restricted ROM of elbow

[Mike Davis]

I have a client who has an elbow injury. he is not sure of the cause or when it actually started to become restricted in movement. He is an ex shearer.

The problem is he cant bend his arm far enough to touch his shoulder. Even if he applies maximum force with his other arm he still cannot touch his shoulder.

Does anyone know
1. what his injury is
2. exercises or treatment that may increase his ROM in the arm.

Thanks
Mike

[Nicholas]

It might be possible for him to get a screw put in his elbow to stabalise it.

[Mischap123]

Mike,
It could be numerous things. First thing to do would be to rule out a bony block, arthritis, neoplasm via a set of x-rays. If this comes back negative then there is a good chance it'll be a soft tissue restiction or cartilage problem. Let us know how you go.

[IanS]

I have a bone chip in my right elbow that normally resides in a position that only restricts ROM a little. I could not quite touch my right shoulder but could straighten out the arm. Ocassionally after a fair bit of work with the right arm such as chain sawing logs, the bone chip would move and restrict my movement to about 90 degrees. After shaking the arm and resting it, usually within minutes the chip moved again and everything was OK.
I had it X-rayed and showed a bone chip that was loose in the joint. Just had an ankle replacement December 13th 2007 and have been on crutches. I guess the extra loading of the arm agrivated it and about a week ago the chip has lodged itself in that bad position where I can not bend the arm more than 90 degrees from straight. It is still there.
Does anyone know what the sucess rate of arthroscopic surgery is of the elbow?? I am concerned about nerve damage as I am right handed and to lose the use of some of my fingers would be a disaster.

[Zaynah]

I agree with Mischap123... There could be alot of reasons for the block... If the endfeel of the movement is bony, instead of the normall soft tissue bouncy feeling (contact of biceps on forearm and stretching of triceps) at end of range (when flexing, bending the elbow), it could be a loose fragment, malalignment etc. If the end range of motion is stiffened like a piece of leather or tight elastic, it indicates soft tissue abnormality in the structures that are on stretch (the triceps tendon, elbow ligaments etc). If theres a grinding clicking sound in the joint it could indicate arthritis or bony fragments etc. A X-Ray with elbow extended, semi-flexed and full flexed positions should be done with AP and lateral views to get a good look at all the joint at the elbow complex. If negative for bony/articular abnormalities, a MRI could show the soft tissue abnormality if present. Good luck with the diagnosis.

[Zaynah]

To: IanS...

There is always risk of injury to nerves when operating on a joint as nerves cross these joints and in the elbow's case, there are 3 nerves crossing the elbow. Surgeons trained in Arthroscopy know very well where all the nerves and arteries run that they must miss. Sometimes damage to a nerve occurs, but very rarely permanent in scope surgery because of the smaller incisions used than with open surgery. The scope instruments used just nick or pull on the nerve and the damage is partially and temporary... within weeks normal and healed. But there has been a few rare cases of bad nerve damage, but so will you find with other scope surgeries on other joints.

Its important to know and understand the nerves crossing the joint to know how it will affect you if they get damaged. The first one, "Median" nerve crosses your elbow in the front where it bends and it goes to the hand on the palm side. It supplies the forearm muscles that bend and flex your wrist and fingers, and some small hand muscles that help with grip and fine finger movements. The second one "Radial" nerve comes from the back of your arm (through triceps) and crosses your elbow at the outside or the joint about where the outside indentation next to the big elbow bump. It runs in your forearm to the back of your hand and supplies the muscles in your forearm that extend and pull back your wrist and fingers, and helps to move your thumb. The last one "Ulnar" nerve runs on the inside of your upperarm and crosses your elbow in the inner indentation next to the elbow bump, aka the funny bone (it's actually because of the nerve!). The nerve goes to the hand and supplies 2 muscles in the forearm and the muscles of your little finger. These nerves supply muscles and skin in different areas, and damage to one could mean temporary or permnanent loss of sensation or motorfunction, or both.

Discuss your concerns with your surgeon, and ask about his personal experience of complications post operative (they should include stiffness, nerve damage, infections etc). I'm sure you'll be fine. I had arthroscopy done on my hip 1 month ago to remove cartilage, labrum and drill holes in the bone after a piece of cartilage and bone broke off in my hip socket, and i haven't had residual stiffness, sensation loss infections or other complications. Good luck

[IanS]

Zaynah:
Thank you for the information on the nerves in the elbow. Actually it made me very nervous... I had gone to a surgeon in the spring when I had an CT scan done of the elbow back in the summer. He said that they would not use arthroscopy, and warned me about nerve damage. Well to make a long story short, today I tried doing the reverse of what seemed to cause the chip to slip in the first place. I loaded up the joint as hard as I could and then I guess the Gods were on my side because after 14 days, it slipped back and I can now use my right hand again to eat. Was getting a little tired of using my left hand.
Thanks again for the response,
Ian