Top 10 Conditions Affecting The Elbow - Causes, Symptoms, Diagnosis, Treatment
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Conditions Affecting The Elbow

Dr.Surya Rao Poodipeddi profile Authored by Dr.Surya Rao Poodipeddi on 20 May 2014 - 16:00.

Any condition can affect the elbow joint. These conditions vary depending on the cause, could be a fracture or a dislocation of the elbow. Both these conditions might have common symptoms and signs. However, treatment for a fracture requires longer rest to the part for recovery of the movements where as a dislocation can be reduced immediately and movements of the joint restored almost immediately.

On the other hand, a sprained elbow might need a different type of treatment unless there is a tear in the ligaments associated with the broken joint. The elbow may be affected through inflammatory process in the joint itself like arthritis of various types. The elbow can also get affected due to sport activities or repetitive strain injuries. The list is long and only the important conditions affecting the elbow will be covered. These include:

  • Broken elbow
  • Dislocated elbow
  • Epicondylitis
  • Golfers elbow
  • Repetitive strain injury 
  • Tennis elbow
  • Thoracic outlet syndrome
  • Ulnar nerve injury
  • Arthritis

Broken Elbow

Amongst all the conditions affecting the elbow joint broken elbow is the commonest problem encountered both in adults and children. Early recognition and treatment of an injury in the elbow can reduce the risk of complications and disabilities that are likely to follow such injury.

Greater importance is given to broken elbow, especially in children, because a fracture in the bone(s) of the elbow joint can affect the growth and development of the bones. There are many growth centers in the bones of children from which growth of bones takes place throughout childhood. A fracture, therefore can affect the development of the bones among children.

Causes of broken elbow:

The main causes for a broken elbow include athletic injuries resulting from overuse of the joint and a sudden traumatic event like a fall or a direct blow to the elbow.

Whatever may be the cause of the injury, it can lead to a broken elbow.

Symptoms of Broken Elbow:

If you notice any of the following signs it is possible that you have a broken elbow:

  • Swelling immediately above or below the elbow
  • Deformity of your elbow or the areas near your elbow that were not noticed before the injury.
  • Discoloration like bruising or redness over the area of elbow.
  • Limitation of movements. You are unable to bend your forearm fully which under normal circumstances enables you to touch your shoulder with the fingers. You are also unable to do pronation and supination movements (ability to bring the palm of your hand up or down with the elbow straight).
  • Numbness - decreased sensation or a sensation of coolness in the forearm, hand or fingers: Three major nerves namely the median, radial and ulnar travel from the arm to the forearm through the elbow and can get damaged due to a serious injury to the elbow. Many blood vessels pass from the arm to the forearm and these may get torn or compressed resulting in loss of muscle function.
  • A cut or an open wound on the elbow after injury due to trauma.
  • Severe pain, often intolerable, after an injury to the elbow.
  • A sensation of tightness in the area of the elbow or the forearm.

It is important to see a doctor immediately, for assessment of the injury to administer the right treatment.

Diagnosis:

The doctor may perform the following procedures in his attempt for proper evaluation. While evaluating the injury he will lay importance on: your age, whether a left hander or a right hander, your profession, your lifestyle (active/inactive), history of any operations on the elbow, history health conditions like high blood pressure, diabetes or heart problems, history of any bleeding disorders and vascular problems, medications if any, history of any allergies and your social habits like smoking and drinking.

After a careful study of all these factors, the nature of the injury is identified.

Physical examination is limited to gentle handling of the elbow, the arm and the forearm so as not to aggravate the already existing pain. If necessary he may give you a sedative to calm you down. He will check your blood pressure, pulse and respiration to assess the degree of involvement of the vital factors resulting from the injury.

X-ray of the part is an absolute must. This will identify any fracture or a dislocation. The X-ray is taken in two positions AP & Lateral. While dealing with children it may be necessary to take x-ray of the affected part as well as the unaffected side to compare because of the fact that children’s bone is not completely formed.

Special tests like CT scan or even an MRI may be necessary if X-ray cannot detect soft tissue injury and there is a suspicion of injury to the blood vessels or nerves.

Treatment: Consists of self-care at home, medical treatment and surgical intervention.

Self-care: Do’s and Don’ts:

  • If you have the slightest doubt that you have a broken bone consult a doctor immediately without trying any self-measures.
  • If there is an open wound cover it with a clean bandage. If there is bleeding, apply a firm bandage above the level of bleeding and keep the arm raised.
  • Apply an icepack over the swollen area which gives relief from pain.
  • Never attempt to straighten a broken bone.
  • If you find that a broken piece of bone is projecting outside, never attempt to straighten it or else you may aggravate the problem and injure the nerves or blood vessels. The best thing to do is to leave it alone and just cover it with a clean cloth or bandage and go to emergency at once.

Medical treatment: This depends on the type of the injury that you have suffered. It may be as simple as just elevating the properly splinted arm, applying ice to any swollen area and taking some drugs to relive pain. Treatment may also include performing operations to repaire the bones, nerves and blood vessels. Children and adults differ in elbow injuries and have different ways of healing which is why different methods of treatment become necessary while dealing with adults and children.

Choice of medicines depends on the severity of the condition. Simple pain killers, applying analgesic sprays or administering intramuscular injections, or sometimes intravenous drugs, are some of the methods used depending on the injury.

Surgery: Some cases may require surgical procedures to repair and stabilize a broken bone. This is true when you have an open wound through which the broken bone is projecting outside. Open reduction of a fracture involves approximation of the broken bone, grafting if a piece of the broken bone is missing or cannot be aligned, holding the broken bones through stainless rods or screws or repair of any torn blood vessels and then applying plaster which remains for a minimum period of 6 to 8 weeks.

Other methods of therapy: Besides self-care, medical and surgical treatment for a broken elbow, there are other methods which are followed depending on the nature of involvement of the condition affecting the elbow. These include:

  • If the elbow joint is filled with blood (haemoerthrosis) or other fluid the joint needs to be drained, in a well-equipped emergency operation theatre. Finding relief from pain and swelling is the initial benefit of draining a joint filled with blood or any other fluid.
     
  • Some conditions may need application of splints and plaster casts. Splints are applied as a temporary method of immobilizing the part affected. If there is no evidence of fracture the splint will remain in position for few more weeks till the movements are restored. If there is evidence of a fracture a plaster cast is the only choice.
     
  • However, plaster casts are not applied until the swelling subsides to make sure that there is no swelling inside the plaster cast. If there is a wound, the cast is applied leaving a window open at the area of the wound so that periodical dressing of the wound is done.
     
  • Whether a splint or a cast, the affected forearm needs to be kept elevated at 90 degrees. To reduce the pressure and weight of the splint or cast, an arm sling is used to give maximum comfort to the patient. The angle of the sling can be adjusted in accordance with the comfort zone for the patient.
     
  • If a bone in the elbow is broken it needs to be reset. A reset bone will heal better. Improperly set bones will lead to mal union. In some cases there may be dis-union, meaning the bones don’t heal at all in which case surgical intervention becomes necessary. Sometimes there may be bleeding around the seat of fracture or some nerves might get entangled. Therefore, a reset bone eliminates risk of involvement of nerves and blood vessels.

Monitoring (Follow-up) whatever method of treatment the doctor chooses, it is highly essential to closely monitor the joint for any possible complications that may emerge.

The treating doctor will guide you about this. This will help the doctor to deal with any unforeseen developments. It is therefore, important to follow the doctor’s advice.

After the first visit, your doctor will ask you to observe the following:

  • To keep your arm elevated for relief from pain.
  • Use pain killers as advised only when needed.
  • Not meddle with the splint or cast and always keep it as it was applied.
  • Prescribe antibiotics either to cure an existing infection or prevent the possibility of the wound getting infected.

Precautions: One must visit the doctor immediately if the following is observed:

  • The hand is cold on touch
  • The hand is pale or blue
  • Numbness, tingling sensation or a feeling of dead part in your hand
  • If the forearm hurts if you move the wrist, hand or fingers.

Prevention: As the saying goes that prevention is better than cure, it is always good to observe some steps to prevent the occurrence of a broken elbow by being wary of the situation and cautious to avoid accidents whether at home or outside by taking the necessary steps to avoid them.

Prognosis: (Outcome)

As with every other disease, prognosis depends on several factors - on the way it got broken, your age when it broke, and other medical conditions at the time you broke it and the type and extent of the injury.

Prognosis differs in adults and children. Certain types of broken elbow are associated with particular types of problems as they begin to heal. Children tend to heal better than the adults. It is important to remember that most of the elbow injuries heal without any problems. However, it depends on what the doctor advices and how you follow the instructions.

Complications:

Some of the complications and sequel resulting from broken elbow include:

  • Infection in open injuries.
  • Inability to use the elbow as well as it was before the injury due to stiffness of the elbow a condition seen in some cases.
  • Non-union, meaning that a broken bone doesn’t grow back together. This if happens can be treated with joint replacement with an artificial joint or through bone grafts involving placement of additional bone around the area of nonunion.
  • Malunion in which the broken ends unite in a wrong position leaving angulations and deformity.
  • Abnormal bone growth where there is growth of bone at areas not wanted. Arthritis which literally means an inflammation of the joint not to be mistaken as other types of arthritis which gives pain while doing movements.
  • Hardware problems. Sometimes doctors use steel rods and pins, plates and screws in some special types of injury. These devices might cause pain due to rubbing of soft tissue during movements.
  • Compression of nerves. The three main nerves which pass through the elbow might get compressed giving rise to pain.
  • A fairly large bored artery passes very near the elbow joint to supply blood to the forearm, wrist and the hand. Some types of elbow injury may cause a kink in the artery or even cut through the blood vessel. Sometimes, while trying to reset the broken bones pressure on the artery might get relieved. In some cases operative procedures might me needed to relieve pressure on the artery and/or repair to the injured artery.

It is your elbow. You only can use it effectively and you only can safeguard the joint if only you understand the working of the joint, and what causes problems and how to avoid them in the first place.

 

*Disclaimer: This is not medical advice. The content is for educational purposes only. Please contact your doctor for any health care issues.