the Blackheath train station.
Book an appointment online today or call us at 020 8318 7722.
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