Elbow rehabilitation

The elbow has a very complex anatomy and function. It is formed where the humerus, ulna and radius meet. The elbow is exposed to injuries as well as to a number of other diseases and conditions. The most common problems are overuse syndromes – so-called tennis elbow and golfer's elbow – which can develop in manual workers but also from working at a computer. Historically, these have been linked to sport, especially epicondylitis of the outer part of the elbow, known as tennis elbow, but interestingly it is also common in surgeons and dentists.

Metabolic diseases such as diabetes and gout can affect the elbow and the surrounding structures, causing bursitis and arthritis. Autoimmune inflammatory diseases such as rheumatoid arthritis and psoriatic arthritis cause swelling of other joints in the body and can also affect the elbow, reducing elbow movement and destroying the joint structures; in RA, rheumatoid nodules develop. The consequences of trauma vary, from reduced movement, dislocation and subluxation to fractures of both the olecranon and the head of the radius. Myositis ossificans, heterotopic ossification and osteochondritis dissecans can develop as a result of trauma, but also idiopathically.

Elbow rehabilitation requires a relatively shorter period of immobilisation than other joints, because the elbow is very prone to contractures. Careful analysis of both X-ray and ultrasound images is important. Normal elbow movements are painless, with a full range of motion and full load-bearing: extension and flexion 0/140 degrees, supination/pronation 90/80 degrees. A normal elbow angles away from the body so that loads can be carried, and this varies from person to person. Besides ligaments and tendons, a number of blood vessels and nerves pass through and around the elbow; of these, the ulnar nerve is the most exposed to injury in this area.