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Posterior impingement and loose bodies

What is Posterior elbow impingement?

Posterior impingement causes pain at the back of the elbow that is felt on full extension activities, such as throwing, serving or boxing.  More commonly this is felt posterolaterally (e.g. boxers, racket sports players and canoeists), but posteromedial pain can also occur (e.g. javelin thrower and pitchers).  Patients may feel swelling in their elbow.  In later stages, symptoms of loose bodies (locking) can occur.

It is caused by repetitive hyperextension: the olecranon process of the ulna (the tip of your elbow) slams into the groove at the back of your elbow with each action.  Over time this causes inflammation of the joint lining and, later, damage to the cartilage and the formation of bony spurs.  These bone spurs then exacerbate the problem. .  Motions that tend to open up the inside of your elbow (valgus strain) can worsen impingement, as the ligaments on the inside of your elbow stretch over time to allow the posteromedial olecranon tip to engage the back of the humerus.

How is it Diagnosed?

The history and examination findings are suggestive. Plain x-rays sometimes show a small spur, but they may be normal in the earlier stages.  An MRI may help, but even this may be inconclusive.

How is it treated?

Sometimes an injection (cortisone and local anaesthetic) into the posterior elbow compartment can be both diagnostic and therapeutic. This cortisone settles the inflamed synovium (joint lining) and this can reduce the impingement. 

Physiotherapy can improve the strength of your elbow (triceps, forearm flexors) and help you to retain movement.

 Sports technique is often something that can be improved in order to offload the elbow.  It is worth you and your coach examining your technique to see if this is relevant to you and your elbow.

If these measures fail, or if you have loose bodies, an elbow arthroscopy can be performed to remove debris and loose bodies.  At the same time any bone spurs can be resected to reduce the impingement. This is call 'osteoplasty'. Occasionally, the bony impingement is too close to the nearby ulna nerve, or too extensive, for arthroscopy to be the best option.  In this case, an open surgery can be performed to remove the impingement lesions.

If you have significant ligament compromise, you may require these ligaments to be reconstructed.

Loose bodies in the elbow

Loose bodies within the elbow are relatively common.  They arise from impingement lesions, or from arthritis. They can also come from cartilage injuries and developmental cartilage problems (osteochondritis dissecans).

Most patients with loose bodies describe pain, locking and catching of their elbow. Sometimes the elbow feels swollen and, occasionally, patients can feel loose bodies floating inside their joint.

Arthroscopy is a good technique for finding and removing loose bodies from your elbow.  Please see the elbow arthroscopy section for more detail on this procedure.