The Final Elbow

This week's guests are Lisa Nguyen, MD, and Chris Johnson, MD, family practice residents at Ochsner University Hospital & Clinics.

Battle after battle, deciphering riddles to find the next location, the hero finally enters the last dungeon. He raises his sword to swing and-

OW! A sudden tingling sensation, like ants crawling on my skin, travels down my ring finger and pinky. Young teen me was binge-watching this new show on my laptop, chin resting on my hands, elbows on the bed. I shake out my arm and slowly the ant crawling fades away. It was exactly like when I hit my funny bone...but I didn't hit it!

So, what happened? The “funny bone” is actually a nerve (the ulnar nerve) that travels from your spinal cord, through the elbow, down to your hand, and provides feeling and muscle function in your pinky and ring fingers. It runs through that groove on the inside of the back of your elbow, and when you smack that groove on the edge of something or put pressure on it (like my position did, or sleeping on it), it gets compressed and stunned. Relieve the compression and the nerve recovers in a few minutes. Zero long-term effects!

Sometimes when children break elbow bones, compression and inflammation can cause more-long term effects, like muscle weakness and clumsiness. That's something for orthopedic surgeons to take care of. Very few kids need surgery or have permanent nerve damage.

With today's computer and game technology, children are more sedentary. They sit for long periods, heavily absorbed in tablets, phones or consoles. But just like to prevent your foot from falling asleep, it's good to remind them to move every so often so hands and fingers don't fall asleep either. Better still, maybe some outdoor playtime wielding their own (plastic) swords?

One of Dr. Hamilton's cousins once called him up, voice shaky: “I think I broke my daughter's elbow!” After hearing what happened, he told them to come over to his house. “Don't we need X-rays?” his cousin asked. “Nah, just come over.” Dr. Hamilton did something with the elbow that made it “click,” and she was cured!

“Nursemaid's Elbow” is a common injury. Have you ever swung your child by the arms while walking? Pulled on a hand to prevent a fall? Some infants and toddlers have weak “annular ligaments” in their elbows. When their wrist gets pulled, the radius bone in the forearm becomes dislodged from that ligament. The child then cries when they try to bend the elbow. One aspect of the injury is it's painless when kids let the arm hang. They only fuss when they try flexing it.

When my own 1-year-old daughter had it, I only noted a hanging arm. I asked about the “hurt,” and she pointed to her left elbow. Examining her, I could tell there wasn't swelling or pain when squeezing, like with broken bones. I used a procedure to put it in place and felt the little “pop.” Then she went right back to playing, using the arm just fine. I knew now to avoid pulling on her wrists until she was around six, when those ligaments tighten up.

We don't see this injury happen often, like when toddlers are playing in another room. One child comes running out holding their elbow - did they fall on it or have it pulled? We X-ray those to rule out fractures before we maneuver it. If there's a reliable story of pulling, we can fix those in our own kitchens, no X-ray needed!