DOCTOR'S VIEWS ARCHIVE
Elbow Pain -- Star Pitcher Out
The Chicago Cubs star pitcher Kerry Wood will miss the entire 1999 season because of an elbow injury, leaving the Cubs without the pitcher who dazzled baseball in 1998 when he was the National League Rookie of the Year.
The 21-year-old right-hander damaged the ulnar collateral ligament in his right elbow during his spring training debut this year.
The elbow is a frequently injured joint. Three long bones meet there -- the bone of the upper arm (the humerus), the inner bone of the forearm (the ulna), and the outer bone of the forearm (the radius) -- to allow the elbow to act as a hinge. The radius and ulna also meet in the elbow to allow for rotation of the forearm.
The outside bony portion of the elbow is referred to as the lateral epicondyle and is a part of the humerus bone. The lateral collateral ligament is attached to this area which can be injured, causing inflammation or tendonitis (lateral epicondylitis, or "tennis elbow").
The inner bony portion of the elbow is called the medial epicondyle. The ulnar collateral ligament attaches here and can be injured, causing inflammation or tendonitis (medial epicondylitis, or "golfer's elbow"). It is the ulnar collateral ligament that Kerry Wood injured.
A fluid-filled sac (bursa), which serves to reduce friction, overlies the tip of the elbow (olecranon bursa). The elbow can be affected by inflammation of the tendons (tendonitis) or the bursae (bursitis), or conditions which affect the bones and joints, such as fractures, arthritis, or nerve irritation.
The lateral epicondyle is the outside bony portion of the elbow where large tendons attach to the elbow from the muscles of the forearm. These tendons can be injured (causing "tennis elbow"), especially with repetitive motions of the forearm, such as using a manual screwdriver, washing windows, or hitting a backhand in tennis play.
Tennis elbow results in pain over the outside of the elbow, occasionally with warmth and swelling, but always with local tenderness. The elbow maintains its full range of motion, as the inner joint is not affected, and the pain can be particularly noticed toward the end of the day. Repeated twisting motions or activities which strain the tendon typically causes increased pain. X-rays can reveal calcium deposits in the tendon or other unforeseen abnormalities of the elbow joint.
The treatment of lateral epicondylitis includes ice packs, resting the involved elbow, and anti-inflammatory medications. Anti- inflammatory medications typically used include aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) such as naproxen (NAPROSYN), diclofenac (VOLTAREN), and ibuprofen (MOTRIN). Bracing the elbow can help. Local cortisone injections are given for persistent pain. Activity involving the elbow is resumed gradually. Ice application after activity can reduce or prevent recurrent inflammation. Occasionally, supportive straps can prevent repeated injury. In severe cases, an orthopedic surgical repair is performed.
Medial epicondylitis is inflammation at the point where the tendons of the forearm attach to the bony prominence of the inner elbow. As an example, this tendon can become strained in a golf swing, but many other repetitive motions can injure the tendon. Golfer's elbow is characterized by local pain and tenderness over the inner elbow. The range of motion of the elbow is preserved because the inner joint of the elbow is not affected. Those activities which require twisting or straining the forearm tendon can elicit pain and worsen the condition. X-rays for epicondylitis are usually normal but can indicate calcifications of the tendons if the tendonitis has persisted for extended periods of time.
The usual treatment of medial epicondylitis involves ice packs, resting the elbow, and medications including aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs). Examples of NSAIDs include naproxen (NAPROSYN), diclofenac (VOLTAREN), and ibuprofen (MOTRIN). With severe inflammation, local corticosteroid (cortisone) injections are sometimes given. Using a strap can help prevent repeated injury. After a gradual rehabilitation exercise program, a return to usual activity is best accompanied by ice applications after use to avoid recurrent inflammation.