Elbow: The Silent Joint

Considering the incredible and constant strain that it is subjected to, the elbow is a strong joint indeed. The elbow is a hinge-type joint, formed by the humerus bone of the upper arm, and the radius and ulna bones of the lower arm. Although only flexion and extension occur around the elbow itself, the joint also permits rotation of the radius around the ulna. Like the knee, the elbow is encased within an extensive synovial membrane, which synthesizes synovial fluid for the purpose of lubricating the joint. The elbow is quite stable, owing to the numerous tendons and ligaments that contribute to its integrity.

Acute traumatic elbow injuries are thankfully rare. Those that do occur are almost always the result of extreme stress in power and explosion events, such as throwing. Falls from activities like skating, football or rugby and impact as in combat sports or hockey also sometimes result in sudden traumatic elbow injury. Traumatic injuries of any type must receive immediate medical attention by a qualified sports medicine physician.

Chronic injuries in the elbow are usually a result of overuse, resulting in conditions like the tennis elbow syndrome. Boxers often suffer from such conditions. It important to notice that most people fail to consider the cumulative impact of all stressful events on the elbow, limiting their attention to training related stress only. On the job, mechanics, secretaries, office workers and health professional, for example, are at risk for repetitive overdue syndrome to the elbow, due to constant and excessive contracting of the griping muscles, all of which cross the elbow joint. Most repetitive overuse syndrome of the elbow is seen in the dominant side of a patient.

The biggest problem with the elbow is the tiny size of the tendinous attachment sites, of which there are many. Both impact and the dynamic forces of leverage can progressively weaken these sites. This leverage means that 10 pounds in the hand equals approximately 45 pounds at the shoulder joint, for a person with average arm length. Another way to view this phenomenon is to compare the force you get by turning a bolt with a long handled wrench, as opposed to a short handle wrench. Now consider that a tennis player, for instance, makes this already long lever even longer by putting a racquet in the hand. The impact of receptively hitting the ball, compounded by the very long lever arm created by the racquet, results in cumulative microtrauma to the tendentious attachment sites of the elbow.

Over time, if not treated, these tendons actually begin to fray, much like a nylon rope would if stretched beyond its tensile strength. Eventually, the tendon can detach from its attachment site at the elbow, requiring surgical repair.

Orthopedic Corner | Leon Mead MD Orthopedic Doctor | 730 Goodlette Road North, Suite 201  Naples Florida 34102 | Phone: (239) 262-1119