ELBOW CONTUSION, ULNAR NERVE ("Crazybone" or "Crazy Nerve" Contusion) |
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General Information
DEFINITION--Bruising injury from a direct blow to the ulnar nerve where it lies close to the surface at the elbow. Contusions cause bleeding from ruptured small capillaries that allow blood to infiltrate the nerve. Direct injury to the nerve causes damage even if bleeding of capillaries is not a factor.
BODY PARTS INVOLVED
Ulnar nerve.
Ulnar groove in the elbow portion of the humerus (bone of the upper arm).
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SIGNS & SYMPTOMS
Swelling in the elbow--either superficial or deep.
Immediate pain in the elbow.
Shocking, electric sensations extending down to the ring fingers and little fingers.
Gradually increasing numbness and pain along the route of the ulnar nerve in the forearm and hand.
Atrophy of muscles in the hand.
CAUSES
Direct blow to the elbow area from a blunt object.
Falling on the elbow.
RISK INCREASES WITH
Contact sports such as football, soccer or hockey, especially when elbows are not adequately protected.
Medical history of any bleeding disorder such as hemophilia.
Poor nutrition, including vitamin deficiency.
HOW TO PREVENTWear appropriate protective gear, such as elbow pads, during competition or other athletic activity if there is risk of an elbow injury.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Doctor's care unless the contusion is quite small.
Surgery to treat the contused nerve. This usually involves transferring and transplanting the nerve into muscle where it is sutured in place.
Self-care for minor contusions or during rehabilitation following surgery for serious ulnar-nerve contusions.
Physical therapy following surgery.
DIAGNOSTIC MEASURES
Your own observation of symptoms.
Medical history and physical exam by a doctor for all except minor injuries.
X-rays of the elbow to assess total injury to soft tissue and to rule out the possibility of underlying fractures. The total extent of injury may not be apparent for 48 to 72 hours.
POSSIBLE COMPLICATIONS
Permanent damage to the ulnar nerve, leading to disability in the forearm and hand.
Prolonged healing time if usual activities are resumed too soon.
Infection if skin over the contusion is broken.
PROBABLE OUTCOMEHealing time varies from 2 to 6 weeks, depending on the extent of injury and whether surgery is required or not. In a few cases, some symptoms may be permanent.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AIDUse instructions for R.I.C.E., the first letters of REST, ICE, COMPRESSION and ELEVATION. See Appendix 1 for details.
CONTINUING CARE
Wrap an elasticized bandage over a felt pad on the injured area. Keep the area compressed for about 72 hours.
Immobilize the arm in a sling.
Use ice soaks 3 or 4 times a day. Fill a bucket with ice water, and soak the injured area for 20 minutes at a time.
After 72 hours, apply heat instead of ice if it feels better. Use heat lamps, hot soaks, hot showers, heating pads, heat liniments or ointments, or whirlpool treatments.
Massage gently and often from the fingers upward to the shoulder to provide comfort and decrease swelling.
MEDICATION
For minor discomfort, you may use:
Acetaminophen or ibuprofen.
Topical liniments and ointments.
Your doctor may prescribe stronger medicine for pain.
ACTIVITYBegin activities slowly and stop exercise as soon as pain begins. Increase activity as healing progresses.
DIETDuring recovery, eat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Your doctor may prescribe vitamin and mineral supplements to promote healing.
REHABILITATION
Begin daily rehabilitation exercises when movement is comfortable and sling is no longer needed.
Use ice massage for 10 minutes before and after workouts. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage firmly over the injured area in a circle about the size of a softball.
See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
You have symptoms of an elbow or ulnar-nerve contusion.
Any of the following occur after surgery:
Increasing pain, swelling, redness, drainage or bleeding in the surgical area.
Signs of infection: headache, muscle aches, dizziness, fever, or a general ill feeling.
Nausea or vomiting.
Constipation.
New, unexplained symptoms develop. Drugs used in treatment may produce side effects.
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