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The elbow is a complex joint formed by the upper arm (the humerus), the forearm (the radius and ulna) and an intricate system of ligaments and muscles, which connect the bones. Dr. Balaguer specializes in degenerative conditions of the elbow such as arthritis of the elbow and offers several arthroscopic elbow surgery options.

Medical Conditions of the Elbow
Lateral Epicondylitis
Tennis Elbow

Tennis elbow, or lateral epicondylitis, is a painful condition of the elbow caused by overuse. Up to 50 percent of all tennis players develop the condition. It most commonly affects individuals between 30 and 50 years old.


The symptoms of tennis elbow develop gradually. Common signs of tennis elbow include:

 - Pain with resisted wrist extension

 - Pain with gripping activities

 - Decreased grip strength

The symptoms are often worsened with forearm activity.

Physical Exam

In a medical examination, pain experienced in any of the following movements can indicate the possibility of tennis elbow:

 - Point tenderness at ECRB insertion into lateral epicondyle

 - Resisted wrist extension with elbow fully extended

 - Resisted extension of the long fingers


Non-operative treatment options include:

 - Activity modification, ice, NSAIDS, physical therapy, ultrasound

 - First line of treatment

 - Up to 95 percent success rate with nonoperative treatment, but patience is required.

Surgery is considered when the pain is incapacitating and has not responded to other treatments. Operative treatment options involve:

 - Debridement of ECRB origin (minimally invasive, quick recovery)

 -- radiofrequency ablation (TOPAZ)

 -- ultrasound guided microdebridement (FAST procedure)

 - Release and debridement of ECRB origin

 -- very effective

 -- long recovery time

Recovery from surgery will include physical therapy to regain motion of the arm.

Injuries at the Elbow
Biceps Tear

Tears of the biceps tendon at the elbow are uncommon and represent about 10 percent of biceps ruptures. They are most often caused by a sudden injury.

Risk Factors

Men, age 30 years or older, are most likely to tear the distal biceps tendon. Additional risk factors for distal biceps tendon tear include:

 -  Anabolic steroids

 - Smokers have a 7.5 times greater risk than nonsmokers


There is often a painful “pop” as the elbow is eccentrically loaded from flexion to extension. Other symptoms include:

 - Swelling in the front of the elbow

 - Weakness and pain, primarily in supination

Physical Exam

Observation of the injured extremity may reveal significant bruising and swelling. A provocative “hook test” may be performed, where the examiner attempts to hook her index finger over the biceps tendon as the muscle is contracted. If the tendon is ruptured, she will be unable to hook the finger over the tendon. With an intact tendon, the finger can be inserted 1 cm under the tendon.


An MRI is the test typically used to identify a torn biceps tendon, along with other soft tissue injuries.


Nonsurgical treatment is an option for management of a biceps tendon rupture, particularly for patients who have lower demands, such as elderly individuals.

Surgery to repair the tendon should be performed during the first 2 to 3 weeks after injury. Further delay may preclude a straightforward, primary repair. Surgical reattachment of the tendon to the radial tuberosity may be performed.


Elbow immobilization for up to four weeks is generally recommended. Return to full-strength activities is typically not allowed until a minimum of 3 months.

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The Miami Institute for Joint Reconstruction
11801 sw 90th St, Suite 201 Miami, FL 3318
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