The elbow is really two closely related joints.
One is a simple hinge joint that operates
from straight to about 150 degrees of flexion.
The second allows the forearm to twist. The
first action allows us to eat, and the second
is required to eat soup. Several structures
around the elbow may give trouble. Over the
point of the elbow is the olecranon bursa, a
frequent location for bursitis. On the inside
and outside of the elbow are bony bumps to
which the muscles attach. These are frequent
sites of tendinitis; for example, tennis elbow is
a tendinitis on the outside bump. The joint
space can be the location of infection or gout;
these conditions will cause the part to hurt
even though it is not being moved. Young
children, usually after being swung by their
arms by their parents, sometimes suffer a kind
of dislocation. The elbow is exposed enough
so that fracture is not uncommon. This injury
can be difficult to treat because the bones that
usually break are right at the joint.

Apply rest combined with exercises to prevent
stiffness. If you know the cause of the prob-
lem, stop doing it. For example, a tennis
elbow is caused by a bad, jerky backhand,
which puts extra strain where the forearm
muscle joins the bone. You can stop tennis for
a while, and later you can take some lessons
to improve that stroke. For tennis elbow, an
elastic strap over the upper forearm (available
at tennis shops) will take tension off the sore
tendon and can allow healing or even con-
tinued play.

Listen for the pain message and let it tell
you what not to do. Avoid activities that make
the problem worse either right away or the
next day. Remember that you have to let the
inflammation subside and let the part heal; at
least six weeks are required to build full
strength. To avoid reinjury, your activity must
be below the level that would tear the weak-
ened tendon.

Avoid strong painkillers, as they get in
the way of your reception of the pain mes-
sage. Aspirin or acetaminophen is all right,
but they won't help you much.

Rest means take it easy with the elbow.
The sling (triangular cravat) described in
Shoulder Pain (S14) is the best way to rest it.
Wear the sling every day for at least a few
days; it will rest the elbow and will keep you
from using it.

Exercise starts from day one. As with the
shoulder, we don't want to build strength, we
just want to keep the joint loose so that
adhesions and stiffness do not result. The
most likely deformity is inability to straighten
the arm, so we want to pay particular
attention to that motion.

Exercise is passive and very simple.
Straighten the arm. Let it hang by your side.
Flex it and let it straighten out again. Do this
at least ten times, twice a day, but don't force
too hard at first. Then twist the forearm. Start
with your arm extended outward, palm fac-
ing the floor, then turn your palm upward to
face the ceiling. Repeat ten times, twice a day.
If the elbow is really tight, exercise in the
shower with warm water running on the
elbow. As you get better, do the exercises
faster and force them a little harder. But don't
force all the way. As soon as you feel the
beginning of pain, back off.

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