How to Destroy Your Elbow
Unless we’re in pain we seldom give much thought to the complex system of bones, muscles, cartilage, tendons and nerves that makes up our elbow joints. Here’s an explanation of how your elbow works, and the many things can destroy its vital function and put you in pain.
The Elbow and How it Works
The elbow joint connects the three bones of the arm. The largest is the upper arm bone (the humerus), which is the thick, weight-bearing part of the forearm bones. The forearm has two bones: the radius and the ulna. The motion of the joint is very complex, from the basic hinge action of bending your forearms to lift a baby, or type or stir a pot, to the precise twist needed to turn a doorknob or position your hands to play the guitar. Movement of the upper arm and elbow joint depends on a coordinated flexing and relaxing of the biceps and triceps muscles above the elbow, and the brachioradilis or elbow flexor in the forearm. Alongside the elbow joint are routed important three nerve bundles (the ulnar, radial and median nerves) and blood vessels that provide sensation, circulation and muscle control to your arm and hands.
Nerve pressure and injury
Most people are painfully familiar with how much it hurts when you bump your elbow just the wrong way. That lightning bolt of “funny bone” pain followed by the tingling sensation up and down your arm happens when you jolt the spot where your ulnar nerve passes beneath the skin of your elbow relatively unprotected, and gets pinched against the underlying bone. The ulnar nerve runs from the shoulder down the arm, past the elbow and into the hand; it communicates with your brain to provide sensation in the little finger and part of the ring finger. It also directs forearm muscles that help you grip, and many of the small tensor and flexor muscles that control fine movements of the hand. It hurts when you bump it, but pain – and permanent nerve damage – can result when the ulnar nerve is subjected to stress over a period of time. Stress positions like driving while leaning your elbow on the car window sill, or leaning your wrist on the steering wheel can cause trouble. Tennis Elbow and the similar condition of Golf Elbow can combine muscle strain with insult to the nerve for a double dose of discomfort. It’s even possible to incur damage, with the resulting pain and tingling, just by holding your smart phone in one position for long periods of time. This chronic neuropathy (nerve damage), is sometimes referred to as Cubital tunnel syndrome.
You can help prevent ulnar neuropathy by taking care not to put stress-inducing weight or strain on your elbows and arms for long periods of time – at your desk, in the car or at home. Take breaks to stretch your arms, and if you notice pain or tingling in the mornings, think about your sleeping position and make changes to reduce pressure on your elbows. If you suffer continuous tingling or pain, see your doctor to determine what’s wrong.
Causes of elbow injury
Elbow injuries often result from sports, recreation or play – particularly in kids. When a child or a teenager injures an elbow, it’s important to make sure there’s no longer-term effect. This is because their skeletons are still growing, and injury to the ‘growth plates’ at the end of long bones like the humerus can impair normal development.
Once we join the working world, even the fittest of us can injure an elbow with repetitive motion, or because of a strain-inducing desk or work station setup.
Middle-aged adults who are not so active sometimes overestimate their fitness, and incur an elbow injury. In older folks, the risk of injury shifts toward falls and accidents, with the loss of muscle mass and tone, and sometimes because of balance and vision deficits that come with age. The likelihood of fractures increases if the person has weakened bones due to osteoporosis.
Types of elbow injury
Elbow injuries can be grouped into two broad categories.
Overuse injuries come from over-stressing the joint or surrounding muscles and tendons either in a throwing or swinging activity or through repetition. Injuries or conditions due to overuse include:
Olecranon bursitis is a swelling at the point of the bony point of elbow that can be caused by leaning heavily on the elbow, or by sharp impact. This condition is sometimes referred to as ‘swellbow’ or Popeye elbow.
Lateral epicondylitis is a variety of tendinitis, a strain in the tendons that connect the forearm muscles to the bone at the elbow. Common names for this condition are Tennis or Golf elbow, but the same kind of injury can occur from work like meat cutting, plumbing or carpentry, or daily activity like gardening.
Tendinosis, which involves small tears in the connective tissue in or around the tendon, can develop due to overuse for longer periods of time.
Infections in the elbow area can cause swelling, redness and warmth at the site, pain and discharge, as well as fever or chills, and enlarged lymph nodes in the armpit. People who inject drugs into veins near the elbow can develop such an infection, sometimes called “shooter’s abscess.”
Nerve damage, such as compression of the ulnar nerve where it crosses the joint, can result from repeated motion or habitual pressure on the elbow joint.
Acute injuries are usually caused by impact, twisting or jamming or a penetrating wound. Acute injuries include:
Fracture – Elbow fractures can be caused by sharp impact to the joint, or from the force absorbed by falling or catching yourself with your arm. These can be extremely painful and can make normal use of the elbow very difficult, even impossible. The simplest fractures can be immobilized with a cast or splint until the bone heals. However, in cases where the arm bones are separated or displaced from the elbow joint, surgery and more complex fixation (including temporary external bracing or permanent metal rods or plates) may be needed to allow the broken bones to knit properly.
Dislocation of the elbow joint is not common, and can occur when a person falls on their outstretched hand, or if they try to brace their upper body in a high-force car accident by reaching out forward. A simple dislocation could disrupt the joint without damage to the bones. More severe dislocations include damage to bone, ligament and tendon tissue, requiring emergency surgery. The most acute dislocations cause damage to the nerves and blood vessels that pass through the elbow, and at worst
Ligament Injury occurs when one or more of the bands of tough tissue that connect the bones of the arm at the elbow become stretched, frayed or torn. This results mainly from overuse, and is common among people who play throwing sports, especially baseball pitchers. One surgical repair technique, involving replacement of the severely damaged ulnar collateral ligament using a tendon from elsewhere in the patient’s body or one harvested from a donor cadaver. First performed in 1974 on the Los Angeles Dodgers pitcher Tommy John (and now widely known as Tommy John Surgery), the procedure grows more common with each passing year, and is being performed on younger and younger patients.
Tendon Injury involves separation of the biceps muscle from the tendon at the elbow, or a tear at the end of the tendon attached to the bone.
Muscle Tear sharp motion incurred in a fall or sports activity can tear the biceps or triceps muscles. More violent forces, like those that occur in an auto accident, can result in a combination of muscle and bone injury, requiring surgery to repair the damage, and physical rehabilitation to recover from the injury and the repair.
Muscle Strain A strained bicep muscle is not uncommon in people who lift weights or are active in sports involving physical contact. Biceps strains are more likely at the shoulder, but do occur at the place where the tendon and muscle meet to attach the muscle to the bone at the elbow.
The best treatment for your elbow injury depends on where the injury is located, and the nature and severity of the problem. For minor injuries, the P.R.I.C.E. Principle is often the best approach:
- Protect the injury site
- Rest and refrain from activity that could exacerbate injury or delay recovery
- Ice, applied for 20 minutes at a time, and then removed, repeated at two-hour intervals
- Compression if practical, can be used between ice sessions to control swelling and to help immobilize the injured area
- Elevation is useful to help reduce swelling and bruising, by reducing blood flow to the injured area. Raise the elbow above heart level, and rest on a soft surface like a pillow or pad
When in doubt, be sure and have a doctor look at your injury. This is prudent practice, even if it only confirms your own assessment. One reason is that the doctor is trained to judge the severity of the damage, and has both diagnostic tools and treatment options at hand. Even more important is the fact that complete healing can sometimes depend on prompt treatment and rehabilitation. Put simply, if you delay examination and treatment for some elbow injuries, you could be stuck with long term pain or disability. Don’t tough it out – ask a medical professional to examine your injury. The doctor will either confirm your approach to healing or diagnose a more serious injury and prescribe appropriate treatment. Since you’ll want a working, pain-free elbow joint for as long as you live, don’t let inaction destroy your elbow: Let prudence and caution be your guide.