Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Dr. Lee was born in Shanghai, China, and received his college and medical training in the United States. He is fluent in English and three Chinese dialects. He graduated with chemistry departmental honors from Harvey Mudd College. He was appointed president of AOA society at UCLA School of Medicine. He underwent internal medicine residency and gastroenterology fellowship training at Cedars Sinai Medical Center.
Catherine Burt Driver, MD, is board certified in internal medicine and rheumatology by the American Board of Internal Medicine. Dr. Driver is a member of the American College of Rheumatology. She currently is in active practice in the field of rheumatology in Mission Viejo, Calif., where she is a partner in Mission Internal Medical Group.
What are diseases and conditions that can cause
elbow pain, and how are they treated?
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.
Cellulitis
Inflammation of the skin
related to infection (cellulitis)
commonly occurs as a result of abrasions of the skin. When abrasions or puncture
wounds occur, bacteria on the surface of the skin can invade the deeper layers
of the skin. This causes inflamed skin characterized by redness, warmth,
and swelling. The most common bacteria that cause cellulitis include
Staphylococcus and Streptococcus. Patients can have an associated low-grade
fever. Cellulitis generally requires
antibiotic
treatment, either orally or intravenously. Heat application can
help in
the healing process. Cellulitis can lead to infection of the olecranon bursa, causing olecranon bursitis, as described above.
Infected elbow joint (septic arthritis)
Infection of the elbow joint with bacteria (septic arthritis)
is
uncommon. It is most often seen in patients with suppressed
immune systems
or diabetes, those taking cortisone medications, or intravenous
drug
abusers. The most common bacteria that cause infection of the
elbow joint
are Staphylococcus and Streptococcus. Septic arthritis of the
elbow
requires antibiotic treatment and often surgical drainage. It is
characterized by heat, swelling, redness, and pain,
with limited
range of motion of the elbow joint. Septic arthritis is often associated with
fever,
sweats, and chills.
Osteochondritis dissecans
Osteochondritis dissecans is an uncommon disease of cartilage in the joint whereby the cartilage effectively flakes away from the bone. This can lead to locking, pain, and loss of range of motion of the elbow. Osteochondritis
dissecans is diagnosed by MRI scan or contrast CT scan imaging of the involved elbow joint. This is generally treated by arthroscopic surgical repair and removal of the diseased cartilage.
Tumors
Bone tumors of the elbow joint are rare. Primary bone cancer
can occur.
It can be painless or associated with pain in the elbow joint.
It is
usually detectable by X-ray testing. Nuclear medicine bone
scanning can
also be helpful for detection.
Ulnar nerve entrapment
The ulnar nerve is the "funny bone" nerve which
travels
between the tip of the elbow and the inner elbow bone. At this
site it can
be "pinched" by normal structures or swollen
structures after
injury. This pinching is referred to as entrapment. When ulnar
nerve
entrapment occurs, numbness and tingling of the little and ring
finger of
the hand may be felt. Pain may occur in the entire forearm,
usually the
inner side. Hand dexterity can be affected. Sometimes, the
numbness is
reproduced by elevating the hand. Treatment consists of
avoiding repeated
trauma or pressure to the elbow area and resting the elbow
joint.
Occasionally, ice can help. In severe cases, surgical
repositioning of the
ulnar nerve can be required. This relocates the ulnar nerve to
a position
where it will not be continually compressed by the surrounding
structures.
A pinched nerve can be caused of a variety of conditions, for example, carpal tunnel syndrome, herniated disc, sciatica, arthritis, spinal stenosis, trauma, and more. Common symptoms of a pinched nerve include pain, numbness, tingling, and weakness. Treatment of a pinched nerve depends on the cause of the pinched nerve.
In the U.S., more than 2,000 people are diagnosed with bone cancer every year. There are many types of bone cancer. The most common forms of bone cancer are osteosarcoma, Ewing's sarcoma, chondrosarcoma, malignant fibrous histiocytoma, fibrosarcoma, and chordoma. Pain is the most common symptom. Treatment usually involves surgery, chemotherapy, and radiation therapy.
Cellulitis is an acute spreading bacterial infection below the surface of the skin characterized by redness, warmth, inflammation, and pain. The most common cause of cellulitis is the bacteria Staph (Staphylococcus aureus).
Arthritis is inflammation of one or more joints. When joints are inflamed they can develop stiffness, warmth, swelling, redness and pain. There are over 100 types of
arthritis including osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, lupus, gout,
and pseudogout.
Bursitis is inflammation of a bursa. A bursa is a tiny fluid-filled sac that functions as a gliding surface to reduce friction between tissues of the body. There are 160 bursae in the body. The major bursae are located adjacent to the tendons near the large joints, such as the shoulders, elbows, hips, and knees.
Fractures occur when bone cannot withstand the outside forces applied to the bone. Fractures can be open or closed. Types of fractures include: greenstick, spiral, comminuted, transverse, compound, or vertebral compression. Common fractures include: stress fracture, compression fracture, rib fracture, and skull fracture. Treatment depends upon the type of fracture.
An injury to a ligament is called a sprain, and an injury to muscle or tendon is called a strain. Sprains and strains may be caused by repetitive movements or a single stressful incident. Symptoms include pain and swelling. Though treatment depends upon the extent and location of the injury, rest, ice, compression, and elevation are key elements of treatment.
Chronic pain is pain (an unpleasant sense of discomfort) that persists or progresses over a long period of time. In contrast to acute pain that arises suddenly in response to a specific injury and is usually treatable, chronic pain persists over time and is often resistant to medical treatments.
Septic arthritis, or infectious arthritis, is infection of one or more joints by bacteria, viruses, or fungi. Symptoms and signs of septic arthritis include fever, joint pain, chills, swelling, redness, warmth, and stiffness. Treatment involves antibiotics and the drainage of the infected joint.
Nonsteroidal antiinflammatory drugs (NSAIDs) are prescribed medications for the treatment of inflammatory conditions. Examples of NSAIDs include aspirin, ibuprofen, naproxen, and more. One common side effect of NSAIDs is peptic ulcer (ulcers of the esophagus, stomach, or duodenum). Side effects, drug interactions, warnings and precautions, and patient safety information should be reviewed prior to taking NSAIDs.
With osteochondritis dissecans, bone and its adjacent cartilage loses its blood supply. Though osteochondritis dissecans can involve any joint's bone and cartilage, elbows and knees are most commonly affected. Though there is no known cure, arthroscopic surgery is frequently performed to remove the damaged cartilage and bone tissue from the joint.
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