…clear, understandable information about muscles, bones and joints
Hitting your funny bone can cause a very unpleasant sensation. Some people feel pain, others feel an uncomfortable tingling from the elbow down.
You’re right, the funny bone isn’t a bone, but a spot where your ulnar nerve is exposed in the elbow. The ulnar nerve reaches from your collar bone down your arm, passing through your elbow. When you hit the little nook in your elbow, you actually hit the nerve which is then compressed and reacts, causing the pain or unpleasant sensation.
The so-called funny bone is the spot in your elbow where if you hit it, you feel a jarring, unpleasant sensation from your elbow and down into your lower arm. What you are hitting is the ulnar nerve, which passes through the elbow as it makes its way from the collar bone to the lower part of your arm.
While hitting the funny bone doesn’t usually cause any harm if it’s done occasionally and not too violently, repeated pressure on the nerve, from leaning on it on a desk, for example, can cause the nerve to be compressed and cause long-term damage.
An elbow fracture in someone with rheumatoid arthritis (RA) is a bad break. Surgery is often needed. There are two basic choices: open reduction and internal fixation (ORIF) or total elbow replacement (TER). ORIF involves using a metal plate, wires, and/or screws to hold the broken bone(s) together. Plates and screws are referred to as instrumentation.
A recent report from the Mayo Clinic offered some thoughts on the treatment of patients such as yourself. The authors made note of the fact that elbow deformity caused by the arthritis and age-related osteoporosis of the bones make surgical management difficult. They studied a series of 16 elbows with similar injuries to your own.
They found that ORIF works well for patients with mild arthritis. But joint replacement is usually needed for patients with severe arthritis. The decision as to which procedure to use was based on X-ray findings, strength of the bone, and patient preferences. Whenever possible, the surgeons tried to use ORIF because it preserves the joint and is a less invasive procedure.
In some cases, when both elbows are involved, surgery may be ORIF on one side and total joint replacement on the other side. Your surgeon will be able to advise you based on all things considered. The final decision may be made during the operation. Once the surgeon gets inside the joint and sees the extent of damage from the fracture and deformity from the arthritis, the most appropriate choice for you may be very clear.
The first step is to go back to your surgeon for a follow-up evaluation. Depending on what your surgeon finds, there may be several options to choose from. First, a firm commitment to a rehab program may be in order. Working with a physical therapist may be advised. If this is a viable option, you’ll have to work hard for at least three months to restore motion and regain function.
But beware that elbows are notoriously difficult to rehab. But it’s worth it if you can avoid or delay surgery. However, if rehab is not a good option or doesn’t result in improvement, then surgery may be the next step. Again, your surgeon will guide you through this process.
It may be as simple as removing the hardware to restore motion again. Or it’s possible the joint will need to be replaced. A total elbow joint replacement is possible. Because the implants aren’t expected to last more than 10 to 15 years, this procedure isn’t always recommended for younger patients. It all depends on your level of pain, motion, activities, and function.
Football, as you know, is a high contact sport. Anytime two (or more) people make contact as they do in football, people are going to get hurt. Obviously, the players and the others in the sports leagues want to minimize injuries as much as possible. This is why manufacturers are coming up with new and improved sports protection whenever they can.
However, the only way to completely avoid injury from a sport completely is to not play it. Since this isn’t a good option, the next best thing includes being in as good shape as possible and to use safety equipment at all times in the way it is supposed to be used.
Football injuries include many of the leg (knee, ankle, hamstring, and many other types of injuries) and of the arm, they include the elbow, wrist, and forearm. While we may think that the leg is injured more often, the arm (wrist, forearm, and elbow) has many as well.
A recent study showed that four percent of football-related injuries affected the arm. The injuries, which most often are caused by tackling, blocking, or being tackled or blocked, affect the offensive linesmen most often, followed closely by the defensive linemen.
Only a doctor can diagnose if you have cubital tunnel syndrome, which is what happens when there is pressure on the ulnar nerve, which passes behind the elbow. Cubital tunnel syndrome can be caused by constant pressure on the elbow that then squeezes against the nerve. As well, it can be caused by injury to the elbow or repetitive motions. If you feel tingling or pain in your ring (fourth) finger and little finger, and perhaps decreased sensation, it is possible that you are having problems with the ulnar nerve.
There’s a short answer and a long answer to this question. The short answer is that carpal tunnel syndrome affects the wrist and the nerves that pass through it, and cubital tunnel syndrome affects the elbow, and the nerve that passes along it.
Here’s the longer answer: In the wrist, there an area called the carpal tunnel. This is where the nerves from your arm enter your hand. What can happen with repetitive motions is the area becomes inflamed and irritated, and the tendon (tough, fibrous tissue that helps move your fingers), get thicker and presses on the nerves. With cubital tunnel syndrome, it’s repetitive motions of the arm and elbow that cause trouble, or something else that may press on the nerve, like a cyst or tumor. The ulnar nerve, which passes behind the elbow, where you would call your “funny bone” is pressed on and this affects how your hand feels along the ring (fourth) and little fingers.
A common fracture in young children is a supracondylar fracture of the humerus (upper arm bone). This fracture occurs most often around ages six to seven. Humeral fractures are named for the location of the break. A supracondylar fracture tells us the bone is broken at the lower end of the humerus above the elbow.
It is generally caused by a fall on an outstretched hand. The force of the impact hyperextends the arm and translates enough force through the bone to cause a fracture above the elbow. The break goes all the way through the humerus. The two ends of the bone may become separated or displaced partially or completely.
Surgery is needed to reduce and fix the fracture. Reduction refers to the process of putting the two displaced ends of the bone back together. The surgeon uses a special X-ray imaging technique called fluoroscopy to see the bone. This can be done without making an incision and opening up the arm. A pin or a special wire called Kirschner (K-wire) is used to hold it in place until healing occurs.
Without knowing what exactly happened to your son’s elbow, it’s not possible to give you a specific answer. Usually, elbows are so well protected that repeat dislocations aren’t a problem. That being said, that doesn’t sound like your son’s situation. Has your son gone to see any other orthopedic doctor since he has reached adulthood? It may be worth having the arm examined and perhaps re-x-rayed to see if there is anything that can be done to help stabilize it
Dislocated elbows can differ from person to person because of how the bones move apart. For example, one person may have an anterior dislocation, where the bone has moved to the front, while another may have one that moved to the back. Another person may also have a broken arm along with the dislocation, while another may have sustained some nerve damage. These are but a few examples of the differences that can occur from person to person.
So, to answer your question, the treatment for a dislocation depends on the type of injury, if there any other injuries, and the doctor’s preference.
It’s impossible to say if your friend’s shoulder was completely dislocated or was injured and felt like it might have been. It may appear that a joint pops back into place, however, true dislocations should be treated by a doctor. This is because it’s possible that there are other injuries that occurred along with the dislocation. For example, the doctor will check if the blood flow to the hand is still ok – the injury may have also affected the artery that provides blood to the lower arm and hand. As well, it is important to check the nerves in the hand to be sure they weren’t damaged either.
You may be confusing nitrous oxide with nitric oxide. Nitrous oxide is what we also know as laughing gas used to relax dental patients. Nitric oxide is a cellular molecule that appears to have a wide variety of functions. For example, it acts like Teflon in the blood vessels to keep blood moving smoothly. It also enhances tendon healing. By improving blood flow, it helps improve memory and blood pressure.
Treatment is with patches placed over the painful area. Nitric oxide in the patch is absorbed by the area of tendon damage promoting healing. Studies using the patches for six months showed improved function and strength because of decreased pain. And the pain relief can occur as fast as 24 hours after starting the patch. Nitric oxide provides more than just pain relief. There’s evidence of actual tendon healing as well.
Studies in animals and humans using nitric oxide for tendonitis and tendinopathy are ongoing right now. With tendonitis, there is acute inflammation. Tendinopathy refers to a condition with tendon degeneration but no active inflammation. These studies may help us better understand the mechanism by which nitric oxide works for these conditions.
This may be a classic sign of lateral elbow instability after dislocation. The lateral collateral ligament (LCL) may be torn. Without this ligament, the elbow may be partially dislocating (called subluxation). Pushing down on a stationary object like the arm of a chair actually reduces the joint (puts it back in place).
Most patients with this symptom also report feeling as if the elbow might come out of joint. There’s often tenderness along the outside of the elbow. Full motion is present but turning the hand in the palm up position with the elbow extended gives the feeling that it may dislocate again.
It may be best to see an orthopedic surgeon for an evaluation. You may be able to participate in a rehab program to help strengthen and restabilize the elbow. It depends on how severely damaged the soft tissues are and what’s your activity level.
He may have a torn medial collateral ligament (MCL). This ligament is made up of three separate bundles of fibers that blend into one another. Along with the ligament complex on the outside of the elbow, these soft tissues form the capsule around the elbow joint. The capsule envelopes the elbow, holds the bones together, and provides stability during overhead activities.
In the normal elbow, a significant amount of force can be applied to the elbow during the overhead throwing motion. The ligaments of the elbow combined with the forearm muscles seem to dissipate the energy force created by this motion.
But chronic overuse of the throwing motion can cause microtears in the ligaments that don’t heal. Over time, with enough use and trauma, a partial tear or complete rupture of the ligament can occur.
When that happens, the athlete may not feel pain until as much as 80 per cent of the throwing motion is complete. In some cases, pain may not occur until after throwing. It may require a medical evaluation to know for sure. An orthopedic surgeon or sports physician can assess the arm and elbow to find out what’s going on.
Early detection of problems and treatment right away can help prevent worsening of the condition. Sometimes rest, activity modification, and a specific rehab program can heal the damage and restore the athlete to full function. If not, surgery is another option.
There are some new statistics on return-to-sports after shoulder versus elbow surgery. It seems that athletes with surgically repaired elbow injuries have a better chance of recovery over those who have shoulder surgery.
The reasons for this aren’t entirely clear. This was true even with experienced surgeons doing the operations. It may depend on the type of surgical repair. For example, in this one study, shoulder procedures included labral repairs, labral débridement, rotator cuff tear repair, and capsular release. Elbow problems required removal of loose fragments inside the joint, relocation of a nerve, and ligament reconstruction. Players with elbow injuries and surgery were more likely to return to pre-injury levels than athletes who had shoulder surgery.
Return to play statistics were kept for each group. It turned out that only one in 12 players at the upper league level was able to go back to his pre-injury level of play. Players with labral tears (shoulder injury) were more likely to retire from baseball after surgery.
However, with rehab, many players are able to return to the same or higher playing level after surgery. Sometimes players do retire after serious injuries. Some play at a lower level after recovery.
The most commonly torn elbow ligament in baseball players is the medial collateral ligament (MCL). Sometimes they call this the ulnar collateral ligament (UCL). It’s on the side of the elbow closest to the body. Medial means inside and ulnar refers to the bone along that side of the forearm. That’s how it gets two different names for the same thing.
Injuries of this ligament can sometimes be treated without surgery. But most of the time surgery is needed. This is especially true for athletes. In the few cases that the ligament retears, a second operation is needed.
Results of the surgery are classified as excellent, good, fair, and poor. Excellent means that after surgery the player returns to the game at the same level as before the injury. The athlete participates for at least one full year.
A good outcome is described as returning to a lower level of play but for more than one year. The player is able to throw or pitch daily during practice. Players with a fair result are able to play recreationally. And a poor result means the athlete can’t throw or compete at any level.
Studies show that 85 per cent of players have an excellent result after the first repair. About two percent retear the ligament requiring a revision (second) surgery. Forty per cent (40%) of the players who have a revision procedure have complications. Problems such as stiffness, retear, and scar tissue have been reported.
There doesn’t seem to be any way to predict who might have problems after this type of surgery. It’s impossible to tell who will be able to return to full participation in sports.
Reconstruction of medial collateral ligament tears can be very complicated. If there’s been a long history of pain before the operation, the ligament can be scarred and fibrotic. The nerve can get bound down in the soft tissues as well.
The same thing can happen after a primary (first) surgery. Pain, numbness, and tingling are the first symptoms of a nerve problem. Surgery to free the nerve requires meticulous dissection. Nerves covered in scar tissue can be damaged trying to remove the fibrotic tissue from around them.
The surgeon will try to use the same incisions as in the first surgery. This will help reduce further scarring. If there are any bone spurs pressing on the nerve, these will be removed. Most often, the nerve is transposed (moved) so that nothing is pressing on it or compressing it.
It is possible to return to play after surgery of this type. Recovery may include physical therapy to help with painful symptoms. The therapist will instruct the athlete in exercises that will keep the tendons and nerve gliding freely and smoothly.
Ulnar collateral ligament (UCL) injuries of the elbow are common among overhead throwing athletes. Baseball pitchers, javelin throwers, and tennis players are affected most often. But reports of UCL tears are on record for wrestlers, cheerleaders, basketball players, and hockey players.
Most athletes try a course of nonoperative care first before considering surgery. Six weeks to three months of conservative care can get some athletes well on their way to returning to their sport. The full rehab program can take four to six months (or more) and shouldn’t be rushed.
But when rehab doesn’t work, then surgery may be the next step. Whenever possible, the surgeon will repair the torn ligament. A simple tear that’s present only at one end of the ligament can be stitched back in place. The rehab process is the same but it’s delayed until the ligament has time to heal.
If there is widespread damage to the ligament, then reconstructive surgery may be needed. A tendon graft is used to replace the ligament. There are various graft fixation methods used to accomplish this. Some are more successful than others.
Overall, the success rate for UCL reconstruction is around 85 per cent. This means that 85 per cent of the players are able to return to a level of participation that is equal to (if not better) than their preinjury play.
The 15 per cent who are left may return to their sport but at a lower level than before the injury. Some athletes choose not to return to sports at all. Others are unable to do so. In about 10 per cent of all cases, nerve damage results in numbness, tingling, and other sensory changes in the elbow and/or forearm. This can be temporary or permanent.
An orthopedic surgeon would really have to make that decision. The type of injury determines what treatment is best. Most elbow ligamentous injuries do require some kind of intervention. Early diagnosis and treatment can provide a good result. It’s best not to wait-and-see with these kinds of injuries.
Sometimes, a rehab program of stretching and strengthening for the entire arm is needed. A physical therapist evaluates the athlete and prescribes and supervises such a program. When enough soft tissue healing has occurred, then sports-specific exercises are introduced. This type of program helps make sure the athlete can return to his or her prior level of participation without reinjury.
Postoperative bracing for the elbow protects the healing ligament while still allowing some range of motion. An adjustable hinged-brace may be used to set the motion allowed. As the athlete progresses through healing and recovery, the allowed motion can be increased.
Bracing a joint that doesn’t need bracing can result in joint contractures (limited motion). Check with your team physician or coach about what’s best for your daughter given her age and injury status.