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Median Nerve Injury

Injury to the median nerve at the elbow may cause symptoms to appear in the forearm, wrist and hand. Injuries to the median nerve at the elbow are either lesions – where the nerve is torn either partially or fully, or compressed due to displacement of a fracture or excess fluid following injury.

Symptoms of a Median Nerve Injury

  • Injury above the elbow may result in difficulty or even inability to turn the hand over or flex the wrist down.
  • Injuries below this may cause tingling or numbness in the forearm, thumb and the three adjacent fingers.
  • Weakness with gripping.
  • Inability to move the thumb across the palm.
  • Wasting of the muscles at the base of the thumb.

The median nerve emerges from the neck at the brachial plexus between the 5th cervical (neck) and 1th Thoracic (upper back) vertebrae. It then passes down the arm, past the elbow and splits into branches which serve the thumb and three fingers (missing just the little, pinky finger!).

At the elbow, the nerve passes to the inner side of the joint and so injuries in this area are most at risk of causing median nerve injury. It also runs alongside the brachial artery and so an acute injury to the median nerve may also cause injury to this major blood vessel.

Injuries such as a supracondylar fracture, elbow dislocation or any form of fracture should be examined for damage to the median nerve. Even relatively minor injuries, to the medial ligament for example, may result in median nerve symptoms due to increased pressure on the nerve from bleeding and swelling in the area.

Injuries to the median nerve at the elbow are either lesions – where the nerve is torn either partially or fully, or compressed due to displacement of a fracture or excess fluid following injury. Lesions are more serious, long-term injuries. Compression injuries usually resolve when swelling dissipates or when a displaced fragment of bone is removed.

The most common injury involving the median nerve is Carpal Tunnel Syndrome. However this is caused by a decrease in space at the carpal tunnel in the wrist and so would not occur as a result of an elbow injury. Pronator Teres Syndrome is another entrapment neuropathy of the median nerve, this time as it passes between the two heads of the pronator teres muscle.

Treatment

As median nerve injuries at the elbow are usually caused by another acute injury, the priority is to treat the initial injury. This may be a fracture or dislocation or a soft tissue injury. But in many cases, treating the offending injury, eases the median nerve symptoms.

Applying ice, compression and elevation to a soft tissue injury will help to reduce swelling, in turn reducing pressure on the median nerve.

A displaced fracture at the elbow, which is compressing the median nerve may also be corrected by surgery to remove or realign the fragment, again easing pressure on the nerve.

Median nerve symptoms may clear up very quickly if no long term damage was sustained. However, if the nerve was damaged, the symptoms listed above may be more long-lasting.

Stop the pain and get your Elbow check, call +65 6471 2744 / Email: info@boneclinic.com.sg

What cause elbow pain?

Your elbow is a hinge joint consisting of three bones. The upper portion of the hinge is at the end of the upper arm bone (humerus), and the lower portion is the top of the two forearm bones (radius and ulna) which are side by side. All three of these bones are in contact with each other. The joint is surrounded and lined by cartilage, muscles, and tendons that provide support and stability, and make it easy for you to move.

It’s your elbow joint that lets you bend, extend, and rotate your arm. Your range of motion is dependent upon the proper articulation of this joint.

In a healthy elbow joint, the surfaces of these bones are very smooth and covered with a tough protective tissue called cartilage. Arthritis causes damage to the bone surfaces and cartilage where the three bones rub together. These damaged surfaces eventually become painful. Ligaments (another type of soft tissue) lie along the sides and back of the elbow, holding the bones of the elbow joint in place. These ligaments work with the muscles that control the bones and the tendons that connect the muscles to the bones so you can bend and straighten your elbow. Fluid-filled sacs (bursae) cushion the area where skin or tendons glide across bone. The elbow also has a lining (synovium) that secretes a clear liquid called synovial fluid. This fluid lubricates the joint, further reducing friction and making movement easier. 

As you might expect, there are many different reasons why you could be feeling elbow pain, including injury, infection, and arthritis.

Post-traumatic arthritis

Periodically, traumatic events to the elbow region result in bone fractures and severe dislocation of the joint structures. This typically can result in surgery that attempts to heal bone fragments in their proper orientation. Periodically, this attempt is not completely successful in either addressing damage to the cartilage from the injury or in precisely rebuilding your elbow as it was prior to the injury. As a result, the cartilage in your elbow may see forces differently than before the injury occurred. This can result in premature wear of the cartilage in the area of the injury and is called post-traumatic arthritis.

Rheumatoid arthritis

In rheumatoid arthritis, the synovium (lining of the joint) becomes inflamed. The inflammation causes chemicals to be released that thicken the synovium and damage the cartilage and bone of the affected joint. This inflammation of the synovium causes pain and swelling.

The good news about arthritis in the elbow is that it can be treated. Arthritis is a disease that typically worsens over the years, so it is common for treatment to involve more than one approach and to change over time. For some people, nonsurgical treatments such as lifestyle changes, medications, and physical therapy help alleviate the pain. For others, elbow replacement surgery may be a long-term solution. Together, you and your doctor can determine the best treatment options for you.

Stop the pain and Get your Elbow checked today! Call +65 6471 2744 (24 Hours) or Email: info@boneclinic.com.sg

Patient education about elbow pain

Your elbow is a hinge joint consisting of three bones. The upper portion of the hinge is at the end of the upper arm bone (humerus), and the lower portion is the top of the two forearm bones (radius and ulna) which are side by side. All three of these bones are in contact with each other. The joint is surrounded and lined by cartilage, muscles, and tendons that provide support and stability, and make it easy for you to move.

It’s your elbow joint that lets you bend, extend, and rotate your arm. Your range of motion is dependent upon the proper articulation of this joint.

In a healthy elbow joint, the surfaces of these bones are very smooth and covered with a tough protective tissue called cartilage. Arthritis causes damage to the bone surfaces and cartilage where the three bones rub together. These damaged surfaces eventually become painful. Ligaments (another type of soft tissue) lie along the sides and back of the elbow, holding the bones of the elbow joint in place. These ligaments work with the muscles that control the bones and the tendons that connect the muscles to the bones so you can bend and straighten your elbow. Fluid-filled sacs (bursae) cushion the area where skin or tendons glide across bone. The elbow also has a lining (synovium) that secretes a clear liquid called synovial fluid. This fluid lubricates the joint, further reducing friction and making movement easier. 

As you might expect, there are many different reasons why you could be feeling elbow pain, including injury, infection, and arthritis.

Post-traumatic arthritis

Periodically, traumatic events to the elbow region result in bone fractures and severe dislocation of the joint structures. This typically can result in surgery that attempts to heal bone fragments in their proper orientation. Periodically, this attempt is not completely successful in either addressing damage to the cartilage from the injury or in precisely rebuilding your elbow as it was prior to the injury. As a result, the cartilage in your elbow may see forces differently than before the injury occurred. This can result in premature wear of the cartilage in the area of the injury and is called post-traumatic arthritis.

Rheumatoid arthritis

In rheumatoid arthritis, the synovium (lining of the joint) becomes inflamed. The inflammation causes chemicals to be released that thicken the synovium and damage the cartilage and bone of the affected joint. This inflammation of the synovium causes pain and swelling.

The good news about arthritis in the elbow is that it can be treated. Arthritis is a disease that typically worsens over the years, so it is common for treatment to involve more than one approach and to change over time. For some people, nonsurgical treatments such as lifestyle changes, medications, and physical therapy help alleviate the pain. For others, elbow replacement surgery may be a long-term solution. Together, you and your doctor can determine the best treatment options for you.

Cure your elbow pain today and get it check, call us at +65 6471 2744 (24 Hours) / Email: info@boneclinic.com.sg

Elbow Pain Tips and Prevention

Overuse or repeated pressure on the elbow joint can cause small tears to form in the soft tissue, particularly where the tendon anchors to bone. If a number of these tears occur over a period of time, they can cause pain and reduced movement of the elbow joint. Depending on the location and severity of the injury, full recovery can take months.

The most common type of elbow pain is known as ‘tennis elbow’. ‘Golfer’s elbow’ is a less common but similar overuse injury. Despite their names, these injuries can occur as a result of a range of physical activities – racquet sports, rowing, canoeing, weightlifting, hockey, wrestling, swimming – as well as repetitive work tasks undertaken in a variety of occupations.

The elbow joint
If you bend your arm, you can feel three bumps at your elbow joint. Injury to the tendons that anchor muscles to the two bumps on either side of the elbow are a common cause of elbow pain:

  • Lateral epicondyle (‘tennis elbow’) – the bump on the outer side of the elbow. The muscles on the back of your forearm, responsible for curling your wrist backwards, are anchored to this bony point. Pain in this bump is called lateral epicondylitis. This area is particularly susceptible to tennis elbow because it has a poor blood supply.
  • Medial epicondyle (‘golfer’s elbow’) – the bump on the inner side of the elbow. The muscles on the front of your forearm, responsible for curling your wrist up, are anchored to this bony point. Pain in this bump is called medial epicondylitis.

Symptoms
Some of the symptoms of elbow pain include:

  • Pain in the elbow joint, especially when straightening the arm
  • Dull ache when at rest
  • Pain when making a fist (medial epicondylitis)
  • Pain when opening the fingers (lateral epicondylitis)
  • Soreness around the affected elbow bump
  • Weak grip
  • Difficulties and pain when trying to grasp objects, especially with the arm stretched out.

A range of causes
Some of the many conditions and events that may contribute to elbow injuries include:

  • Lack of strength or flexibility in the forearm muscles
  • Lack of strength in the shoulder muscles
  • Instability of the elbow joint
  • Poor technique during sporting activities (especially tennis and golf) that puts too much strain on the elbow joint
  • Inappropriate sporting equipment, such as using a heavy tennis racquet or having the wrong sized grip on a tennis racquet or golf club
  • Repetitive movements of the hands and arms, such as working on an assembly line
  • Continuously making the muscles and joint take heavy loads
  • Other factors such as neck symptoms or nerve irritation.

First aid
Suggestions for first aid to elbow injuries include:

  • Stop whatever you are doing.
  • Rest your elbow for a few days.
  • Use icepacks every two hours, applied for 15 minutes.
  • Massage and stretch the muscles after 48 hours to relieve stress and tension.
  • See your doctor or physiotherapist for diagnosis and further treatment, if necessary
Prevention strategies
Ways to reduce the risk of elbow injury include:

  • Always warm up and cool down thoroughly when playing sport.
  • Make sure you use good technique and proper equipment when playing your chosen sports.
  • Do strengthening exercises with hand weights – your physiotherapist can prescribe the correct exercises for you.
  • Regularly stretch relevant muscles before beginning any potentially stressful activity. Your physiotherapist can prescribe the correct exercises for you.
  • Avoid or modify work tasks that put excessive pressure on muscles of the forearm or that include the use of fingers, wrists and forearms in repetitive work involving forceful movement, awkward postures and lack of rest.

Inflammation and rupture of the triceps tendon

What is the triceps tendon?

The triceps tendon is the one at the back of the upper arm – as shown opposite. It inserts into the back of the elbow. If you fall onto your hands you can rupture this tendon. If you over-do the weights or try to push something too heavy you can also rupture the tendon or it could become inflamed through over use.

Symptoms include:

  • Elbow pain at rest and during exercise.
  • A painful swelling on the back of the elbow.
  • Limited mobility in the elbow.

Treatment

  • Rest
  • Apply ice or cold therapyto the injury in the first two days.
  • See a sports injury professional for advice on treatment and rehabilitation.