The elbow — common disease patterns and treatment options

The elbow joint has beco­me the focus of inte­rest in recent years. Diver­se dise­a­se pat­terns in child­hood and adult­hood lead to pro­blems with the elbow joint. On the one hand, free joint bodies can acu­te­ly block the move­ment in the elbow joint, inser­ting ten­dons can be dege­ne­ra­ti­ve and even tear, post-trau­ma­tic mal­po­si­ti­ons or soft tis­sue con­trac­tures lead to mas­si­ve move­ment rest­ric­tions. Both open and arthro­sco­pic, recon­s­truc­ti­ve and endo­pro­sthe­tic pro­ce­du­res are reco­gni­zed sur­gi­cal tech­ni­ques. In the fol­lo­wing, the most com­mon sym­ptoms of the elbow and sui­ta­ble the­ra­py opti­ons are pre­sen­ted to you.

1. Ten­nis elbow (Epi­con­dy­lo­pa­thia hume­ri radialis)
2. Free joint bodies, osteo­chon­dro­sis dissecans
3. Stiff elbow
4. Rup­tu­re of the distal biceps and tri­ceps tendons
5. Elbow insta­bi­li­ties
6. Frac­tures of the elbow joint
7. Osteo­ar­thri­tis of the elbow joint

Tennis elbow

The epi­con­dy­lo­pa­thia hume­ri radia­lis, also known col­lo­qui­al­ly as ten­nis elbow, is cau­sed by ove­r­use in the area of the exten­sor ten­dons with an attach­ment to the outer pro­tru­ding bone of the elbow joint. The focus is pri­ma­ri­ly on con­ser­va­ti­ve the­ra­py with phy­sio­the­ra­py and, if neces­sa­ry, infil­tra­ti­on the­ra­py. If the sym­ptoms per­sist, any sur­gi­cal the­ra­py should be recon­side­red, which can be car­ri­ed out mini­mal­ly inva­si­ve­ly (arthro­sco­pi­cal­ly) or openly.

Free joint bodies, osteochondrosis dissecans

For reasons that are not yet ful­ly unders­tood, bone tis­sue may break down in young, often spor­ty pati­ents. As the dise­a­se pro­gres­ses, the under-sup­pli­ed bone sepa­ra­tes and, as a free joint body in the elbow joint, leads to com­plaints and blocka­ges in move­ment. Here, too, the­re is stage-appro­pria­te the­ra­py in the form of arthro­sco­pic or open pro­ce­du­res. Free joint bodies can also occur in the cour­se of dege­ne­ra­ti­ve pro­ces­ses, which can easi­ly be remo­ved using elbow joint arthro­sco­py (see illustration).

Stiff elbow

An elbow joint stiff­ness can occur as a con­se­quence of an acci­dent or as part of dege­ne­ra­ti­ve pro­ces­ses. This is trea­ted by elbow arthro­sco­py by remo­ving excess bone and remo­ving the thi­c­ke­ned cap­su­le. In the case of lar­ge ossi­fi­ca­ti­ons (het­e­ro­to­pic ossi­fi­ca­ti­ons), howe­ver, the joint some­ti­mes has to be ope­ned and the pro­tru­ding bones remo­ved. After the ope­ra­ti­on, fur­ther tre­at­ment takes place on a moto­ri­zed splint in order to main­tain the mobi­li­ty that has been gained.

Rupture of the biceps and triceps tendons at the elbow joint

Hea­vy phy­si­cal acti­vi­ty as well as incor­rect sport­ing acti­vi­ties can lead to tearing of the lar­ge flex­or (biceps) or exten­sor ten­don (tri­ceps ten­don) at the elbow joint. In the case of non-sur­gi­cal tre­at­ment, a loss of strength can occur, so that reat­tach­ment (refix­a­ti­on) of the ten­don is usual­ly recom­men­ded sur­gi­cal­ly. This is usual­ly achie­ved by inser­ting anchors into the bone. It takes about 12 weeks to heal.

Elbow instabilities

A trau­ma­tic dis­lo­ca­ti­on of the elbow joint (elbow dis­lo­ca­ti­on) can in some cases result in an ope­ra­ti­on in which the sta­bi­li­zing col­la­te­ral liga­ments are sutured again. If dis­lo­ca­ti­ons occur again and again, the only opti­on is to replace them with a liga­ment repla­ce­ment with the help of ano­ther ten­don from the elbow joint, knee joint or the tis­sue bank. Post­ope­ra­tively, the immo­bi­liza­ti­on takes place in a splint, which allows an axi­al­ly cor­rect move­ment wit­hout stres­sing the new­ly recon­s­truc­ted liga­ments. Here, too, a mini­mum heal­ing peri­od of around 12 weeks can be expected.

Fractures of the elbow joint

The elbow joint con­sists of the hume­rus and two fore­arm bones, which are con­nec­ted by two joint com­part­ments. In addi­ti­on to the exten­si­on and fle­xi­on, the elbow joint is also invol­ved in the tur­ning move­ment. A direct impact trau­ma on the elbow or a fall on the outstret­ched arm can lead to frac­tures with and wit­hout dis­lo­ca­ti­on of the joint, some of which requi­re an ope­ra­ti­on. Screws and pla­tes are inser­ted to sta­bi­li­ze the frac­tu­re. In some cases, the recon­s­truc­tion of the arti­cu­lar sur­face is not pos­si­ble, so that, for exam­p­le, the spo­ke head has to be repla­ced by a radi­us head prosthesis.

Osteoarthritis of the elbow joint

Post-trau­ma­tic secon­da­ry con­di­ti­ons or various forms of osteo­ar­thri­tis can lead to a com­ple­te des­truc­tion of the joint, so that joint-pre­ser­ving the­ra­py is no lon­ger pos­si­ble. The implan­ta­ti­on of an arti­fi­ci­al elbow joint impli­es a reduc­tion in the car­ry­ing weight of the affec­ted extre­mi­ty to 5kg. Becau­se of this, the indi­ca­ti­on for implan­ta­ti­on is only to be made if the­re is a strict indication.

Current research projects

In the area of elbow patho­lo­gies, the­re are still many unans­we­red ques­ti­ons, so that rese­arch at the Cen­ter for Mus­cu­los­ke­le­tal Sur­gery is also con­cer­ned with cla­ri­fy­ing the­se ques­ti­ons. The main focus is on elbow insta­bi­li­ty, pos­si­ble forms of cell the­ra­py for car­ti­la­ge dama­ge to the elbow joint and alter­na­ti­ve forms of the­ra­py for the tre­at­ment of the ten­nis elbow joint.