Ulnar Nerve Neuritis

Get professional Opinion and Treatment about your Ulnar Nerve Neuritis. Effective and fast relief treatment by Experienced Elbow Specialist. Call us +65 97731458 to schedule for an appointment.

What is Ulnar Nerve Neuritis?
One of the nerves that supplies the hand is called the ‘ulnar nerve’. Like a telephone cable, it passes through a protective conduit (a tunnel) behind the inner bony prominence of the elbow. This bony prominence is called the ‘medial epicondyle’ (the ‘funny bone’). The other bony prominence is the tip of the elbow. The tunnel is between these bony prominences and is called the ‘cubital tunnel’. The roof of the tunnel is formed by a band that attaches to these bony prominences (‘Osbourne’s ligament’). The nerve can get compressed in this tunnel and cause symptoms. The condition is known as a ‘Cubital Tunnel Syndrome’.

 

What is the cause?
This is the second most common cause of nerve entrapment. In the majority of patients, we do not know what causes this syndrome. Mechanically the nerve gets stretched every time we bend the elbow and it pushes against the medial epicondyle. With time this causes irritation and compression of the nerve. It usually occurs in middle age. The condition is associated with diabetes, previous elbow injuries/fractures, arthritis & rheumatoid disease.

What are the symptoms and how is the condition diagnosed?
The main symptom is tingling or pins and needles in the hand. The symptoms usually affect the little finger and ring fingers. This is because the ulnar nerve supplies sensations to these fingers. Tingling is often worse at night or first thing in the morning. This is because most people sleep with their elbows bent or with their arms above their head.

In the early stages, the symptoms are intermittent but later become continuous as the condition worsens. Patients may initially complain of pain on the inner aspect of the elbow and will notice numbness in the fingers. Later symptoms of weakness and wasting of the muscles of the hand may develop. The most commonly wasted muscle mass is in the first web space, on the back of the hand between the thumb and the index finger. Patients may drop objects and feel clumsy with their hand(s).

The diagnosis is further confirmed by various clinical tests that assess the strengths of various muscles supplied by the median nerve.

Will further tests or investigations be needed?
The diagnosis of cubital tunnel syndrome is made clinically but you will nearly always be referred for electical tests (nerve conduction studies). The tests may be to confirm the diagnosis in patients in whom the symptoms and signs are not typical, and also to confirm that the nerve is not compressed elsewhere (usually in the neck from where it begins or rarely on the front of the wrist).

What is the treatment?

  • Splints: They keep the elbow from bending and may be useful if worn at night. Instead of an expensive splint you could wrap a towel round the elbow and hold it in place with a tape (like a pig in a blanket). Avoid activities that keep the elbow bent for a long time. Keep more space between your work and your chest when working at the desk to keep the elbows more straight.
  • Surgery: The primary aim of surgery is to prevent deterioration by creating more space for the nerve and to reduce pressure on the nerve. There are several methods described but the choice of the operation depends on the surgeons’ experience and anatomy of the ulnar nerve and the elbow.

Decompression of the ulnar nerve: This is a standard operation advised and is an open surgical release of the cubital tunnel. A skin incision of 5 cm is required and at surgery the roof of the cubital tunnel is opened, thereby decompressing the ulnar nerve. The procedure can be carried out under local or general anaesthesia, as a day case. At surgery a tourniquet cuff is applied around the arm so as to stop bleeding and make the operation safer and quicker. This tourniquet is needed for about 15 minutes and can be uncomfortable when the operation is carried out under local anaesthesia. After the operation, a sticky dressing is applied over the surgical wound. A bulky supportive cotton-wool dressing then goes on top of that. This supportive dressing is reduced after a couple of days. The small sticky dressing should be left for 10 -12 days when the stitches will need to come out. The arm should be kept elevated after surgery for 1-2 days as this will prevent the fingers swelling and causing discomfort. Light use of the limb should be possible immediately after the day of surgery. Active movements of the fingers/ wrist/ shoulder are recommended soon after surgery.

Endoscopic decompression of the cubital tunnel: Some surgeons advise endoscopic decompression of the cubital tunnel (key hole surgery). A telescope is used and surgery is visualized on a television monitor. A smaller incision is needed and an earlier return to work is possible. The risks associated with the procedure are greater. It is debatable as to whether the benefits of this procedure significantly outweigh the risks.

Ulnar nerve transposition: This is another common type of surgery where the ulnar nerve is moved from behind the funny bone, to beneath the muscle on the front of the funny bone. This way, the nerve will not stretch when the elbow is bent. In about 7-10% of patients the ulnar nerve can flip to the front of the elbow by itself (subluxing nerve) and this operation will be considered. Similarly this is the operation of choice for patients with an elbow deformity.

Medial epicondylectomy: This operation is sometimes advised, though less commonly in this UK. Here, the funny bone is removed allowing the nerve to move freely as the patient bends the elbow.

  • When certain other conditions like (rheumatoid) arthritis are present, clearing of the soft tissue lining (synovectomy) or excision of any bony spurs, may be needed.

What happens if it is not treated?
Some mild cases of cubital tunnel syndrome may recover spontaneously. If the condition is neglected most people will find that symptoms become progressively worse. The ulnar nerve will continue to be compressed, resulting in total, constant numbness, due to wasting and weakness of the muscles supplied by the nerve in the hand. This will lead to permanent, irreversible muscle weakness, affecting functionality.

What is the success of surgical treatment?
The operation has a very good success rate in the early stages. It results in good resolution of night pain and tingling within a few days. However if the condition has been present for a long time, then recovery from symptoms of constant numbness and muscle weakness is unpredictable. However one of the aims and benefits of surgery is to stop the nerve from deteriorating due to constant compression. Thus even if the procedure does not reverse the symptoms, it will help to prevent progressive worsening of the nerve function.

What are the complications of surgical treatment?
The surgical scar may appear reddish for 2-3 weeks and may be tender for 6-8 weeks. However it is seldom troublesome in the longer term. An area of numbness may persist around the scar.

Infection of the wound is possible and in the early stages can be successfully treated with antibiotics. If pain increases after surgery infection needs to be ruled out.

Stiffness of the upper limb joints is possible and hence the need to exercise the limb soon after surgery. Severe complex regional pain syndrome (CRPS) is a rare but serious complication after upper limb surgery. Unfortunately it is not possible to predict this problem but needs to be watched and treated (usually with just physiotherapy) if it develops.

Damage to the ulnar nerve is possible but very rare when the open surgical technique is used. The risk is higher when the endoscopic technique is used.

Any surgical intervention has the risk of developing unpredicted complications or setbacks. These complications may have the potential to leave the patient worse than before surgery.

Is there anything I can do to improve outcome?

  • After surgery keep the hand up so as to help reduce swelling.
  • It is advised against wearing rings on the operated hand for 4-6 weeks following surgery.
  • Start exercising your limb immediately after surgery (Make a fist, and then stretch your fingers out; bend your wrist forwards and backwards and touch each finger tip in turn with your thumb). This will help avoid finger swelling and stiffness.
  • Keep the wound dry.
  • Once the stitches have come out the scar can be massaged regularly with a soft non-perfumed cream for a couple of months.
  • If the scar is tender to press, tapping along the scar and on either side of it firmly with your fingertips a few times a day may be useful.

When can I do various activities?
Return to work depends on many factors including the nature of the job and hand dominance.

  • Generally patients can return to a desk job within a few days and perform reasonable tasks with the hand.
  • Avoid pressing heavily on the scar.
  • Manual work should be avoided for 4-6 weeks.
  • Driving should be possible within a week of the operation.

Get professional Opinion and Treatment about your Ulnar Nerve Neuritis. Effective and fast relief treatment by Experienced Elbow Specialist. Call us +65 97731458 to schedule for an appointment.

Olecranon Bursitis (Elbow Bursitis)

Get professional Opinion and Treatment about your Olecranon Bursitis (Elbow Bursitis). Effective and fast relief treatment by Experienced Elbow Specialist. Call us +65 97731458 to schedule for an appointment.

Elbow bursitis, also called olecranon bursitis, causes fluid to collect in a sac that lies behind the elbow, called the olecranon bursa. A bursa is a slippery, sac-like tissue that normally allows smooth movement around bony prominences, such as the point behind the elbow. When a bursa becomes inflamed, the sac fills with fluid. This can cause pain and a noticeable swelling behind the elbow.

Why did I get elbow bursitis?

Elbow bursitis may follow a traumatic accident, such as a fall onto the back of the elbow, or it may seemingly pop up out of nowhere. People who rest their elbows on hard surfaces may aggravate the condition and make the swelling more prominent.

How is the diagnosis of elbow bursitis made?

The common symptoms of elbow bursitis include:

  • Pain around the back of the elbow
  • Swelling directly over the bony prominence of the tip of the elbow
  • Slightly limited motion of the elbow

There are other conditions that can cause elbow pain and swelling, and these should also be considered as a possible diagnosis. Your doctor can usually diagnose elbow bursitis on examination, but an x-ray will often be done to ensure the elbow joint itself appears normal. A MRI is not necessary to diagnose elbow bursitis, and will only be done if there is uncertainty about the diagnosis.

Are the complications of elbow bursitis?

Occasionally, the swelling and inflammation can be the result of an infection within the bursa, this is called infected elbow bursitis. Patients with systemic inflammatory conditions, such as gout and rheumatoid arthritis, are also at increased risk of developing infected elbow bursitis.

Get professional Opinion and Treatment about your Olecranon Bursitis (Elbow Bursitis). Effective and fast relief treatment by Experienced Elbow Specialist. Call us +65 97731458 to schedule for an appointment.

Platelet Rich Plasma (PRP)

Platelet Rich Plasma (PRP) therapy holds Great Promise to heal the Soft Tissue, Chronic Tendon Injury, Knee Osteoarthritis, Sports Injury, Acute Ligament and Muscle Injury. Get your PRP done with us today. Call us at +65 97731458 to schedule for an appointment

During the past several years, much has been written about a preparation called platelet-rich plasma (PRP) and its potential effectiveness in the treatment of injuries.

Many famous athletes Tiger Woods, tennis star Rafael Nadal, and several others have received PRP for various problems, such as sprained knees and chronic tendon injuries. These types of conditions have typically been treated with medications, physical therapy, or even surgery. Some athletes have credited PRP with their being able to return more quickly to competition.

Platelet Rich Plasma

What is Platelet Rich Plasma (PRP)?

Although blood is mainly a liquid (called plasma), it also contains small solid components (red cells, white cells, and platelets.) The platelets are best known for their importance in clotting blood. However, platelets also contain hundreds of proteins called growth factors which are very important in the healing of injuries.

PRP is plasma with many more platelets than what is typically found in blood. The concentration of platelets and, thereby, the concentration of growth factors can be 5 to 10 times greater (or richer) than usual.

To develop a PRP preparation, blood must first be drawn from a patient. The platelets are separated from other blood cells and their concentration is increased during a process called centrifugation. Then the increased concentration of platelets is combined with the remaining blood.

How does Platelet Rich Plasma (PRP) works?

Although it is not exactly clear how PRP works, laboratory studies have shown that the increased concentration of growth factors in PRP can potentially speed up the healing process.

To speed healing, the injury site is treated with the PRP preparation. This can be done in one of two ways:

  • PRP can be carefully injected into the injured area. For example, in Achilles tendonitis, a condition commonly seen in runners and tennis players, the heel cord can become swollen, inflamed, and painful. A mixture of PRP and local anesthetic can be injected directly into this inflamed tissue. Afterwards, the pain at the area of injection may actually increase for the first week or two, and it may be several weeks before the patient feels a beneficial effect.
  • PRP may also be used to improve healing after surgery for some injuries. For example, an athlete with a completely torn heel cord may require surgery to repair the tendon. Healing of the torn tendon can possibly be improved by treating the injured area with PRP during surgery. This is done by preparing the PRP in a special way that allows it to actually be stitched into torn tissues.

What conditions are treated with Platelet Rich Plasma (PRP)?

Research studies are currently being conducted to evaluate the effectiveness of PRP treatment. At this time, the results of these studies are inconclusive because the effectiveness of PRP therapy can vary. Factors that can influence the effectiveness of PRP treatment include:

  • The area of the body being treated
  • The overall health of the patient
  • Whether the injury is acute (such as from a fall) or chronic (an injury developing over time)

– Chronic Tendon Injuries

According to the research studies currently reported, PRP is most effective in the treatment of chronic tendon injuries, especially tennis elbow, a very common injury of the tendons on the outside of the elbow.

The use of PRP for other chronic tendon injuries such as chronic Achilles tendonitis or inflammation of the patellar tendon at the knee (jumper’s knee) is promising. However, it is difficult to say at this time that PRP therapy is any more effective than traditional treatment of these problems.

– Acute Ligament and Muscle Injuries
Much of the publicity PRP therapy has received has been about the treatment of acute sports injuries, such as ligament and muscle injuries. PRP has been used to treat professional athletes with common sports injuries like pulled hamstring muscles in the thigh and knee sprains. There is no definitive scientific evidence, however, that PRP therapy actually improves the healing process in these types of injuries.

– Surgery
More recently, PRP has been used during certain types of surgery to help tissues heal. It was first thought to be beneficial in shoulder surgery to repair torn rotator cuff tendons. However, the results so far show little or no benefit when PRP is used in these types of surgical procedures.Surgery to repair torn knee ligaments, especially the anterior cruciate ligament (ACL) is another area where PRP has been applied. At this time, there appears to be little or no benefit from using PRP in this instance.
– Knee Arthritis
Some initial research is being done to evaluate the effectiveness of PRP in the treatment of the arthritic knee. It is still too soon to determine if this form of treatment will be any more effective than current treatment methods.
– Fractures
PRP has been used in a very limited way to speed the healing of broken bones. So far, it has shown no significant benefit.Treatment with platelet-rich plasma holds great promise. Currently, however, the research studies to back up the claims in the media are lacking. Although PRP does appear to be effective in the treatment of chronic tendon injuries about the elbow, the medical community needs more scientific evidence before it can determine whether PRP therapy is truly effective in other conditions.Even though the success of PRP therapy is still questionable, the risks associated with it are minimal: There may be increased pain at the injection site, but the incidence of other problems — infection, tissue damage, nerve injuries — appears to be no different from that associated with cortisone injections.

If you are considering treatment with PRP, be sure to check your eligibility with your health insurance carrier. Few insurance plans, including workers’ compensation plans, provide even partial reimbursement.

Platelet Rich Plasma (PRP) therapy holds Great Promise to heal the Soft Tissue, Chronic Tendon Injury, Knee Osteoarthritis, Sports Injury, Acute Ligament and Muscle Injury. Get your PRP done with us today. Call us at +65 97731458 to schedule for an appointment

Golfer Elbow (Medial Epicondylitis)

Stop your Elbow Pain today. Effective Treatment, Non Surgery. Discuss with our Elbow Specialist for the Diagnosis, Treatment and Prognosis of your Elbow Pain. Call us +65 97731458 to schedule for an appointment.

Medial Epicondylitis is inflammation at the point where the tendons of the forearm attach to the bony prominence of the inner elbow. As an example, this tendon can become strained in a golf swing, but many other repetitive motions can injure the tendon. Golfer’s elbow is characterized by local pain and tenderness over the inner elbow. The range of motion of the elbow is preserved because the inner joint of the elbow is not affected. Those activities which require twisting or straining the forearm tendon can elicit pain and worsen the condition.

What is Golfers Elbow?

These problems, tennis elbow and golfer’s elbow, are both forms of tendonitis. Tendons are the ends of muscles that attach to bone. Because of the force of the muscle, the points of insertion of the tendon on the bone are often pointed prominences. The medical names of Tennis Elbow (lateral epicondylitis) and Golfer’s Elbow (medial epicondylitis) come from the names of these bony prominences where the tendons insert, and where the inflammation causes the pain. The pain of golfer’s elbow is usually at the elbow joint on the inside of the arm; a shooting sensation down the forearm is also common while gripping objects.

What causes golfers elbow?

The mechanism of this injury can vary from a single violent action to, more commonly, repetitive stress injury where an action is performed repeatedly and pain gradually develops. No one is immune from these injuries, but they are most common at the beginning of the golf season, or when the offending activity is increased in intensity or duration. Golf is one common cause of these symptoms, but many other sport- and work-related activities can cause the same problem. Another common cause of this injury is with weekend carpenters who use hand tools on occasion.

What are the treatment options available for golfers elbow?

Treatment includes Medicines and Anti-inflammatory injection for mild cases, Shockwave Therapy will be one of the effective non-invasive treatment, PRP and Surgery intervention will be the last source of treatment if all the conservative treatments do not respond well.

Stop your Elbow Pain today. Effective Treatment, Non Surgery. Discuss with our Elbow Specialist for the Diagnosis, Treatment and Prognosis of your Elbow Pain. Call us +65 97731458 to schedule for an appointment.

Elbow Arthritis

Definition of Arthritis of the Elbow

Inflammation of the elbow joint (arthritis) can occur as a result of many systemic forms of arthritis, including rheumatoid arthritis, osteoarthritis, gouty arthritis, psoriatic arthritis, ankylosing spondylitis, and reactive arthritis (formerly called Reiter’s disease). Generally, they are associated with signs of inflammation of the elbow joint, including heat, warmth, swelling, pain, tenderness, and decreased range of motion. Range of motion of the elbow is decreased with arthritis of the elbow because the swollen joint impedes the range of motion.

Causes of Elbow Arthritis

Arthritis involves the breakdown of cartilage. Cartilage normally protects the joint, allowing for smooth movement. Cartilage also absorbs shock when pressure is placed on the joint, like when you walk. Without the usual amount of cartilage, the bones rub together, causing pain, swelling (inflammation), and stiffness.

You may have joint inflammation for a variety of reasons, including:

  • An autoimmune disease (the body attacks itself because the immune system believes a body part is foreign)
  • Broken bone
  • General “wear and tear” on joints
  • Infection (usually caused by bacteria or viruses)

Often, the inflammation goes away after the injury has healed, the disease is treated, or the infection has been cleared.

With some injuries and diseases, the inflammation does not go away or destruction results in long-term pain and deformity. When this happens, you have chronic arthritis. Osteoarthritis is the most common type and is more likely to occur as you age. You may feel it in any of your joints, but most commonly in your hips, knees or fingers. Risk factors for osteoarthritis include:

  • Being overweight
  • Previously injuring the affected joint
  • Using the affected joint in a repetitive action that puts stress on the joint (baseball players, ballet dancers, and construction workers are all at risk)

Arthritis can occur in men and women of all ages. About 37 million people in America have arthritis of some kind, which is almost 1 out of every 7 people.

Symptoms of Elbow Arthritis

If you have arthritis, you may experience:

  • Joint pain
  • Joint swelling
  • Reduced ability to move the joint
  • Redness of the skin around a joint
  • Stiffness, especially in the morning
  • Warmth around a joint

Exams and Tests of Elbow Arthritis

First, our doctor will take a detailed medical history to see if arthritis or another musculoskeletal problem is the likely cause of your symptoms.

Next, a thorough physical examination may show that fluid is collecting in the joint. (This is called an “effusion.”) The joint may be tender when it is gently pressed, and may be warm and red (especially in infectious arthritis and autoimmune arthritis). It may be painful or difficult to rotate the joints in some directions. This is known as “limited range-of-motion.”

In some autoimmune forms of arthritis, the joints may become deformed if the disease is not treated. Such joint deformities are the hallmarks of severe, untreated rheumatoid arthritis.

Tests vary depending on the suspected cause. They often include blood tests and joint x-rays. To check for infection and other causes of arthritis (like gout caused by crystals), joint fluid is removed from the joint with a needle and examined under a microscope. See the specific types of arthritis for further information.

Treatment of Elbow Arthritis

Treatment of arthritis depends on the cause, which joints are affected, the severity, and how the condition affects your daily activities. Your age and occupation will also be taken into consideration when your doctor works with you to create a treatment plan.

If possible, treatment will focus on eliminating the cause of the arthritis. However, the cause is NOT necessarily curable, as with osteoarthritis and rheumatoid arthritis. Treatment, therefore, aims at reducing your pain and discomfort and preventing further disability.

It is possible to greatly improve your symptoms from osteoarthritis and other long-term types of arthritis without medications. In fact, making lifestyle changes without medications is preferable for osteoarthritis and other forms of joint inflammation. If needed, medications should be used in addition to lifestyle changes.

Exercise for arthritis is necessary to maintain healthy joints, relieve stiffness, reduce pain and fatigue, and improve muscle and bone strength. Your exercise program should be tailored to you as an individual. Work with a physical therapist to design an individualized program, which should include:

  • Low-impact aerobic activity (also called endurance exercise)
  • Range of motion exercises for flexibility
  • Strength training for muscle tone

A physical therapist can apply heat and cold treatments as needed and fit you for splints or orthotic (straightening) devices to support and align joints. This may be particularly necessary for rheumatoid arthritis. Your physical therapist may also consider water therapy, ice massage, or transcutaneous nerve stimulation.

Rest is just as important as exercise. Sleeping 8 to 10 hours per night and taking naps during the day can help you recover from a flare-up more quickly and may even help prevent exacerbations. You should also:

  • Avoid holding one position for too long.
  • Avoid positions or movements that place extra stress on your affected joints.
  • Modify your home to make activities easier. For example, have grab bars in the shower, the tub, and near the toilet.
  • Reduce stress, which can aggravate your symptoms. Try meditation or guided imagery. And talk to your physical therapist about yoga or tai chi.

Other measures to try include:

  • Apply capsaicin cream (derived from hot chili peppers) to the skin over your painful joints. You may feel improvement after applying the cream for 3-7 days.
  • Eat a diet rich in vitamins and minerals, especially antioxidants like vitamin E. These are found in fruits and vegetables. Get selenium from Brewer’s yeast, wheat germ, garlic, whole grains, sunflower seeds, and Brazil nuts. Get omega-3 fatty acids from cold water fish (like salmon, mackerel, and herring), flaxseed, rapeseed (canola) oil, soybeans, soybean oil, pumpkin seeds, and walnuts.
  • Taking glucosamine and chondroitin — these form the building blocks of cartilage, the substance that lines joints. These supplements are available at health food stores or supermarkets. While some studies show such supplements may reduce osteoarthritis symptoms, others show no benefit. However, since these products are regarded as safe, they are reasonable to try and many patients find their symptoms improve.
  • Lose weight, if you are overweight. Weight loss can greatly improve joint pain in the legs and feet.

SURGERY AND OTHER APPROACHES FOR ELBOW ARTHRITIS

In some cases, surgery to rebuild the joint (arthroplasty) or to replace the joint (such as a total knee joint replacement) may help maintain a more normal lifestyle. The decision to perform joint replacement surgery is normally made when other alternatives, such as lifestyle changes and medications, are no longer effective.

Normal joints contain a lubricant called synovial fluid. In joints with arthritis, this fluid is not produced in adequate amounts. In some cases, a doctor may inject the arthritic joint with a manmade version of joint fluid. The synthetic fluid may postpone the need for surgery at least temporarily and improve the quality of life for persons with arthritis.

When to Contact a Medical Professional

Call our doctor if:

  • Your joint pain persists beyond 3 days.
  • You have severe unexplained joint pain.
  • The affected joint is significantly swollen.
  • You have a hard time moving the joint.
  • Your skin around the joint is red or hot to the touch.
  • You have a fever or have lost weight unintentionally.

Prevention of Elbow Arthritis

If arthritis is diagnosed and treated early, you can prevent joint damage. Find out if you have a family history of arthritis and share this information with your doctor, even if you have no joint symptoms.

Osteoarthritis may be more likely to develop if you abuse your joints (injure them many times or over-use them while injured). Take care not to overwork a damaged or sore joint. Similarly, avoid excessive repetitive motions.

Cubital Tunnel Syndrome

Get professional Opinion and Treatment about your Cubital Tunnel Syndrome. Effective and fast relief treatment by Experienced ELbow Specialist. Call us +65 97731458 to schedule for an appointment.

Definition of Cubital Tunnel Syndrome:

Nerve compression syndromes cause symptoms including pain, numbness, and weakness. Nerves can become pinched for a variety of reasons. Most people are familiar with carpal tunnel syndrome, a condition where the median nerve is pinched in the wrist. In the case of cubital tunnel syndrome, one of the other nerves of the upper extremity, the ulnar nerve, is pinched as it passes behind the elbow. This is the same nerve that causes the tingling sensation of hitting your “funny bone.”

Hitting your funny bone is actually a sensation caused by irritating the ulnar nerve behind the elbow. When struck, this causes a shooting sensation and tingling in the small and ring fingers. The ulnar nerve transmits signals to your brain about sensations in these fingers–that’s why the fingers tingle when you hit the nerve in your elbow.

Symptoms of Cubital Tunnel Syndrome
In patients with cubital tunnel syndrome, the ulnar nerve is pinched in one of several locations in the back of the elbow. Common symptoms of cubital tunnel syndrome include:

  • Pain, tingling and numbness in the small and ring fingers
  • Weakness of the muscles in the hand

These weakened muscles, called the intrinsic muscles of the hand, help with finger movements. Patients with more severe symptoms of cubital tunnel syndrome may experience a tendency to drop objects or have difficulty with fine movements of the fingers.

Diagnosis of Cubital Tunnel Syndrome

The diagnosis of cubital tunnel syndrome is made after a thorough history and examination. X-rays or other tests may be ordered if there is a concern of something abnormal pressing on the nerve. Nerve tests, called EMGs, can help to determine the extent of nerve compression, and the location of the nerve compression.

Treatment of Cubital Tunnel Syndrome

Treatment of cubital tunnel syndrome usually begins with some simple steps. Many cases of cubital tunnel syndrome will resolve with a few simple treatments:

  • Anti-inflammatory medications
  • Splinting the elbow, especially at night
  • Padding the elbow for work activities

If these simple treatments fail, surgery may be necessary. Surgery is performed to remove the pressure from the ulnar nerve. Because the nerve can be pinched at one of several locations behind the elbow it is important to know specifically where the nerve is pinched, or to release pressure from all f the possible areas of compression. In some patients, treatment consists of moving the nerve to the front of the elbow, so the nerve is under less tension when the elbow is bent; this is called an ulnar nerve transposition.

Depending on the severity of nerve damage, symptoms may resolve very quickly or they may never entirely resolve. In the most severe cases of cubital tunnel syndrome, some of the symptoms may persist despite surgical treatment.

Get professional Opinion and Treatment about your Cubital Tunnel Syndrome. Effective and fast relief treatment by Experienced ELbow Specialist. Call us +65 97731458 to schedule for an appointment.

Tennis Elbow (Lateral Epicondylitis)

Stop your Elbow Pain today. Effective Treatment, Non Surgery. Discuss with our Elbow Specialist for the Diagnosis, Treatment and Prognosis of your Elbow Pain. Call us +65 97731458 to schedule for an appointment.

What is Tennis Elbow or Lateral Humeral Epicondylitis?

Lateral epicondylitis, commonly known as tennis elbow, is not limited to tennis players. The backhand swing in tenis can strain the muscles and tendons of the elbow in a way that leads of repetitive activities can also lead to tennis elbow. But many other types of repetitive activities can also lead to tennis elbow: painting with a brush or roller, running a chain saw and using many types of hand tools. Any activities that repeatedly stress the same forearm muscles can cause symptoms of tennis elbow.

What parts of the elbow are affected?

Tennis elbow causes pain that starts on the outside bump of the elbow, the lateral epicondyle. The forearm muscles that bend the wrist back (the extensors) attach on the lateral epicondyle and are connected by a single tendon. Tendons connect muscles to bone.

Tendons are made up of strands of a material called collagen. The collagen strands are lined up in bundles next to each other.

Because the collagen strands in tendons are lined up, tendons have high tensile strength. This means they can withstand high forces that pull on both ends of the tendon. When muscles work, they pull on one end of the tendon. The other end of the tendon pulls on the bone, causing the bone to move.

When you bend your wrist back or grip with your hand, the wrist extensor muscles contract. The contracting muscles pull on the extensor tendon. The forces that pull on these tendons can build when you grip things, hit a tennis ball in a backhand swing in tennis, or do other similar actions.

What are the causes of Tennis Elbow or Lateral Humeral Epicondylitis?

Overuse of the muscles and tendons of the forearm and elbow are the most common reason people develop tennis elbow. Repeating some types of activities over and over again can put too much strain on the elbow tendons. These activities are not necessarily high level sports competition. Hammering nails, picking up heavy buckets, or pruning shrubs can all cause the pain of tennis elbow.

In an acute injury, the body undergoes an inflammatory response. Special inflammatory cells make their way to the injured tissue to help them heal. Conditions that involve inflammation are indicated by -itis on the end of the word. For example, inflammation in a tendon is called tendonitis. Inflammation around the lateral epicondyle is called lateral epicondylitis.

However, tennis elbow often does not involve inflammation. Rather, the problem is within the cells of the tendon. Doctors call this condition tendinosis. In tendinosis, wear and tear is thought to lead to tissue degeneration. A degenerated tendon usually has an abnormal arrangement of collagen fibers.

Instead of inflammatory cells, the body produces a type of cells called fibroblasts. When this happens, the collagen loses its strength. It becomes fragile and can break or be easily injured. Each time the collagen breaks down, the body responds by forming scar tissue in the tendon. Eventually, the tendon becomes thickened from extra scar tissue.

No one really knows exactly what causes tendinosis. Some orthopaedics think that the forearm tendon develops small tears with too much activity. The tears try to heal, but constant strain and overuse keep re-injuring the tendon. After a while, the tendons stop trying to heal. The scar tissue never has a chance to fully heal, leaving the injured areas weakened and painful.

What does Tennis Elbow feel like?

The main symptom of tennis elbow is tenderness and pain that starts at the lateral epicondyle of the elbow. The pain may spread down the forearm. It may go as far as the back of the middle and ring fingers. The forearm muscles may also feel tight and sore.

The pain usually gets worse when you bend your wrist backward, turn your palm upward, or hold something with a stiff wrist or straightened elbow. Just reaching into the refrigerator to get a carton of milk can cause pain. Sometimes the elbow feels stiff and won’t straighten out completely.

How is Tennis Elbow or Lateral Humeral Epicondylitis diagnosed?

Our specialist will first take a detailed medical history. You will need to answer questions about your pain, how your pain affects you, your regular activities, and past injuries to your elbow.

The physical exam is often most helpful in diagnosing tennis elbow. Our specialist may position your wrist and arm so you feel a stretch on the forearm muscles and tendons. This is usually painful with tennis elbow. There are also other tests for wrist and forearm strength that can be used to detect tennis elbow.

You may need to get X-rays of your elbow. The X-rays mostly help our specialist rule out other problems with the elbow joint. The X-ray may show if there are calcium deposits on the lateral epicondyle at the connection of the extensor tendon.

Tennis elbow symptoms are very similar to a condition called radial tunnel syndrome. This condition is caused by pressure on the radial nerve as it crosses the elbow. If your pain does not respond to treatments for tennis elbow, our specialist may suggest tests to rule out problems with the radial nerve.

When the diagnosis is not clear, our specialist may order other special tests. A magnetic resonance imaging (MRI) scan is a special imaging test that uses magnetic waves to create pictures of the elbow in slices. The MRI scan shows tendons as well as bones.

Ultrasound tests use high frequency sound waves to generate an image of the tissues below the skin. As the small ultrasound device is rubbed over the sore area, an image appears on a screen. This type of test can sometimes show problems with collagen degeneration.

What are the treatments of Tennis Elbow or Lateral Humeral Epicondylitis?

Nonsurgical Treatment:

The key to nonsurgical treatment is to keep the collagen from breaking down further. The goal is to help the tendon heal.

If the problem is caused by acute inflammation, anti-inflammatory medications  may give you some relief. If inflammation doesn’t go away, our specialist may inject the elbow with anti-inflammatory medication.

Shock wave therapy is a newer form of nonsurgical treatment. It uses a machine to generate shock wave pulses to the sore area. This is to help generate the healing process of the tendon.

Surgical Treatment:

Sometimes nonsurgical treatment fails to stop the pain or help patients regain use of the elbow. In these cases, surgery may be necessary.

– Tendon Debridement

When problems are caused by tendinosis, surgeons may choose to take out (debride) only the affected tissues within the tendon. In these cases, the surgeon cleans up the tendon, removing only the damaged tissue.

– Tendon Release

A commonly used surgery for tennis elbow is called a lateral epicondyle release. This surgery takes tension off the extensor tendon. The surgeon begins by making an incision along the arm over the lateral epicondyle. Soft tissues are gently moved aside so the surgeon can see the point where the extensor tendon attached on the lateral epicondyle.

The extensor tendon is then cut where it connects to the lateral epicondyle. The surgeon splits the tendon and takes out any extra scar tissue. Any bone spurs found on the lateral epicondyle are removed. (Bone spurs are pointed bumps that can grow on the surface of the bones). Some surgeons suture the loose end of the tendon to the nearby fascia tissue. (Fascia tissue covers the muscles and organs throughout your body). The skin is then stitched together.

Stop your Elbow Pain today. Effective Treatment, Non Surgery. Discuss with our Elbow Specialist for the Diagnosis, Treatment and Prognosis of your Elbow Pain. Call us +65 97731458 to schedule for an appointment.

Elbow Pain

Dr Ambrose Yung Knee, Sports and Orthopaedic Centre Knee, Sports and Orthopaedic Clinic

Stop your Elbow Pain today. Effective Treatment, Non Surgery. Discuss with our Elbow Specialist for the Diagnosis, Treatment and Prognosis of your Elbow Pain. Call us +65 97731458 to schedule for an appointment.

Elbow pain is most often the result of tendinitis, which can affect the inner or outer elbow. Treatment includes ice, rest, and medication for inflammation. Elbow pain has many other causes including arthritis and bursitis. Funny bone sensation is irritation of a nerve at the elbow that causes numbness and tingling of the inner elbow, forearm as well as little and ring fingers. Bacteria can infect the skin of a scraped (abraded) elbow to cause pain.

Your elbow is a complex joint that allows you to perform pushing and pulling movements and to rotate your forearm. Elbow pain can be caused by injury or strain to the bones in your elbow joint, the surrounding muscles or the tendons, which attach the muscles to the bones. Elbow pain may also be due to damage arising from the elbow joint’s network of nerves, blood vessels and ligaments. On occasion, problems in your neck, shoulder and upper arm, or your forearm and wrist can result in elbow pain. Elbow pain usually isn’t serious, but because you use your elbow in so many ways, elbow pain can definitely affect your life.

Elbow pain is an extremely common complaint, and there are many common causes of this problem. It is important to make an accurate diagnosis of the cause of your symptoms so that appropriate treatment can be directed at the cause.

Elbow Pain

 

If you have elbow pain, some common causes include:

  • LATERAL EPICONDYLITIS (TENNIS ELBOW) – Tennis elbow is characterized by soreness or pain on the outside of the upper arm near the elbow. There may be a partial tear of the tendon fibers which joins the muscle to bone near their point of origin on the outside of the elbow.
  • MEDIAL EPICONDYLITIS (GOLFER’S ELBOW) – Golfer’s elbow, or medial epicondylitis, is similar to its counterpart, tennis elbow. The primary differences between these conditions are the location of the pain and the activity that leads to injury.
  • OLECRANON BURSITIS – Elbow bursitis, also called olecranon bursitis, causes fluid to collect in a sac that lies behind the elbow, called the olecranon bursa.
  • CUBITAL TUNNEL SYNDROME – Nerve compression syndromes cause symptoms including pain, numbness, and weakness. Nerves can become pinched for a variety of reasons.
  • ULNAR NERVE NEURITIS – Ulnar nerve neuritis begins with a little bit of tingling in the little and ring fingers especially when placing the elbow on arm rests in cars or on a chair.

When do you need to CALL US about your elbow pain?
If you are unsure of the cause of your elbow pain, or if you do not know the specific treatment recommendations for your condition, you should seek medical attention. Treatment of these conditions must be directed at the specific cause of your problem. Some signs that you should be seen by a doctor include:

  • Inability to carry objects or use the arm
  • Injury that causes deformity of the joint
  • Elbow pain that occurs at night or while resting
  • Elbow pain that persists beyond a few days
  • Inability to straighten or flex the arm
  • Swelling or significant bruising around the joint or arm
  • Signs of an infection, including fever, redness, warmth
  • Any other unusual symptoms

What are the best treatments for elbow pain?
The treatment of elbow pain depends entirely on the cause of the problem. Therefore, it is of utmost importance that you understand the cause of your symptoms before embarking on a treatment program. If you are unsure of your diagnosis, or the severity of your condition, you should seek medical advice before beginning any treatment.

Stop your Elbow Pain today. Effective Treatment, Non Surgery. Discuss with our Elbow Specialist for the Diagnosis, Treatment and Prognosis of your Elbow Pain. Call us +65 97731458 to schedule for an appointment.

Singapore Knee, Sports and Orthopaedic Centre

Dr Ambrose Yung Knee, Sports and Orthopaedic Centre Knee, Sports and Orthopaedic Clinic
Orthopaedics, specialising in degenerative, chronic orthopaedic condition and sports injuries to the musculoskeletal system with an exceptional record in orthopaedic treatment especially to the Knees, Hip, Elbow, Foot and Ankle, Wrist and Hand, and Shoulder joints; with special interest in Sports Medicines, Partial and Total Joint Replacement, and Minimal Invasive Trauma Surgery.

Orthopaedics is the area of medicine focusing specifically on the body’s musculo-skeletal system. This includes bones, ligaments, joints, muscles, tendons, and even nerves – essentially, all the parts of the body needed move, work and enjoy your life.

At Singapore Knee, Sports and Orthopaedic Centre, we aim to partner with you to maintain your health, allowing you to lead an enriched, fulfilling life. In-house Orthopaedic Surgeon, Dr Ambrose Yung Wai Yin is an established professional with a solid medical background and qualifications.

In addition to our specialism in sports injuries of the musculo-skeletal system, we can also help with orthopaedic problems of all different natures.

We have an exceptional record in treating sport injuries, especially to the knees, shoulder and ankle joints. We specialise in:

  • Complex knee ligamentous reconstruction, using soft tissue tendon allographs
  • Meniscus repair
  • Meniscus allograft transplantation
  • Autologous chondrocyte implantation, using stem cells
  • Double bundle anterior cruciate ligament reconstruction
  • Arthroscopy of knee, elbow, shoulder, ankle and hip joints
  • Ankle sprain treatment
  • Treatment of stiff and painful shoulders
  • Complex Partial and Total Joint Replacement
  • Minimal Invasive Trauma Surgery

As professionals, we treat your health with passion and care through 4 key aspects: Diagnosis, Treatment, Rehabilitation and Prevention.

READ MORE ABOUT COMMON ORTHOPAEDICS PROBLEM