The elbow is a very complex joint, with three bones, the humerus, radius, and ulna, coming together to move in flexion, extension, and rotation. The structures most often of clinical significance are the radial head (fracture), the ulnar nerve, the tendinous origin of the extensor muscles, the radial nerve, and the olecranon bursa.
Tennis elbow (lateral epicondylitis) is a painful inflammation of the tendon on the lateral aspect of the elbow, caused by the pull of the muscles which extend the wrist and fingers. It can be caused by acute or repetitive injury. In tennis, it is caused by excessive forces on the elbow with the backhand shot.
The diagnosis of tennis elbow is made by physical examination. Treatment of tennis elbow includes the use of tennis elbow straps, judicious use of cortisone injections, physiotherapy (especially strengthening exercises), heat, ice, and anti–inflammatory medications. If these measures fail, surgical treatment may be indicated, consisting either of removing the necrotic and/or inflammatory tissue, or release of the tendon from the humerus. This can be done as an open operation or through a stab wound as an office procedure. Tennis players can use larger racquet grips, looser strings, and, probably most importantly, tennis lessons to decrease the forces at the elbow.
Ulnar Nerve Compression
The ulnar nerve provides sensation for the small and ring fingers and innervates many of the small muscles of the hand. It can be compressed at the elbow by the ligament of Osborne as the nerve passes through the medial aspect of the elbow, causing numbness, pain, and even weakness in the forearm and hand. The diagnosis is made by physical examination and often confirmed by electrical studies, which measure the nerve’s function. Treatment consists of encouraging the patient to keep pressure off the ulnar nerve at the elbow. If this fails, or is the compression is severe, surgical relief of the pressure by cutting the ligament of Osborne and, frequently, moving the nerve to the front of the elbow. The results of ulnar nerve surgery are usually quite good, although some patients will continue to have symptoms despite nerve decompression.