If you’re experiencing elbow pain, you want to know the cause of the pain so you can make good decisions about your treatment options. In this video, Elbow Specialist Dr. J. Michael Bennett talks about the common causes of elbow pain and painful locking or popping of the elbow. Don’t ignore your elbow pain. If you do, your condition could worsen and your treatment could be more likely to require surgery.
If you have questions, please call for an appointment at our Sugar Land office or the Houston office. Dr. Bennett is a Board Certified Orthopedic Surgeon and Fellowship Trained Sports Medicine Specialist.
Welcome back to the Whiteboard Series. I’m Dr. J. Michael Bennett, I’m a Board Certified Orthopedic Surgeon specializing in sports medicine and minimally invasive surgery of the shoulder, elbow and knee.
Today we’re talking about popping joints. Specifically, we’re talking about the elbow and elbow pain — painful popping in the elbow or a painful pop in the elbow. What if you find yourself in a position where you were lifting something heavy and you feel a loud pop in your elbow? What if it almost felt like somebody slapped your arm and then you notice significant bruising and swelling in the elbow?
First off, let’s go over some of the basic elbow anatomy. The elbow joint is here. This is the humerus that you’re seeing right here. Over here is the radial head and then the ulna so there’s three bones that articulate, that create the elbow joint. It allows you to flex and extend as well as what we call pronation and supination, which is palm down and palm up.
The ligaments that stabilize the elbow are the ulnar collateral ligament on the medial side or the inside of the elbow. The lateral collateral ligament is on the outside of the elbow joint.
There’s the biceps, the distal biceps which inserts on the radial tuberosity right here that allows you to give you strength with supination or twisting as well as reflection and that’s where the biceps comes down and inserts right there.
So going back to the scenario we just discussed. What happens if you lifted something or caught something and felt a painful popping in your elbow? You notice a lot of bruising and swelling afterwards so what do you do?
Well, the first thing you want to think about is the possibility, is your biceps tendon and that biceps tendon comes down and inserts right on that radial tuberosity. When it does pop it will disrupt right at the base where it inserts and it retracts.
The amount of degeneration you have at the distal biceps or the amount of force you absorbed when you caught something that was falling, determines how far the distal biceps tendon will retract upward in patients that have maybe a partial tear of the distal biceps.
Sometimes you can have a full thickness rupture, where the distal biceps tendon retracts all the way up past the joint line. All muscles retract like a rubber band when you take it and it snaps back, so the muscles are going to do the same thing and retract.
The thing about the biceps is that if you do have a distal biceps tendon rupture, it’s serious. You want to get it looked at immediately especially if you’re active or you depend on a laborious activity for your livelihood or you work with your hands.
You want it to be evaluated by an elbow specialist because if it is a significant tear and you depend on your hands for a living it might be something you want to consider to have fixed. When we fix this, we actually bring this biceps tendon back down to the bone and repair it down to the bone.
If you do not fix it and it continues to retract upward, you can lose a significant amount of strength with rotating and with flexion, so just keep that in mind and get it evaluated.
What are other possibilities regarding the popping and clicking in the elbow joint particularly with swelling? If you have a history of a trauma or a fall on the elbow, you can have a dislocation of the elbow. When a dislocation occurs you can get a disruption of all the ligaments here in the elbow — the medial and lateral side of the elbow.
That actually means that the joint has physically popped out, it’s popped out of joint, so the ligaments on the inside have been torn. The ligaments on the lateral side have also been torn or at least stretched.
A lot of these dislocations do actually fairly well without any kind of surgery so we actually just splint you and actually put you in range of motion brace for about four weeks or so and get you moving. And a lot of these ligaments will actually stabilize, so you can get by without having to do anything surgical.
If you do have a history of dislocation, then it’s very important that if you do have a dislocation it be immediately popped back into place and reduced. So you should go to the emergency room or seek the help of an orthopedic surgeon to at least get you in a good alignment and get the joint reduced. We see elbow dislocations in the emergency room or we see them out on the football field or anywhere that a patient’s had a traumatic injury to the elbow.
Other elbow injuries are overuse injuries and these can occur in baseball players and throwers. It usually occurs with repetitive movement of the elbow and stretching of the ligaments.
The most problematic or most common one is with the ulnar collateral ligament and it’s usually seen in throwers. This is where this ligament is actually disrupted and the elbow becomes weak and when the elbow becomes weak and this medial side becomes weak these bones open up and separate because the stabilizer is gone.
So if your livelihood is throwing pitches for a living, this is something you have to have diagnosed and treated appropriately. A lot of times it can require a Tommy John reconstruction, if you depend on throwing as your livelihood.
If you’re a professional athlete, a collegiate athlete, a high school player who has a potential career in throwing in college this might be something that you need to have reconstructed so please see an orthopedic specialist to get an appropriate recommendation and evaluation. You can also have stretching of that ligament or even a sprain of that ligament and that oftentimes can be treated without surgery just using a brace and conservative measures.
On the outside of the elbow is the lateral collateral ligament. That ligament can be disrupted with a traumatic injury, such as an elbow dislocation that just didn’t heal right. This bone, the radial head, can pop out of joint, because these ligaments here are no longer there. So when you supinate or rotate the arm, you actually see this bone pop out of joint and you have to pop it back in. That’s called posterolateral rotatory instability.
Posterolateral rotatory instability does needs to be evaluated by an orthopedic specialist to make the diagnosis. Depending on your age and activity level, that can require a reconstruction or surgery.
The last thing that may be causing some popping or clicking in the elbow, particularly associated with pain, may be a cartilage flap or a loose spot. That’s where a piece of cartilage from anywhere in the joint becomes dislodged from the cartilage. It just starts floating around in the joint or it can actually hinge on the cartilage, and it creates a locking sensation in the elbow.
Sometimes we see this in kids and it’s called osteochondritis dissecans in kids and adults as well. Usually if an adult has this, it’s associated with significant arthritis in that joint.
If you have a loose body floating around in the joint, it can cause significant damage to the surrounding cartilage and speed up arthritis. So this is something that needs to be evaluated early by an elbow specialist to make sure you do not have progressive arthritis at an early age.
So if you have any of these symptoms that I’m describing, please seek advice from an orthopedic specialist. You can contact us for an appointment at 281-633-8600 for our Sugar Land office or 713-234-3152 for our Houston office. Thank you very much.
If you ignore elbow pain, it’s more likely that your treatment will require surgery and your recovery will take more time. Many elbow injuries can be treated with conservative measures like rest and an elbow brace. If you ignore your injury and it worsens, it’s more likely that surgery will be needed.
So don’t ignore your elbow pain. Call us for an appointment. We’ll get started in helping you return to the activities you enjoy, without elbow pain. Please check out Dr. Bennett’s library of patient education videos on elbow pain and treatments for elbow injuries.