Triceps Tendon Rupture

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The triceps tendon is the one at the back of the upper arm - as shown opposite. It inserts into the back of the elbow. If you fall onto your hands you can rupture this tendon. If you over-do the weights or try to push something too heavy you can also rupture the tendon or it could become inflamed through over use.


Symptoms include:
  • Elbow pain at rest and during exercise.
  • A painful swelling on the back of the elbow.
  • Limited mobility in the elbow.


              Treatment For Triceps Tendon Rupture
  • Rest.
  • Apply ice or cold therapy to the injury in the first two days.
  • Use ultrasound or laser treatment.
  • Prescribe anti-inflammatory medication such as ibuprofen.
Physiotherapy Rehabilitation

Aims of rehabilitation
  • To reduce initial pain, inflammation and swelling.
  • Restore or improve flexibility.
  • Increase strength.
  • Return to full fitness.
Decreasing pain and inflammation
  • Ice - apply for 20 minutes at least three times a day. Every two hours if possible for the first day.
  • Rest - avoid any activities which cause pain. If it hurts you are probably making it worse.
  • NSAID (Non Steroidal Anti-inflammatory Drugs) e.g. Ibuprofen can help reduce inflammation in the early stages. Always consult a Doctor or Pharmacist before taking any medication. Ibuprofen should not be taken by people who have asthma.
  • Maintain fitness by running or walking. It is important that you maintain some kind of training routine.
Improving flexibility
  • Stretching exercises for the tricep muscle can begin as soon as pain allows.
  • Stretching should be done regularly, three times a day initially and should be maintained long after the injury has healed to prevent the injury returning.
  • Hold the stretch for 20 to 30 seconds, repeat 5 times as long as there is no pain.
  • Use sports massage techniques. This will help prevent adhesions (sticky bits) forming. These adhesions stop the tendon sliding smoothly in its sheath.
  • Sports massage should also be used on the tricep muscles themselves to aid in improving the flexibility and general condition of these muscles.

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((Triceps stretch)) Place the arm to be stretched behind the neck, with the elbow pointing to the ceiling. Gently use the other arm to pull the elbow further towards the head and increase the stretch. You should feel a stretch in the back of the upper arm. If it is painful then ease off or stop completely until it is not painful. Hold for 20 to 30 seconds. Repeat 5 times and stretch at least every day. Three times a day is preferable in the early stages of rehabilitation.
StrengtheningExercises
  • Strengthening exercises should begin as soon as they can be done without pain. This may be as early as 2 days after injury but could be a week or more depending on severity.
  • If you can move the arm comfortably without pain then you may be able to begin strength training.
  • Strengthening exercises should be done 3 to 4 times a week. As the intensity of exercise increases, so must the rest period to allow the elbow to recover before the next training session.
  • Strengthening sessions should always be done with a good stretch before and after.
  • Apply ice after strengthening sessions to keep inflammation down, especially in the first few sessions
Simple Strengthening Exercises Pictures (Click on the picture to read description)
 
 

Elbow (Olecranon) Bursitis

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Bursae are thin, slippery sacs located throughout the body that act as cushions between bones and soft tissues. They contain a small amount of lubricating fluid that allows the skin to move freely over the underlying bone.

The olecranon bursa lies between the loose skin and the pointy bone at the back of the elbow called the olecranon.

Normally, the olecranon bursa is flat. If it becomes irritated or inflamed, more fluid will accumulate in the bursa and bursitis will develop.


Causes:

Cause Elbow bursitis can occur for a number of reasons.
  • Trauma: A hard blow to the tip of the elbow can cause the bursa to produce excess fluid and swell
  • Prolonged pressure: Leaning on the tip of the elbow for long periods of time on hard surfaces, such as a tabletop, may cause the bursa to swell. Typically, this type of bursitis develops over several months.
  • Infection: If an injury at the tip of the elbow breaks the skin, such as an insect bite, scrape, or puncture wound, bacteria may get inside the bursa sac and cause an infection. The infected bursa produces fluid, redness, swelling, and pain. If the infection goes untreated, the fluid may turn to pus.
  • Occasionally, the bursa sac may become infected without an obvious injury to the skin.
  • Medical conditions: Certain conditions, such as rheumatoid arthritis and gout, are associated with elbow bursitis.
Symptoms:
Swelling is often the first symptom. The skin on the back of the elbow is loose, which means that a small amount of swelling may not be noticed right away.
As the swelling continues, the bursa begins to stretch, which causes pain. The pain often worsens with direct pressure on the elbow or with bending the elbow. The swelling may grow large enough to restrict elbow motion.

If the bursitis is infected, the skin becomes red and warm. If the infection is not treated right away, it may spread to other parts of the arm or move into the bloodstream. This can cause serious illness. Occasionally, an infected bursa will open spontaneously and drain pus.

Investigation:
After discussing your symptoms and medical history, your doctor will examine your arm and elbow.

Your doctor may recommend an x-ray to look for a foreign body or a bone spur. Bone spurs are often found on the tip of the elbow bone in patients who have had repeated instances of elbow bursitis. Your doctor may choose to take a small sample of bursa fluid with a needle to diagnose whether the bursitis is caused by infection or gout. Blood tests are not usually helpful.

Treatment:
f your doctor suspects that bursitis is due to an infection, he or she may recommend aspirating (removing the fluid from) the bursa with a needle. This is commonly performed as an office procedure. Fluid removal helps relieve symptoms and gives your doctor a sample that can be looked at in a laboratory to identify if any bacteria are growing. This also lets your doctor know if a specific antibiotic is needed to fight the infection. Your doctor may prescribe antibiotics before the exact type of infection is identified. This is done to prevent the infection from progressing. The antibiotic that your doctor prescribes at this point will treat a number of possible infections.

If the bursitis is not from an infection, it is treated with a number of options.
  • Elbow pads. An elbow pad may be used to cushion your elbow.
  • Activity changes. Avoid activities that cause direct pressure to your swollen elbow.
  • Medications. Oral medications such as ibuprofen or other anti-inflammatories may be used to reduce swelling and relieve your symptoms.
If swelling and pain do not respond to these measures after 3 to 4 weeks, your doctor may recommend removing fluid from the bursa and injecting a corticosteroid medication into the bursa. The steroid medication is an anti-inflammatory drug that is stronger than the medication that can be taken by mouth. Corticosteroid injections usually work well to relieve pain and swelling. However, symptoms can return.






 
 

Lateral Epicondylitis

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Lateral epicondylitis also known as (tennis elbow, shooter's elbow and archer's elbow) is a condition where the outer part of the elbow becomes sore and tender.

Tennis elbow is an inflammation of the tendons that join the forearm muscles on the outside of the elbow. The forearm muscles and tendons become damaged from overuse — repeating the same motions again and again. This leads to pain and tenderness on the outside of the elbow.

Anatomy:
Lateral epicondylitis, or tennis elbow, involves the muscles and tendons of your forearm. Your forearm muscles extend your wrist and fingers. Your forearm tendons -- often called extensors -- attach the muscles to bone. They attach on the lateral epicondyle. The tendon usually involved in tennis elbow is called the Extensor Carpi Radialis Brevis (ECRB).

Causes Of Lateral Epicondylitis:

Overuse
Recent studies show that tennis elbow is often due to damage to a specific forearm muscle. The extensor carpi radialis brevis (ECRB) muscle helps stabilize the wrist when the elbow is straight. This occurs during a tennis groundstroke, for example. When the ECRB is weakened from overuse, microscopic tears form in the tendon where it attaches to the lateral epicondyle. This leads to inflammation and pain.

The ECRB may also be at increased risk for damage because of its position. As the elbow bends and straightens, the muscle rubs against bony bumps. This can cause gradual wear and tear of the muscle over time.

Activities
Athletes are not the only people who get tennis elbow. Many people with tennis elbow participate in work or recreational activities that require repetitive and vigorous use of the forearm muscle.

Painters, plumbers, and carpenters are particularly prone to developing tennis elbow. Studies have shown that auto workers, cooks, and even butchers get tennis elbow more often than the rest of the population. It is thought that the repetition and weight lifting required in these occupations leads to injury.

Age
Most people who get tennis elbow are between the ages of 30 and 50, although anyone can get tennis elbow if they have the risk factors. In racquet sports like tennis, improper stroke technique and improper equipment may be risk factors.

Unknown
Lateral epicondylitis can occur without any recognized repetitive injury. This occurence is called "insidious" or of an unknown cause.

Signs And Symptoms:
  1. Pain on the outer part of elbow (lateral epicondyle).
  2. Point tenderness over the lateral epicondyle – a prominent part of the bone on the outside of the elbow.
  3. Gripping and movements of the wrist hurt, especially wrist extensionand lifting movements.
  4. Activities that use the muscles that extend the wrist (e.g. pouring a pitcher or gallon of milk, lifting with the palm down) are characteristically painful.
  5. Morning stiffness.

Investigation for Lateral Epicondylitis:

1) Cozen's Test: The patient's elbow is stabilized by the examiner's thumb, which rests on the patient's lateral epicondyle. The patient is then asked to make a fist, pronate the forearm and radially deviate and extend the wrist while the examiner resists the motion. A positive sign is indicated by sudden severe pain in the area of lateral epicondyle of the humerus.

2) Mill's Test:  While palpating the lateral epicondyle, the examiner pronates the patient's forearm, and flexes the wrist fully and extends the elbow. A positive test is indicated by pain over the lateral epicondyle of humerus.




                    Treatment For Lateral Epicondylitis
  • Rest - The first step toward recovery is to give your arm proper rest. This means that you will have to stop participation in sports or heavy work activities for several weeks.
  • Medication - NSAIDS like aspirin or ibuprofen reduce pain and swelling.
  • Brace - Using a brace centered over the back of your forearm may also help relieve symptoms of tennis elbow. This can reduce symptoms by resting the muscles and tendons.
  • Cold Therapy - should be applied in the early stages - first couple of days. This can ease the pain, reduce swelling, reduce bleeding (initially) and encourage blood flow (later). Do not apply ice directly to the skin as this may cause ice burns - wrap in a wet tea towel.
  • Massage - Can play an important part in the rehabilitation process.
  • Stretching Exercises -  should begin as soon as possible, gently at first and continue throughout the rehabilitation process and after.  Hold stretches initially for 10 - 15 seconds - during the acute stage. Later stretches should be held for up to 40 seconds.
  • Strengthening Exercises should begin as soon as pain allows. This will depend on how bad the injury is. If it hurts during the exercise, after or makes it worse the next day then do not continue with strengthening exercises. Apply cold therapy after strengthening exercises
  • ultrasound or laser treatment to help reduce pain and inflammation as well as stimulate healing. 
  • Soft tissue mobilization is done with and perpendicular to the tissue involved
  • TENS for pain relief.
  • Cortisone Injection - Your doctor may suggest an injection of a small dose of steroid to the affected area. This is not the sort of steroid banned for athletes. If used it can last for up to three months, and although it may need to be repeated you seldom need more than two or possibly three injections.