The main causes of posterior elbow pain are olecranon bursitis, triceps tendinitis and posterior impingement. Gout should always be considered.
Olecranon Bursitis
Olecranon bursitis may present after a single episode of trauma or, more commonly, after repeated trauma, such as falls onto a hard surface affecting the posterior aspect of the elbow. This is commonly seen in basket-ballers taking a charge.It is also seen in individuals who rest their elbow on a hard surface for long periods of time and is known as students elbow. The olecranon bursa is a subcutaneous bursa that may become filled with blood and serous fluid.
Treatment consists initially of NSAIDs, rest and firm compression. If this fails, then aspiration of the contents of the bursa and injection with a mixture of corticosteroid and local anesthetic agents will usually be effective. The needle should be inserted at an oblique angle to reduce the risk of sinus formation. If recurrent bursitis does not respond to aspiration and injection, surgical excision of the bursa is required. Occasionally, olecranon bursitis can become infected. This is a serious complication that requires immediate drainage, strict immobilization and antibiotic therapy. Osteomyelitis and septic arthritis can follow. Excision of the bursa is occasionally required.
Triceps Tendinopathy
Tendinopathy at the insertion of the triceps onto the olecranon is occasionally seen. Standard conservative measures for treatment of tendinopathy should be used. Soft tissue therapy and dry needling to reduce excessive tightness of the triceps musculotendinous complex are often helpful.
Posterior Impingement
Posterior impingement is probably the most common cause of posterior elbow pain. It occurs in two situations. In the younger athlete there is the hyperextension valgus overload syndrome Repetitive hyperextension valgus stress to the elbow results in impingement of the posterior medial corner of the olecranon tip on the olecranon fossa. Over time this causes osteophyte formation, exacerbating the impingement and leading to a fixed flexion deformity.
In the older patient the most common cause is early osteoarthritis, which often predominantly affects the radiocapitellar joint. Generalized osteophytes form through the elbow. Impingement of these osteophytes posteriorly results in posterior pain. The main clinical feature in athletes with posterior impingement is a fixed flexion deformity of some degree and posterior pain with forced extension.
If conservative measures fail, then arthroscopic removal of the impinging posterior bone and soft tissue is very effective in relieving symptoms and improving extension.
Physiotherapy Treatment for Posterior Elbow Pain
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