Pain in the elbow joint is a specific discomfort that indicates the presence of a pathological process in the joint itself or surrounding tissues. Often accompanied by swelling, can be combined with hyperemia, hyperthermia, and other symptoms. It can be diffuse, localized, superficial, deep, dull or acute. It varies from mild to unbearable, sometimes depending on the weather, physical activity or time of day. To determine the cause of pain, radiography, ultrasound, MRI, CT, arthroscopy, and laboratory tests are used. NSAIDs, analgesics, physiotherapy procedures are used for relief.
Bruises are the most common cause of pain. They occur after a blow or fall on the elbow, are manifested by moderately severe pain, which decreases over several days after the injury, is combined with local swelling, some limitation of movement. With tears and ruptures of the ligaments, all symptoms are more pronounced, the pain syndrome intensifies when trying to passively move in the direction opposite to the damaged ligament.
With periarticular and intraarticular fractures of the lower end of the humerus, the upper part of the ulna, the neck and the head of the beam, a sharp explosive pain occurs, from which it darkens in the eyes. Subsequently, the intensity of pain decreases, but the pain remains difficult to bear, intensifies with the slightest attempt to move the joint.
With fractures of the condyles of the shoulder, fractures of the coronoid process, injuries of Montage, the pain is diffuse, felt in the depths of the joint. Fractures of the head and neck of the beam are manifested by more localized pain in a certain area of the elbow bend. With fractures of the olecranon, pain is felt along the back of the elbow. Other symptoms of fractures are significant swelling, deformity, and severe pain during axial loading.
Dislocations of the bones of the forearm are accompanied by unbearable pain, clicking or crunching at the time of injury. In the future, the pain almost does not decrease until the moment of reduction. The joint is swollen, sharply deformed, active movements are impossible, when passive movements are attempted, spring resistance is determined. In children under 5 years of age, after pulling or pulling the hand, subluxation of the head of the beam sometimes occurs, which is manifested by moderate aching pain in the joint, aggravated by trying to bend, feeling the cubital fossa.
Arthritis of the elbow joint is characterized by constant, dull, undulating pains that worsen in the early hours of the morning. The intensity of the pain syndrome varies from insignificant to very strong, depriving sleep, significantly restricting movement. The clinical picture is supplemented by diffuse puffiness, redness, local hyperthermia, stiffness, dysfunction of the joint.
When infected, a severe variant of the disease develops - purulent arthritis, which is characterized by diffuse, bursting, jerking or throbbing pains, combined with severe edema, diffuse hyperemia, local hyperthermia, a significant increase in overall body temperature, and symptoms of general intoxication.
Post-traumatic osteomyelitis of the periarticular ends of the bones occurs after open injuries and operations on the joint, manifested by increasing sharp pains, rapid deterioration, general and local hyperthermia, and the appearance of purulent discharge from the wound. During the transition to the chronic form, the pains become less intense, periodic, pulling or boring, and intensify after exercise. A fistulous tract with purulent discharge is revealed.
Hematogenous osteomyelitis affects the lower part of the humerus less often than the upper one, it is detected in children. Pain within 1-2 days quickly increase, become tearing, pulsating, unbearable, intensify even with minor attempts to move, which makes patients "freeze" in bed. Complemented by general hyperthermia, chills, swelling, redness of the joint.
In acute aseptic bursitis, the pain is moderate, dull, bursting. There is local edema, hyperthermia, fluctuating formation above the olecranon. In the chronic form, the pain subsides, disturbed mainly by pressure, physical activity. Swelling and redness disappear, the formation persists, the skin over it darkens. When infected, the pain syndrome increases sharply, the pains become jerking, bursting, pulsating. Elbow reddened, swollen. The temperature rises, symptoms of general intoxication appear.
Synovitis is not an independent pathology, it occurs with injuries and various diseases of the elbow joint. It is manifested by constant dull, diffuse arching pain, which intensifies as fluid accumulates. The joint increases in volume, its contours are smoothed out. On palpation, fluctuation is determined.
A widespread cause of pain in the elbow joint is enthesopathy - inflammatory and degenerative lesions of the tendons at the point of their attachment to the bones. With lateral epicondylitis (tennis elbow), dull, stabbing or aching pain is localized along the outer surface of the joint, radiating to the shoulder and forearm. Strengthen under load, extension of the middle finger with resistance. Combined with increasing weakness of the hand.
Medial epicondylitis is provoked by repetitive hand movements, occurs in golfers, gymnasts, tennis players, seamstresses, typists. The symptoms are the same as with a lateral lesion, but differ in localization - the pain is felt inside, and not outside the elbow, with palpation and flexion of the hand, pain appears over the inner epicondyle of the shoulder.
Arthrosis of the elbow joint in the initial stages is accompanied by unpleasant sensations, slight pain at the beginning of movements and after a heavy load. With the progression of the pathology, the starting pains become more pronounced, combined with stiffness, after exertion, the pain syndrome remains at rest longer. Movements in the joint are accompanied by crunching.
In the future, pains appear even with little physical activity, disturb at night, become constant, aching, pulling, boring. The joint aches for the weather. Movements are limited, the ability to self-service suffers. Deformations of varying severity are formed, contractures develop.
With chondromatosis, loose bodies form in the joint, which can be infringed and impede movement. This causes the features of the pain syndrome. Along with dull pulling or aching pains that worsen after physical exertion, piercing (shooting, explosive) pain periodically occurs, which is combined with blocking of the joint.
Dissecting osteochondritis often occurs in children and young people, manifested by a pain syndrome that grows throughout the year. First, there is discomfort without a clear localization. Then there are moderate dull pressing or aching pains, combined with a slight crunch and "jamming", blockade of the joint. Subsequently, the pain intensifies, and then weakens, blockades become more rare.
The elbow joint is often affected in rheumatoid arthritis. Features of pain sensations depend on the activity of the rheumatic process. With grade 1 pain in the joint, minor, usually aching, appear in the morning and after exercise, combined with transient stiffness. For grade 2, diffuse deep pulling pains are typical at rest and during movement.
During movement, the pain intensifies, which leads to limited function of the joint. Prolonged stiffness, recurrent effusions, local reddening of the skin are observed. With 3 degrees of activity, the pain is intense, constant, exhausting. They are combined with severe local hyperemia, constant stiffness, persistent synovitis, severe limitation of mobility, development of subluxations and contractures.
For rheumatism, multiple lesions of the joints are typical. Pain quickly migrates from one joint to another. Pain sensations are strong, differ significantly in nature (acute, dull, burning, pulsating, pressing, pulling). Occur after an acute infection, persist for several days, after which they disappear or significantly weaken.
In systemic lupus erythematosus, pain in the elbow joints is usually symmetrical. It is possible to damage several joints (shoulder, elbow, knee, etc.) on one side of the body. With a mild course, the pain is insignificant, short-term, local, dull. For a severe course, long-term progressive pulling or bursting pains are typical, which increase and decrease in waves, combined with edema, hyperemia. Gross restrictions of mobility are uncharacteristic.
Benign neoplasia of the articular ends of the bones, cartilage and surrounding soft tissue structures are characterized by a long course. Pain sensations are insignificant, short-term, dull, pulling, with a fairly clear localization. Symptoms may persist without change for a long time. The growth of the tumor provokes an increase in the pain syndrome, in some cases, due to compression of the nerves, radiating pain occurs, a feeling of "electric shock" or lumbago along the forearm.
Malignant tumors are manifested by rapidly progressive pain syndrome. Initially, the patient complains of dull pain of indeterminate localization, with a tendency to increase at night. Then the pains spread along the joint, acquire a jerking, baking, arching or cutting character, restrict movement, combined with local edema, increasing deformity, asthenia, subfebrile condition, loss of appetite. At the final stage, the pain becomes constant, excruciating, unbearable, it is eliminated only by narcotic drugs.
Neuropathy of the ulnar nerve and ulnar tunnel syndrome are manifested by pulling pains in the form of a strip from the inner epicondyle of the shoulder to the hand. Pain is combined with numbness of the 4th and 5th fingers, aggravated by flexion of the joint. When pressure is applied to the elbow, there is a stabbing pain or a shooting sensation from the elbow to the little finger.
Sometimes pain in the elbow occurs with diseases of the cervical spine. For such pain, sensations of backache are characteristic, spreading along the limb - from the shoulder to the hand. Irradiation of pain in the left elbow joint is possible with coronary artery disease and myocardial infarction. The pain syndrome of this localization can also develop with mental illness and depressive disorders, taking corticosteroids and anabolic steroids.
Diagnosis of traumatic injuries is carried out by traumatologists, non-traumatic lesions of the elbow joint are detected by orthopedists or rheumatologists. The diagnosis is made on the basis of survey data, physical examination and additional studies. To clarify the nature of the pathology, the following methods are used:
In case of injuries, the hand is fixed with a splint or placed on a scarf bandage. Cold is applied to the joint to reduce swelling and bleeding. With intense pain, the victim is given an anesthetic. It is necessary to avoid movements in the elbow joint and attempts to reduce, so as not to aggravate the damage.
For pain without previous injuries, the hand is provided with rest. In the absence of signs of acute inflammation, painkillers and warming agents are used. With a rapid increase in edema, redness of the joint, intense pain, weakness, fever, you should immediately see a doctor.
In case of dislocations and fractures with displacement, reduction or reposition is performed. At the stage of outpatient or inpatient treatment, the patient is recommended a regimen that minimizes the manifestations of the pathological process and creates conditions for recovery. The mode is selected individually, it may include fixation with a plaster splint, suspension of the limb on a scarf bandage, the use of orthopedic devices, or correction of motor activity.
Drug therapy includes NSAIDs and chondroprotectors inside, topical agents. According to indications, chondroprotectors and glucocorticoids are injected into the joint. The elbow joint is considered "capricious", that is, it often reacts negatively to physiotherapeutic methods of treatment, therefore, any procedures are prescribed with caution and only if there are sufficient indications. At the recovery stage, massage and physiotherapy exercises are used.
Operations on the elbow joint are performed using classical open access or minimally invasive arthroscopic techniques. Depending on the nature of the pathological process, the following groups of interventions are distinguished:
With contractures and ankylosis, taking into account the defeat of soft tissue or hard structures, redressing, arthrolysis, arthroplasty or arthrodesis are performed. In some cases, the joint is replaced with an artificial implant during arthroplasty.