+43 1 9974207 ordination@heuberer.at

Dr. Philipp Heuberer – Elbow Specialist in Vienna

Do you have pain in your elbow? Are you no longer able to do your job because you can no longer move your forearm without pain? Do you find everyday activities difficult because you struggle with chronic elbow problems?

The causes of suffering in the elbow area can be varied. The treatment methods to get these problems in the joint under control are just as varied.

I get to the bottom of these problems and will help you!

I would be happy to invite you for a detailed examination in my office in Vienna. Based on this examination, I will make an initial diagnosis that will serve as the basis for an effective treatment plan that I will create together with you.

Depending on the cause and effect, treatment can be by regenerative therapy or cutting-edge pain therapy. Sometimes, however, such a gentle therapy is not sufficient. Should a surgical intervention be necessary, I will of course personally take care of it.

Make an appointment in my Viennese practice and let us eliminate the cause of your pain!

MAKE AN APPOINTMENT

The elbow - the most complex joint

You may sometimes wonder why the elbow or elbow joint, in particular, is so vulnerable. Well, in fact, the elbow is the most complex joint in our body.

The elbow joint is a compound joint. It consists of three partial joints with a common joint capsule, with the bone of the humerus and the two bones of the forearm the radius and the ulna each connected to one another. Stability is provided to the elbow joint by a variety of ligaments and muscles.

The wrong treatment can quickly lead to even more pain and even chronic damage. Indeed, the high number of important vessels and nerves around the joint requires a highly specialized approach to successfully treat the subtle pathologies of the elbow.

Therefore, you should consult an experienced elbow specialist taking care of your symptoms.

This is what I can do for you as your personal elbow specialist!

Finding the right specialist can sometimes be nerve-wracking and take a lot of time. Time you don’t have – because every day that passes can increase the suffering from your elbow or forearm.

Here is my suggestion:

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You have problems with your elbow – maybe you only feel first small symptoms, maybe the discomfort already leads to significant pain and movement restrictions.

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You realize that visiting your family doctor and taking pain medication is no longer enough to bring relief from pain or restoration of mobility.

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You want an experienced elbow specialist to take a look at your discomfort and do something about it so you can finally get back to gripping without pain.

Visit me in my Vienna office. My team and I can help you. Thanks to great experience in the diagnosis and treatment of elbow problems, we will find the right solution for you. Whether this solution is regenerative therapy, pain management, or surgery depends on the nature and extent of the condition.

The correct diagnosis is essential for treatment!

The area around the elbow joint is very susceptible to injury. Incorrect movement, overuse or incorrect loading can affect the sensitive joint and be the beginning of a long history of suffering. By visiting my office, you are taking the first step towards avoiding them.

From this point on, I will take care of you. The beginning and the basis for further treatment is a detailed examination with subsequent diagnosis. Because only when we know exactly what is wrong with the elbow, I can initiate the appropriate therapy.

What are the most common diagnoses?

In my many years of practice, I have been confronted with all kinds of elbow problems. Some of the most common problems include:

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    Lateral epicondylitis, also known as tennis elbow. Such tennis elbow is caused by chronic overuse due to monotonous activities.

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    Nerve constriction syndrome – ulnar nerve syndrome (cubital tunnel syndrome). Possible causes: Nerve overstretch, prolonged propping of the elbow, bony changes in the joint, or dislocation of the nerve.

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    Bursitis. The bursa is also very sensitive. If the bursa is irritated, it swells. The result: inflammation of the bursa.

You want to know more? No problem!

I’ve summarized for you the most common causes of elbow problems while answering three essential questions: Where does the pain occur? Where does it come from? And what can be done about it?

You will find this small encyclopedia of elbow disorders at the bottom of this page.

Of course, this elbow encyclopedia can only provide you with an initial overview of possible causes and treatment options.

In order for us to quickly get to grips with your specific problem, I recommend that you visit our office in the Health Pi Medial Center at Wollzeile 1-3 in Vienna.

Whether it is tennis elbow, inflammation of the bursa, ulnar nerve syndrome, osteoarthritis or completely different complaints in the elbow or forearm area:

I promise you that my team and I will make sure that you can enjoy a pain-free and discomfort-free life again!

Make an appointment in my Viennese practice and let us eliminate the cause of your pain!

MAKE AN APPOINTMENT

The small encyclopedia of elbow complaints

The most common complaints and diseases of the elbow, how to identify them and what treatment really helps.

Tennis elbow - epicondylitis

What is affected?

Popularly known as tennis elbow or epicondylitis humeroradialis, it is a tendon disease of the forearm extensor muscles caused by chronic overuse. On the one hand, it comes from sports such as tennis or golf, but mostly occupationally due to long periods of screwing, sawing, typing or similar monotonous activities, especially between the ages of 30 and 55.

Tennis elbow is initially an inflammation of the tendon insertions of muscles that stretch the fingers and wrist. In the course of the diseases, the inflammation turns into a mostly irreversible degeneration of the tendons. The trigger is mostly that the force that needs to be exerted by the muscles is greater than the muscle strength itself.

The distal biceps tendon

What is affected?

The biceps is a two-headed muscle that connects the shoulder to the elbow and performs flexion at the elbow. Coming from the shoulder with two tendons, the biceps joins at the elbow to form a tendon that attaches extensively to the radius.

This tendon attachment can become inflamed (tendinitis), which can lead to a painful partial rupture and finally to a complete rupture.

Biceps tendinitis causes pain in the elbow due to inflammation. Partial rupture leads to weakness and dysfunction of the muscle via inflammation. The complete tear is a severe soft tissue trauma with copious bleeding and swelling.

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In addition to the pain in the elbow, especially when weight is applied, the increasing tendon defect is manifested by a loss of strength when bending and turning the elbow, which can be up to 50% when bending and 30% when turning.

How is it determined?

The diagnosis of complete biceps retinal rupture is clinically apparent. An ultrasound or MRI confirms the diagnosis and shows how far the tendon has retracted into the upper arm. Tendinitis or partial rupture can only be confirmed by MRI or ultrasonography.

How to treat the discomfort?

Rupture should be operated on as soon as possible, as the tendon can retract severely, and extensive reconstruction with donor tissue may then be necessary. Tendinitis as well as partial rupture can be treated conservatively in the first instance. Eccentric training, focused shock wave therapy, and ultrasound-targeted infiltrations with PRP are promising measures.

In case of failure of conservative therapy or a complete tear, the tendon stump is refreshed and anchored back into the radius during surgery. In my preferred, but not simple, technique, the stump of the tendon is anchored in the depth of the elbow with a metal plate in a blind hole in the radius, sparing important nerves and vessels. This surgical technique with the most stable fixation means that no immobilization is necessary postoperatively and immediate movement is possible. Isometric strength training is not allowed until after 6 weeks, and a return to manual activity or sports is not allowed until after 12 weeks. More info about the biceps tendon.

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Elbow stiffness

What is affected?

In elbow stiffness, the soft tissues around the elbow stick together. Scar strands form in the joint, restricting movement. Ossifications can form as well.

The importance of elbow functions are not immediately obvious, but are extremely limiting when lost, as basic needs such as bringing the hand to the head to eat, drink, blow the nose, put on glasses, and more depend on them.

Inability to bend or extend the elbow or to perform a twisting movement is called elbow stiffness or restricted movement.

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The causes of elbow stiffness can be primarily osteoarthritis, jamming joint bodies, bone neoplasms impeding movement, or prolonged immobilization in a cast.

How is it determined?

Diagnosis is made after clinical examination and by X-ray. The extent of bony neoplasms is best assessed on computed tomography; MRI shows mainly soft tissue thickening.

It is important to first determine why the elbow stiffness occurred, since sometimes a ligament instability can be behind it, which then also needs to be treated.

How to treat the discomfort?

In principle, the treatment is conservative. Especially a pure soft tissue stiffness with thickening of joint capsule, tendons and ligaments can be treated very well with physiotherapy and ultrasound-targeted hydrodilation. This is done analogously to the shoulder, inflating the joint with a mixture of local anesthetic, cortisone, and lots of sodium chloride solution.

Stubborn soft tissue stiffness or elbow stiffness caused by bony causes then require surgical intervention by means of arthroscopy, capsular mobilization, removal of bony obstructions, and possibly nerve mobilization.

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It is important to mobilize the elbow immediately and consistently after surgery, ideally under a pain blockade in which the arm nerve plexus is switched off.

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Arthritis of the elbow

What is affected?

Osteoarthritis of the elbow is less common than in other joints due to the less severe stress and also causes less pain. Predominant is the restriction of movement, which is the main problem.

Causes of elbow osteoarthritis are fractures caused by direct trauma, but also by slight changes in the mechanics of the elbow, causing post-traumatic osteoarthritis, although only tele of the joint may be affected. Normal elbow joint wear is rare, but can occur with certain manual activities, such as work with a sledgehammer.

Repeated microtrauma, such as boxing or even after fractures, can cause free joint bodies to form, leading to entrapment symptoms.

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This and the wear and tear of the cartilage lead to painful synovitis with swelling. Patients with a swollen elbow can then only bend and extend it to a very limited extent.

How is it determined?

An X-ray shows the wear and also already free joint bodies in the elbow. MRI can be used to precisely localize the cartilage lesions, and CT can then be used to localize the free joint bodies

How to treat the discomfort?

Osteoarthritis, especially in the elbow joint, can be successfully treated conservatively for a very long time. Exercise therapy, manual joint distraction, and especially then regenerative measures such as ultrasound-targeted injections with PRP, stem cell concentrates if necessary, and hyaluronic acid can regenerate the joint environment and reduce friction so that the inflammatory response is suppressed.

If conservative therapy fails or if there are signs of entrapment due to free joint bodies, surgical intervention by arthroscopy is recommended to remove the painful joint skin, free joint bodies and sharp-edged osteophytes. After such a procedure, the elbow should be moved again immediately and pain ideally pushed back 5-7 years.

Only in rare cases of pronounced osteoarthritis is surface or joint replacement necessary.

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Posterolateral rotational instability

What is affected?

Chronic overuse, repeated microtrauma or even major trauma can lead to injuries of the lateral ligamentous apparatus at the elbow and thus to instability. Often this pain can be misinterpreted as medial or lateral epicondylitis (tennis elbow or golfer’s elbow) and accordingly treated conservatively for a long time without success.

First and foremost, throwing and impact sports, as well as recurrent overuse and microtrauma to the elbow, pose the risk of permanent instability in addition to major injuries such as elbow dislocation. In particular, the primary suspected diagnosis of epicondylitis and its treatment with cortisone infiltrations can contribute to further injury to the collateral ligament apparatus.

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How is it determined?

The diagnosis of elbow insufficiency or collateral ligament injury is often difficult. The patient typically does not come to the physician with a complaint of instability, but reports the nonspecific symptom of “pain.” Clinical examination of lateral ligament instability is performed by stress testing of the lateral ligamentous apparatus. Internally, instability can usually be diagnosed very well. However, the more common posterolateral roation instability on the outer side can often be insufficiently detected. The problem is that due to the muscular bias, it is hardly meaningful in the awake patient. Only during anesthesia or under arthroscopic control does a provocation test reveal the true instability. Because in posterolateral rotational instability the anatomical unit of the radius and ulna rotates out of the joint to the humerus due to instability of the radial (external) collateral ligament complex, this rotational motion is often known as the mechanism of trauma.

An MRI scan is also a very sensitive exam to detect a collateral ligament injury. Unfortunately, the findings are often misinterpreted as inflammation, and the severity of the instability cannot be determined either, since MRI is a static examination. However, concomitant pathologies such as free joint bodies, cartilage damage, subluxation positions of the joint, etc. can be visualized very well.

Ultimately, diagnostic elbow arthroscopy is the last resort to reliably detect posterolateral rotational instability and perform reconstruction of the insufficient ligaments with autologous tendons to restore joint stability.

How to treat the discomfort?

Treatment is exclusively surgical by reconstructing the torn ligament. This is done with a combined procedure of arthroscopic and open approach. After the instability is identified during elbow arthroscopy, a piece of the triceps tendon is openly harvested and then woven between the humerus and ulna as a ligament replacement. Postoperatively, a splint must be worn for 6 weeks, with movements already allowed during the last 2 weeks. After that, a gradual muscle build-up is carried out. Full loading is possible again after 3 months. The surgery has a success rate of over 90%, but only if performed by a specialist, as it is an extremely complex procedure.

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