Ligament injuries – instability

A fall on the extended arm can cause serious ligament injuries of the elbow such as elbow dislocation or luxation fractures. After conservative or even surgical therapy, relevant elbow instability with ligamentous insufficiency may remain. Symptomatic instability can also develop as a result of repeated microtrauma during sports (especially throwing sports or volleyball). After an elbow arthroscopy to visualize and quantify the instability, ligament reconstruction is performed using an open technique with suture anchors or additional artificial ligaments (ligament bracing), sometimes also with tendon grafts.

Fracture treatment

Fractures of the humerus near the elbow are common in children after falls on the arm. Depending on age, skeletal maturity and the direction of the force, different fracture patterns occur which can be treated either by immobilization in a cuff and collar or in a plaster cast, depending on stability and displacement of the fragments and axial deviation. Fractures can also occur in the radius or ulna. In the case of more severe displacements or malpositions that exceed the potential of spontaneous correction due to the growth in length of the child, the fracture must be surgically set up and stabilized. For this purpose, metal pins (Kirschner wires, titanium nails TEN) or cannulated screws are often used in the child, in some cases plates are also required. To ensure that further growth is not disturbed by the implants, most implants in children must be removed after the fracture has healed. In adults, fractures in the elbow often occur after sports accidents. Depending on the force involved, additional ligament injuries and even dislocations can occur. Shear fractures of the joint surfaces are also not uncommon. In most cases, surgical therapy with exact alignment of the fragments and stabilization is required. The aim is to achieve sufficient stability so that exercise treatment can be started at an early stage. This is the only way to avoid disturbing movement restrictions in the future.

Impingement / joint stiffness

After injuries and microtrauma in athletes, but also due to arthritic joint changes, painful but also painless movement restriction of the elbow joint can occur. In cases of bony impingement, bone attachments form on the bones near the joint and, depending on their location, can restrict extension or flexion. On clinical examination, a hard stop can often be felt at the end of the range of motion. In many cases, additional free joint bodies are responsible for painful entrapment. Scar strands after injuries or hypertrophic mucosal parts can also cause entrapment in the joint space (soft tissue impingement). Typical symptoms are painful movements during extension or flexion and a positive impingement test. During elbow arthroscopy, the impinging soft tissues can be removed from the affected parts of the joint (dorsal or ventral compartment) under visual control. After chronic movement restrictions, capsular fibrosis is also to be expected, which can lead to movement restrictions even after removal of the pinching soft tissues or bone parts. In these cases, it may also be necessary to cut the capsule under arthroscopic view and perform an arthroscopic arthrolysis to improve mobility. In cases of severe arthrofibrosis, it may also be necessary to perform an open arthrolysis.

Cartilage therapy

Circumscribed cartilage damage (focal cartilage lesions) at the elbow joint can occur after fractures, luxations or in the context of chronic instability. Misuse or overuse during sports (especially throwing sports and martial arts) or through heavy physical work can lead to cartilage lesions.
Depending on the size and severity, several treatment options are available, ranging from physiotherapy to improve muscle balance and joint control, arthroscopic surgery with removal of the defective cartilage and bone marrow stimulation by drilling (microfracturing, nanofracture) and defect coverage with cell-free membranes, to open surgery with autologous bone and cartilage transplantation (MACT) for large and deep bone-cartilage defects.

Epicondylitis humeri (tennis and golfer’s elbow)

Overstrain of the tendon insertions of the extensor muscles (tennis elbow) or the flexor muscles (golfer’s elbow) is rarely caused by the practice of these sports. Rather, increased activity at the PC with a mouse and constant strain on the muscles lead to painful overloading of the muscle attachments at the elbow. Poor ergonomics at the workplace or in the home office can exacerbate the problem. Physical activities that often involve repetitive motions can also cause overuse. In most cases, targeted non-surgical therapy with a combination of anti-inflammatory medications as well as specialized physical therapy and manual techniques combined with modification of the problematic movement patterns can result in improvement to the point of freedom from symptoms. Improving ergonomics at the workplace is also often helpful. In stubborn cases, additional injections, especially of autologous blood concentrates and autologous growth factors (PRP, ACP) into the muscle attachments, can also bring about faster pain relief by accelerating the self-healing of the tissue. Only in a few cases is surgery necessary after conservative therapeutic approaches have been exhausted. Here, on the one hand, the affected muscle insertion is loosened somewhat (release). In addition, the sensitive nerve insertions in the area are cut to achieve pain relief.