Posterior Impingement of Elbow
Other popular names
Posterior Impingement Syndrome
Who does it affect?
Why does it happen?
Posterior impingement is due to over use and repetitive forced extensions of the elbow. This may occur during sports, such as overhead racket sports, throwing, swimming and boxing. With repeated extension (straightening of the elbow), the olecranon tip is repeatedly jammed into the fossa at the back of the elbow, which results in inflammation of the joint lining (synovium), eventually resulting in injury to the cartilage and bone. Bone spurs may sometimes form on the tip of the olecranon leading to further injury and soft tissue impingement. There becomes increased risks of impaction and injury when there are shearing forces that occur as at result of a valgus strain (strain that opens up the inner side of the elbow), such as during serving and hitting topspin forehands with an extreme wrist and grip in tennis; similarly, this may occur with badminton.
The typical symptoms are pain and tenderness at the back of the elbow, especially when trying to throw, straighten the elbow, or during serving and overhead racket shots. This may proceed to locking and a catching of the elbow. There may be swelling of the elbow and inability to serve at full speed. There may be some elbow stiffness and towards the late stages an inability to fully straighten the elbow.
Investigations such as x-rays may not adequately reveal the diagnosis unless there are spurs or loose bodies in the back of the elbow. Ultrasound scan and MRI scan are often used.
Posterior impingement syndrome of the elbow is often treatable with non-operative management. A rehabilitation programme to improve strength, flexibility and elbow range of motion may be helpful. Injections into the posterior compartment (back) of the elbow are often useful to reduce the inflammation and swelling, either Cortico-steroids or Hyaluronons may be used. I only perform steroid injections once as further attempts may damage the overlying fat and skin causing a lightening of the skin and a hollow depression. It is likely that I will offer you the choice of surgery at this point
Surgery is carried out as a day case procedure usually either under local or general anaesthetic and takes about 15-30 minutes.
The procedure is identical to the removal of loose bodies or spurs.
You can go home soon after the operation. The anaesthetic will wear off after approximately 6 hours. Simple analgesia (pain killers) usually controls the pain and should be started before the anaesthetic has worn off. The arm should be elevated as much as possible for the first 5 days to prevent the hand and fingers swelling. Gently bend and straighten the fingers and elbow from day 1. The dressing will be removed soon after your operation. The wound is cleaned and redressed with a simple dressing. Avoid forced gripping or lifting heavy objects for 2-3 weeks. The sutures are removed at about 10 days. You should notice an improvement in symptoms within a few weeks but the final result may take some 3-6 months.
Return to normal routine
Keep the wound dry until the stitches are out at 10 days.
Return to driving:
The hand needs to have full control of the steering wheel and left hand the gear stick. You are advised to avoid driving for at least 7 days or until the sutures (stitches) are removed.
Return to work:
Everyone has different work environments. Returning to heavy manual labour should be prevented for approximately 4 - 6 weeks. Early return to heavy work may cause the tendons and nerve to scar into the released ligament. You will be given advice on your own particular situation.
Overall over 95% are happy with the result. However complications can occur.
General risks (less than 1% each):
- Neuroma (nerve pain)
Reflex Sympathetic Dystrophy - RSD (<1% people suffer a reaction to surgery with painful stiff hands, which can occur with any elbow surgery from a minor procedure to a complex reconstruction).
Failure to completely resolve the symptoms (approximately 1%) - this may be due to failure to completely release the area. This is rare, but may be released again.