Anatomy 結構
Elbow is a joint made of 3 bones, Humerus (the arm bone), Radius and ulna (the forearm bones).
The elbow allows a single planar motion, called elbow flexion and extension. But the two bones in the forearm can rotate along a axis. This bring a further degree of freedom, called supination and pronation.
A group of muscles, wrist flexor, has a common attachment at the inner part of the elbow. Another group of muscle, wrist extensor, also has a common attachment at elbow, this time is at the outer aspect. When there are inflammation, they lead to tennis elbow (the outer aspect) and golfer elbow (the inner aspect). While the name implies a condition in sportsman, this is not the case. Housewife and office worker appears being more affected.
Three major nerves travel across the elbow to reach their desination in forearm and hand. The inner elbow has a groove where a nerve, ulnar nerve, pass along. When compression occur there, it will cause numbness over the little finger, a condition called tardive ulnar nerve palsy or Cubital Tunnel Syndrome.
肘關節是由4根骨頭組成。它們分別是肱骨（上臂骨頭），橈骨和尺骨（前臂骨頭）。
肘部允許一個平面運動，即肘部彎曲和伸直。但是前臂的兩根骨頭可以沿軸旋轉。這就帶來了額外的自由度，稱為旋後和旋前（手掌向下翻為旋前，手掌向上翻為旋後）。
屈曲腕向掌心方向的一組肌肉，在肘部內側有一個共同錨點。另一組相反負責屈手腕往手背方向的肌肉，腕部伸肌，在肘部也有一個共同的銜接位置，這次是在外部。當發炎時，它們會導致網球肘（外部）和高爾夫球肘（內部）。雖然這個名字暗示了是運動員的病情，但事實並非如此。家庭主婦和上班族似乎受到多患上這些問題。
有三條主要神經在肘部的前面內外兩側通過，才到達前臂和手。肘部內側有一條骨槽，內藏尺神經。當神經線在那裡被壓時，它將導緻尾指麻木，這就叫延遲性尺神經麻痺或肘隧道症候群。
Pathology 毛病
Disease 病變
The followings are common pathologies in elbow
以下是常見肘病變
- Tennis elbow 網球肘（網球手）
- Golfer elbow 高爾夫球肘（高爾夫球手
- Olecranon Bursitis 肘部滑囊炎
- Tardive Ulnar Nerve Palsy (Cubital Tunnel Syndrome) 延遲性尺神經麻痺（肘隧道症候群）
- Supracondylar fracture 肱骨的髁上骨折
- Olecranon fracture 鷹嘴骨折
- Radial head fracture 橈骨頭骨折
Investigation 評估
MRI is required to review soft tissue status. X-ray would be needed for bony pathology. Nerve conduction study might be indicated for possible nerve palsy.
磁力共震片能夠提供軟組織情況。骨頭問題，例如骨折，就會需要照X光。神經線問題可以電神經測試得知情況。
Management 治療
Conservative treatments are indicated for majority of cases. They included,
- Physiotherapy
- Chiropractor
- TCM practitioner
- Prescribed Exercise
- Medication
For cases failed conservative treatments, or when the injury is unstable, then surgical intervention would be indicated. Persistent nerve palsy is a strong indication for surgical intervention to prevent permanent nerve damage.
For patients with witnessed deterioration, surgical intervention might be advocated.
絕大多數病人只需採取保守治療。他們包括
- 物理治療
- 脊醫
- 中醫
- 處方運動
- 藥物（口服及外敷）
對於保守治療無效的病例，或受傷位置不穩定，醫生會改為介入治療，例如打針甚至手術。如果神經持續有問題，早施手術或許能夠避免永久性神經受損。
對於持續惡化的患者，醫生往往會建議手術，以保肢體功能。
Common Interventions include
- Injection of steroid
- Injection of PRP
- Injection of hyaluronic acid
- casting
- Anterior Transposition of Ulnar Nerve
- Arthroscopic loose body removal
- Surgical reduction and plating
- Radial head Replacement
- Total Elbow Replacement