Posterior Elbow Impingement

What is posterior elbow impingement?

The elbow joint consists of three bones: the ulna, radius and humerus. The ends of these bones are covered with articular cartilage which acts as a cushion and shock absorber within the joint space. When soft tissue (synovium or joint lining, cartilage) in the back of the elbow joint sustains damage, posterior elbow impingement can result. Applied excess forces (a fall) or repetitive motion (overhead throwing) can cause inflammation to the soft tissues around the elbow. When the arm is thrust into extension, the articulating bones compresses the synovium at the back of the elbow. This condition is most commonly seen in athletes like baseball pitchers, javelin throwers, swimmers, and boxers. Dr. Riley J. Williams, orthopedic elbow specialist serving Manhattan, Brooklyn, New York City, NY and surrounding areas has extensive experience in posterior elbow impingement and related elbow injuries.

What are the symptoms of posterior elbow impingement?

Individuals in the New York area who meet with an orthopedic elbow specialist, commonly express the following symptoms of their elbow pain:

• Pain at the back of the elbow
• Stiffness
• Swelling
• Tenderness
• Increased pain during and after activity
• Inability to fully straighten the elbow

How is posterior elbow impingement diagnosed?

Dr. Williams’ evaluation of posterior elbow impingement includes a discussion of the patient’s pain symptoms and causes; Dr. Williams will perform a physical examination as well. Dr. Williams may order imaging tests like x-rays or MRIs to rule out other elbow injuries. In some instances, the body may have created bone spurs, which are small protrusions of excess bone that have grown in the elbow. These bony protrusions can be seen on an x-ray. MRI can detect ligament, tendon and cartilage injuries of the elbow.

How is posterior elbow impingement treated?

Non-surgical treatment:

The majority of individuals who sustain this type of injury can be treated with non-surgical methods. An important non-surgical approach is rest; resting the elbow allows for a decrease in inflammation. Bracing of the elbow may also be helpful in decreasing the symptoms of posterior elbow impingement.  Joint taping can be beneficial in providing relief as well. A physical therapist (PT) or physiotherapist can instruct the proper application of KT tape (kinesio-tape), which can gently reposition muscles and ligaments. Physical therapy exercises that focus on strength training and flexibility are useful in treating posterior elbow impingment. A patient may be instructed to follow the R.I.C.E. procedure for their elbow: rest, ice, compression, and elevation. Over the counter medications, such as ibuprofen or naproxen can also help with inflammation and tenderness. In some cases, a corticosteroid or platelet rich plasma injection may also be helpful in decreasing elbow pain. As an orthopedic elbow specialist, Dr. Williams will discuss which conservative treatment plan the patient should follow.

Surgical treatment:

Surgery may be necessary to treat posterior elbow impingement when conservative methods have failed; mechanical symptoms (locking/catching) and range of motion loss seldom respond to nonoperative treatment strategies alone. Bone spurs that form around the elbow can cause pain and limit extension. These problematic bone spurs can be removed arthroscopically using a minimally invasive approach. In such cases, Dr. Williams removed the excess bone and intervening soft tissues in the posterior elbow to allow for improved elbow range of motion and function. Dr. Williams will prescribe an individualized rehabilitation program following surgery for elbow impingement. Most individuals can anticipate a return to sports approximately three months after surgery.

For more information on posterior elbow impingement, elbow pain and the treatment options available, please contact the office of Riley J. Williams, MD, orthopedic elbow specialist serving Manhattan, Brooklyn, New York City, NY and surrounding areas.