ELBOW

The elbow joint is hinge joint, meaning it bends and straightens like a hinge. The bones of the elbow are the humerus (the upper arm bone), the ulna (the larger bone of the forearm) and the smaller radius. The most common overuse pathologies that can occur in the elbow are lateral and medial epicondylitis (tendonitis) and pump arm syndrome.

Lateral Epicondylitis (Tennis elbow)

Lateral epicondylitis, commonly known as tennis elbow, is not limited to tennis players. The backhand swing in tennis can strain the muscles and tendons of the elbow in a way that leads to tennis elbow. However, many other types of repetitive activities can also lead to tennis elbow: painting with a brush or roller, running a chain saw, and using many types of hand tools. Actually, any activity that repeatedly stresses the same forearm muscles can cause symptoms of tennis elbow (overuse syndrome). The main symptom is tenderness and pain located at the lateral epicondyle of the elbow. The pain may spread down the forearm and the forearm muscles may also feel tight and sore.

The goal of the treatment is to help the tendon heal. If the problem is caused by acute injury and inflammation, anti-inflammatory pills may provide some relief. If inflammation doesn’t go away, cortisone injection might be helpful. However, its benefits are temporary, but they can last for a period of weeks to several months. Sometimes nonsurgical treatment fails to stop the pain or help patients regain use of the elbow. In these cases, surgery may be necessary.

The use of platelet-rich plasma derived growth factors that promote long-term tissue healing has been proven to be beneficial in the treatment of tendon inflammation. Though its effects are not immediate, PRP alleviates symptoms over time, facilitating a remarkable return to previous function.  The aim of PRP injections is to reduce or eliminate pain and inflammation, prevent or contain functional limitations accelerating healing or avoiding alternative treatment, from cortisone and anti-inflammatory injections to surgery.

Medial Epicondylitis (Golfer’s elbow)

Medial epicondylitis is commonly known as golfer’s elbow. The golf swing is a common cause of medial epicondylitis; however, many other repetitive activities can also lead to golfer’s elbow such as throwing, chopping wood with an ax, running a chain saw, and using many types of hand tools. Any activity that stress the same forearm muscles can cause symptoms of golfer’s elbow, similarly with activities that cause tennis elbow (as previously described).The treatment with growth factors (PRP injections) might provide relief of the symptoms and return to previous activities, as per our long-term experience.

A rehabilitation program completes our approach to any type of tendonitis.

Pump Arm Syndrome

Pump arm syndrome is a painful situation of the arm which is commonly identified in motocross riders; however this is an overuse type injury that could be observed in many other activities that involve arm muscle and tendons in repeated activity. This painful compartment syndrome is not unusual in motorcycle racing and very annoying for the motocross rider. Furthermore it might become very dangerous, because it causes a decrease in the ability to control the bike and can lead to a serious accident. Although it is a frequently encountered in motocross problem, only studies have been conducted ti identify the mechanisms and determine this problem. There is only an article published on 1998 in the journal American Journal of Sports Medicine on the compartment syndrome of the forearm and there are few results reported after surgical treatment.

Dr. Alberto Gobbi has an experience in motocross for over 30 years, being either off-road rider himself or a sports doctor for the Italian Motorcyclists Federation (for more than 10 years) and of the Motocross European Racing Team since 1984 up to the present. During these years he has treated decades of motocross riders suffering from pump arm syndrome, with great results.

Many factors may be involved in the etiology: for example, a hernia at the cervical spine, the carpal tunnel syndrome, an ulnar nerve pain, lateral or medial epicondylitis, the presence of cysts or ganglions that compress the muscles, all these can cause pain in the forearm. However the most common cause is a chronic compartment syndrome of the forearm that occurs after few laps as a painful contraction of the muscles and reduces the ability to close the hand while holding the handlebar is painful and the athlete experience finger numbness and inability to control the bike and continue the race. It is important to distinguish the more frequent chronic syndrome, from an acute compartment syndrome (fortunately rare) when the pilot due to a fall may have a broken bone or muscle injury; in this case there is a bleeding, forearm swells abruptly and loss of fingers sensitivity establishes: this is a serious situation that requires immediate hospitalization!

In order to understand the reasons that can lead to this syndrome , it is necessary to understand the anatomy of the forearm: each muscle is surrounded and contained in a membrane called epimysium and the smaller parts of the muscle, muscle fibers, are also surrounded and contained in endomysium. Different muscle groups are then contained within the lodges and surrounded by another band that keeps them together. This band is thin, very strong but not very elastic therefore after an acute increase in the volume of muscles can lead to increase the pressure within the compartment: the symptoms that accompany this situation constitute the so-called compartment syndrome (see figure below).

Motocross rider’s forearm muscles are working very hard during the race and a considerable amount ‘of blood’ is necessary for oxygen supply. As a result, the muscles swell and the space inside the outer band can ‘become insufficient’, the pressure increases because fluids are incompressible blood vessels contained collapse and prevent the normal blood circulation creating a vicious circle: the blood continues to arrive but cannot get out of the muscle and the forearm becomes swollen and painful.

Although surgical treatment has been proposed when conservative treatment fails, we have observed very good and stable outcome with the use of growth factors (PRP) and rehabilitation (see figure below).