The elbow or elbow joint is one of the most complicated joints in the human body and actually consists of three individual joints that are involved in the movement and rotation of the forearm. The humeroulnar joint (i.e. the joint between the humerus and ulna) serves to bend and stretch the forearm, the radioulnar joint (the joint between the radius of the arm and the ulna) and the humeroradial joint (the joint between the humerus and the radius of the arm) serve to rotate the forearm. The elbow joint is surrounded by a joint capsule and is stabilized by several ligaments. A layer of cartilage at the ends of the bones protects them from abrasion. The bursa also protects against excessive strain. Several upper arm muscles are involved in the movement of the forearm, they are connected to the forearm bone via tendons that run across the elbow joint.
In the area of the elbow, various injuries such as bone fractures (fractures), ligament tears, bony ligament tears or luxations (dislocations) can occur. A dislocation is the sudden jumping of a bone out of its natural position, usually as a result of a fall or other external forces. The radial head fracture is the most common fracture in the area of the elbow. Injuries are always associated with the risk of damage to blood vessels and nerves. In addition to the injuries mentioned above, experts in elbow surgery also treat the following diseases:
- A tennis elbow, also known as epicondylitis humeri radialis, develops because the muscles are frequently overstrained and there is inflammation of the muscle attachments on the outside of the elbow. This can be the case with certain sports (such as tennis) or with manual activities. A tennis elbow manifests itself as pain on the outside of the elbow, which can radiate into the forearm and upper arm.
- If the muscle insertions on the inside of the elbow are irritated, it is called a golf elbow (Epicondylitis humeri ulnaris).
- In the case of ulnar channel syndrome (cubital tunnel syndrome), permanent irritation of the ulnar nerve can lead to, among other things, a functional restriction of the hand and fingers (reduced or difficult mobility). It belongs to the nerve impingement syndromes.
- Congenital malformation of the elbow, such as radioulnar synostosis, in which the ulna and radius have grown together, and congenital radius head dislocation, in which the radius head is permanently dislocated.
- Elbow arthrosis, i.e. degeneration of bone and cartilage beyond normal levels, for example due to rheumatoid arthritis.
In addition to questioning the patient about the symptoms (such as pain, sensory disorders and functional limitations), the clinical examination is the main focus of the diagnostics. The physician scans the elbow joint and the adjacent structures, looks for malpositions and swellings, for color changes of the skin and checks the mobility of the arm and hand (functional tests). This already provides information as to whether there is a dislocation, for example, and whether nerves and blood vessels are also affected.
If a bone fracture is suspected or to rule out fractures or elbow dislocation, an X-ray is performed. The bones can be very well displayed with this method. Computed tomography (CT) can be used to obtain an even more accurate representation of the bone structures. It can also be used to detect bleeding, bruising or swelling. Also, it is used for complex elbow dislocations. Magnetic resonance imaging (MRI) is more commonly used for injuries to the ligaments and soft tissues as well as to the muscles and bursa.
Soft tissue structures can also be visualised particularly well with ultrasound examination (sonography). That's why sonogrphy is used for bursitis, increased fluid in the elbow and joint, haematomas and injuries to muscles and tendons. High-resolution ultrasound equipment can even be used to visualize nerves. If a nerve constriction syndrome is suspected, a neurological examination is performed to determine the nerve conduction velocity.
In some cases, the examiner will want to get a more accurate picture of the inside of the joint using arthroscopy. While performing such a minimally invasive procedure, therapeutic interventions can also be performed, such as the removal of bony structures.
The treatment methods used by elbow surgery experts range from arthroscopy and minimally invasive procedures to open surgery. Surgeries are performed to stabilize the elbow joint and to treat injuries and fractures (osteosynthesis, i.e. the surgical connection of individual bones or bone fragments so that they can grow together again). Corrections of congenital malformations and joint replacement surgeries are also performed, as well as the treatment of certain diseases. The range of services offered by an elbow surgeon includes, among other things:
- Therapy of the tennis elbow
- Therapy of the golf elbow
- Treatment of nerve impingement syndromes
- Removal of osteophytes (pathological new bone formation at the edge of the bone)
- Removal of free joint bodies
- Treatment of elbow arthrosis
- Treatment of bursitis
- Removal of the synovial membrane in rheumatoid arthritis (synovectomy)
- Treatment of movement restrictions and joint stiffness
- Treatment of bone fractures and multiple ligament tears; depending on the severity, the joint must be stabilized with plates and screws.
- Reduction of dislocated bone during dislocation
- Deutsche Vereinigung für Schulter- und Ellenbogenchirurgie (DVSE) (2017) Bildgebung in der Schulterund Ellenbogenchirurgie. Obere Extremität 12 (Suppl 1): S1–S84. doi 10.1007/s11678-017-0401-9
- Ellenbogen- und Handgelenkskomitee der AGA in Zusammenarbeit mit dem Komitee Ellenbogen der DVSE (2014) Untersuchungstechniken des Ellenbogen- und Handgelenks. Ellenbogenkomitee der AGA, Zürich
- Schünke M et al. (2018) Prometheus. Allgemeine Anatomie und Bewegungssystem: LernAtlas der Anatomie. Thieme, Stuttgart
- Raschke MJ, Haas NP (2013) Unfallchirurgie. In: Siewert JR, Stein HJ (Hrsg) Chirurgie. 9. Aufl. Springer, Heidelberg