Elbow Injuries

Ulnar Neuritis (Cubital Tunnel Syndrome)

The ulnar nerve is a nerve that runs along the inside (medial) aspect of the elbow and is responsible for giving sensation and motor function to part of the forearm and hand. The ulnar nerve typically travels behind a bony prominence on the medial aspect of the elbow known as the medial epicondyle.

Ulnar neuritis (aka Cubital Tunnel Syndrome) is a condition in which the ulnar nerve becomes irritated at the level of the elbow. In a non-throwing athlete, ulnar neuritis may be caused by positioning with the elbow bent for extended periods of time, such as during sleep. In the throwing athlete, ulnar neuritis is often caused by repetitive micro-trauma during throwing and may be present in combination with injuries to the UCL.

Symptoms can include:

• A feeling of numbness, tingling, heaviness, and/or weakness in the hand, particularly in the small and ring fingers
• Shooting pains down the inner part of the forearm
• Decreased velocity and pain with throwing (for throwing athletes)
• In late stages, patients may even experience atrophy (shrinking) of the muscles within the hand.

Evaluation of ulnar neuritis typically includes an electromyogram and nerve conduction study (EMG/NCS). In the throwing athlete, an MRI of the elbow is recommended to rule out an associated injury to the UCL or other structures within the elbow.

Patients with ulnar neuritis who fail conservative management may be eligible for a surgery called a cubital tunnel release. During this surgery, a small incision is made along the inner part of the elbow and the roof of tissue covering the ulnar nerve is released, which releases pressure on the ulnar nerve. 

A small subset of patients may develop ulnar nerve subluxation after a cubital tunnel release. For those patients, an ulnar nerve transposition is performed during the same surgery.

Snapping Ulnar Nerve

Snapping ulnar nerve (aka Ulnar Nerve Subluxation) is a condition in which the ulnar nerve no longer sits properly in its groove behind the medial epicondyle throughout elbow range of motion. 

Patients may feel a sensation of snapping on the inner part of the elbow when flexing and extending their elbow. They may also have symptoms of ulnar neuritis, as the abnormal movement of the ulnar nerve causes it to be irritated and inflamed. Throwing athletes, in particular, complain of pain or popping along the inner elbow when attempting to throw.

While initial non-operative treatment may be attempted with stopping activities that cause symptoms, symptomatic snapping ulnar nerve is often treated with a surgery called an ulnar nerve transposition in order to prevent the nerve from subluxing back and forth across the elbow.

Ulnar nerve transposition is a surgery in which, in addition to releasing the roof of tissue covering the ulnar nerve, the ulnar nerve is permanently moved (aka transposed) to the front of the elbow. This prevents the ulnar nerve from subluxing back and forth across the elbow during range of motion, therefore removing the snapping sensation and preventing further irritation of the ulnar nerve.

Distal Biceps Tears

The biceps is the muscle in the front of the arm and it is attached at the elbow via a tendon called the distal biceps tendon. The biceps is responsible for giving strength with flexing the elbow, as well as turning your forearm from palm-down to palm-up position (known as supination). 

Tears of the distal biceps tendon are more common in males and usually occur when the elbow is straightened while the biceps muscle is activated. Patients typically feel a pop followed by pain, swelling, bruising, and balling up of the biceps muscle in the upper arm. 

While partial tears can sometimes improve with physical therapy, full tears do not heal on their own. In these cases, surgical repair is generally recommended. Without surgery, patients can expect significant weakness in the elbow, especially with supination.

Our team typically obtains an MRI to confirm the diagnosis and to locate the position of the torn and retracted tendon. Once a full tear is confirmed, surgery is recommended and is ideally performed within 1-2 weeks of the injury. Although surgery may be possible up to 6 weeks from the injury, waiting is not recommended as this can lead to significant scarring of the tendon, increasing the tension on the surgical repair. Beyond 6 weeks the tear is considered chronic and a primary repair may not be possible. At that point, a reconstruction using a donor tendon may be necessary.

Distal biceps repairs are performed with a minimally invasive single-incision technique. Our surgeons utilize the latest technology, including high strength suture and the most advanced suture buttons to give you the strongest repair possible. Distal biceps repairs are performed in the outpatient surgical center and patients are able to go home the same day. Patients are in a splint for the first 2 weeks, followed by a brace for an additional 4 weeks. Strengthening begins 10-12 weeks after surgery and physical therapy generally lasts 2-3 months. Once recovered, patients are allowed to go back to all activities including weightlifting without restriction.

Distal Triceps Tears

The triceps is the muscle located on the back of the arm and is attached to the elbow via a tendon called the distal triceps tendon. Tears of the distal triceps are less common than the distal biceps and usually occur when there is a forceful bending of the elbow when the triceps is activated. 

When a distal triceps tear occurs, patients typically feel a pop followed by pain, swelling, and bruising. While partial tears can sometimes improve with physical therapy, full tears do not heal on their own and surgical repair is generally recommended. Without surgery, patients can expect significant weakness when trying to extend the elbow.

Our team routinely obtains an MRI to confirm the diagnosis. Once a full tear is confirmed, surgery is recommended. Similar to distal biceps tears, our surgeons use the latest technology to perform the strongest repair possible. Distal triceps repairs are performed in the outpatient surgical center and patients are able to go home the same day. Patients are in a splint for the first 2 weeks, followed by a brace for an additional 4 weeks. Strengthening begins 10-12 weeks after surgery and physical therapy generally lasts 2-3 months. Once recovered, patients are allowed to go back to all activities, including weightlifting, without restriction.

Elbow Injury Treatment in Bergen County, NJ

Our team at Cahill Orthopedic treats a full range of elbow injuries. Conservative, non-operative methods are always used as the first line of treatment whenever possible. When surgery is needed, our surgeons utilize the latest techniques and technologies.

Dr. James Cahill is a fellowship trained sports medicine surgeon, and Dr. Erik Contreras is a fellowship trained shoulder and elbow surgeon. If you would like to schedule an appointment with one of our surgeons, please call our office at (201) 489-0022.