Brett Favre Suffers from Elbow Tendonitis
Brett Favre has started in 289 consecutive games. He practiced today, but is complaining of right elbow tendonitis. Let’s look at what is going on with this injury.
The elbow is a hinged joint, with many structural supports on the inner and outer parts of the joint. Three bones make up the elbow joint: the humerus (upper arm bone), the ulna (a forearm bone), and the radius (another forearm bone).
On the inner aspect of the elbow, the medial or ulnar collateral ligament (UCL), gives stability to the elbow. On the outer part of the elbow, the lateral or radial collateral ligament (RCL) and annular ligament provide stability for the elbow. In addition, the muscles that flex the wrist originate from the inner aspect of the elbow. A lot of stress and force passes through these structures with certain activities. The UCL and wrist flexors must withstand a lot of force with throwing.
The motion of throwing produces forces which try to separate the ulna from the humerus. This can irritate or injure the UCL or wrist flexors. This is known as medial epicondylitis or golfer’s elbow.
Repetitive motion activities, such as throwing or typing, can cause irritation to the insertion site of the wrist flexors. Over time, this can lead to pain in the medial (inner) epicondyle.
Athletes complain of pain in the medial epicondyle with throwing activities, wrist flexing activities, or repetitive actions. There can be tenderness and swelling over this area.
The initial treatment is conservative/non surgical management. This includes the use of topical or oral anti-inflammatories, changes in activities, physical therapy, ultrasound, electrical stimulation, or elbow straps. Steroid injections into the medial epicondyle can be beneficial for patients. If extremely painful, patient can be immobilized for short periods of time.
Platelet rich plasma (PRP) has recently gotten a lot of attention. Blood from a patient is harvested and spun in a centrifuge. This concentrates the platelets. The platelets are then reinjected into the injured area. The theory of this treatment is based on the fact that platelets are usually the first substances involved in the healing or blood clotting process. The platelets contain growth factors and healing factors that are thought to be beneficial in healing. By injecting a concentrated amount of platelets into an injured area, the healing factors are believed to aid in healing.
If the non-surgical treatment fails, a patient can undergo a surgical debridement of the wrist flexor origin site. This can be done arthroscopically, with two to three small incisions in the elbow or with an open procedure where a 2 to 3 centimeter incision is made over the medial epicondyle.
WHEN TO SEEK MEDICAL CARE
Individual who have persistent pain, swelling, or difficultly throwing should seek medical attention.
RETURN TO ACTIVITIES/OUTCOMES
Most athletes will respond to conservative care. It usually takes 4 to 6 weeks for the pain to get better. For those athletes who require surgery, about 3 months is needed before throwing activities can be restarted.
For a video animation of “Medial Epicondylitis”, please see the “Education” tab of my website. Click orthopaedics, then elbow, then conditions, then medial epicondylitis.
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