Elbow Pain: Causes, Diagnosis, and Treatment Options - Orthopedics

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Elbow pain, especially when it feels like the joint is "stuck" and cannot fully extend, can be quite frustrating and debilitating. Given your history of elbow issues lasting over 4.5 years, it's essential to explore the potential causes and treatment options thoroughly.


Possible Causes of Elbow Pain
1. Soft Tissue Injury: The pain you describe, particularly in the triceps area (the back of the elbow), could be due to soft tissue injuries such as tendinitis or tendinopathy. These conditions often arise from repetitive motions, such as those involved in basketball, where the elbow is subjected to stress during shooting and passing.

2. Joint Issues: Conditions like elbow bursitis (inflammation of the bursa) or synovitis (inflammation of the joint lining) could also lead to pain and restricted movement. These conditions can develop over time, especially if there has been a history of trauma or overuse.

3. Post-Traumatic Changes: Your history of a previous fracture and prolonged immobilization in a cast could have led to changes in the elbow joint. Sometimes, after a fracture, the joint may develop stiffness or changes in the soft tissues that can lead to chronic pain and limited range of motion.

4. Loose Bodies: In some cases, small fragments of bone or cartilage can become loose within the joint, causing a sensation of locking or catching. This is often seen in cases of previous trauma or degenerative changes.

5. Nerve Entrapment: Conditions such as ulnar nerve entrapment can also cause pain and a sensation of weakness or "sticking" in the elbow. This is particularly relevant if you experience tingling or numbness in the ring and little fingers.


Diagnosis
To accurately diagnose the cause of your elbow pain, a comprehensive evaluation is necessary. While X-rays are useful for identifying fractures and bone abnormalities, they may not reveal soft tissue injuries or subtle joint issues. Here are some recommended diagnostic steps:
1. MRI Scan: An MRI is an excellent tool for visualizing soft tissues, including muscles, tendons, and ligaments. It can help identify conditions like tendinitis, tears, or other soft tissue injuries that may not be visible on X-rays.

2. Ultrasound: This imaging technique can also be useful for assessing soft tissue structures around the elbow and can sometimes be performed in real-time to evaluate movement and function.

3. Physical Examination: A thorough physical examination by a specialist can provide valuable insights into the mechanics of your elbow, including range of motion, strength, and any signs of swelling or tenderness.


Treatment Options
1. Physical Therapy: Since you have already tried some forms of therapy without success, consider a tailored physical therapy program focusing on strengthening the muscles around the elbow, improving flexibility, and addressing any biomechanical issues. A physical therapist can also provide modalities like ultrasound or manual therapy that may help.

2. Corticosteroid Injections: If inflammation is suspected, corticosteroid injections can provide temporary relief and reduce swelling.

3. Surgery: In cases where conservative treatments fail, and if there are structural issues such as loose bodies or significant soft tissue damage, surgical intervention may be necessary. This could involve arthroscopy to clean out the joint or repair damaged structures.

4. Activity Modification: While you enjoy playing basketball, it may be beneficial to modify your activities or take a break to allow your elbow to heal. Engaging in alternative exercises that do not stress the elbow may also be helpful.


Conclusion
Given the chronic nature of your elbow pain and the impact it has on your daily activities, it is advisable to seek further evaluation from an orthopedic specialist who can recommend advanced imaging studies like an MRI. This will help clarify the underlying cause of your symptoms and guide appropriate treatment. In the meantime, consider modifying your activities and continuing with physical therapy to maintain mobility and strength in the elbow.