Elbow
The elbow:
Introduction
The elbow is the joint between the upper and lower arm. The elbow joint is a composition of three joints in a. Because of these joints, the forearm relative to the upper arm over a distance of 130 ° can be bent (flexed) and then be stretched (extension). Again completely The forearm is about its longitudinal axis 80 ° rotation (pronation) inwards and 80 ° outwards rotated (supination).
Bones
There are three bones involved in the elbow movements: the upper arm bone (humerus) and the ulna in the forearm (ulna) and the radius (radius). Be at the height of the elbow joints formed by these three bones: the joint between the upper arm and ulna, the joint between the upper arm and the radius and the joint between the radius and ulna.
Joints
The joint between the upper arm and ulna, the ulna includes the upper arm as a bar. It is a hinge joint which permits only flexion and extension at the elbow. The joint between the upper arm and thigh.
The joint between the upper arm and the radius is in build a ball joint, but by the end of the radius (radial) abuts the ulna, the movement is limited in two directions, namely, stretching and bending the elbow and rotate about its longitudinal axis.
The joint between the radius and ulna at the elbow joint: the joint is formed between the head of the radius and ulna. The head of the radius is against the ulna held by a band that begins at the height of the ulna, runs around the head of the radius, and then again to attach. To the ulna Also this band is coated on the inside with cartilage. In this joint is rotating about the longitudinal axis of the forearm as possible.
Cartilage
The ends of the humerus, ulna and the head of the radius are covered with cartilage. Cartilage is a good springy tissue. Cartilage contains no blood vessels and nerves. All three joints are surrounded by a joint capsule.
Joint Lubrication
The blood vessels in the joint capsule form joint lubricant. The joint lubricant holds the joint surfaces with a thin film. Due to its characteristics, the viscous joint lubricant ensures that the joint surfaces remain separated from each other, so that friction is kept to a minimum and there is no wear of the articular surfaces occurs. One can compare the joint lubricant grease in a bearing which rotates the shaft of a wheel.
Ligaments
The joints are reinforced by ligaments that are called ligaments. The bands consist of layers of strong connective tissue.
Muscles
The muscles that bend the elbow, the two-headed muscle (biceps, muscular = musculus) and upper arm muscle (musculus brachialis).The muscle that extends the elbow, the three-headed arm muscle (triceps brachii). Two muscles in the forearm (pronator teres muscle and musculus pronator quadratus) rotate the forearm inwards. The two-headed muscle (biceps) and a muscle in the forearm (musculus supinator) rotating the forearm outward.
On the outside of the elbow spring on the upper arm of the extensor muscles of the wrist and fingers on the inside of the flexors of the wrist and fingers.
Bursas
A bursa is a thin-walled cavity that is filled with the same viscous liquid as the synovial fluid. Bursas sit in places that are subject to friction: between bone and skin, between tendon and skin and between tendon and a bone. The main bursa at the level of the elbow is located on the rear side of the elbow, between the end of the ulna and the skin.
Problems, diseases and disorders
There are various conditions that a person may have. To the arm or elbow So injuries can be caused by a fall on the elbow joint where the forced movement to make that is outside the normal range. Prolonged and repeated loading of the joint can lead to cracks in various ligaments and tendons, broken bones in the joint and damage to the nerves and blood vessels around the elbow.
Epicondylitis is an inflammation of the attachment sites of the tendons, also called the epicondyli. When it comes to the lateral epicondyle (on the outside of the arm), it is called tennis elbow (lateral epicondylitis), involves an inflammation on the inside this is called a golf elbow (medial epicondylitis). Such inflammation is accompanied by pain and internal scarring. Intensive use of the muscles around the elbow, especially when it comes to making repetitive movements, rubbing the tendon against the bone surface and damage. Tennis elbow is most common in people who are still making the same movements in which the pulse is stretched or is pulled backwards or where the forearm is rotated (like tennis and carpenters).
A golf elbow is often a result of movements in which the wrist is bent and a sweep is made, such as golf, baseball and logging. In both cases, there is pain and swelling of the affected area. Rest and painkillers promote recovery.
Dislocation of the elbow
Among children and teenagers is a dislocated elbow for many, especially if they catch a fall by stretching a hand. The bones of the joint in their place to be printed, causing the joint to lock in place. By the blow This causes pain and swelling. A dislocated elbow should be immediately hospitalized and examined and treated. The doctor can immediately put the joint in place or first make a few x-rays before he / she makes a decision about treatment.
Elbow Fracture
All the bones in the elbow joint to break after a fall or injury, but a break in the part of the humerus is most just above the epicondyle. Before,This is because this part is the narrowest and most fragile. Such a break may be the result of a fall on an outstretched hand. The treatment of this fracture depends on the severity and the extent to which one or more bits are shifted. The treatment can also vary from only a plaster cast (with simple fractions) to surgery (with compound fractures).
Arthritis of the elbow
Arthritis is an inflammatory disease of the articular surfaces of the bones. Many types of arthritis (e.g., rheumatoid arthritis, psoriatic arthritis, gout and osteoarthritis) can affect the elbow joint. In all these conditions there is pain, swelling and stiff joints, often the patient's joint is not fully extend or bend. Treatment depends on the cause. Pain is controlled with painkillers. Physical therapy can help, it should also get plenty of rest the joint. In some cases, surgery may be considered.
Complications
A possible complication after an elbow fracture is that the nerves and blood vessels are damaged around the elbow joint. Generally the ulnar nerve (the nerve behind the medial epicondyle), which runs to parts of the hand, the fingers and the inside of the forearm. May become completely paralyzed. In severe damage
Epicondylitis is an inflammation of the attachment sites of the tendons, also called the epicondyli. When it comes to the lateral epicondyle (on the outside of the arm), it is called tennis elbow (lateral epicondylitis), involves an inflammation on the inside this is called a golf elbow (medial epicondylitis). Such inflammation is accompanied by pain and internal scarring. Intensive use of the muscles around the elbow, especially when it comes to making repetitive movements, rubbing the tendon against the bone surface and damage. Tennis elbow is most common in people who are still making the same movements in which the pulse is stretched or is pulled backwards or where the forearm is rotated (like tennis and carpenters).
A golf elbow is often a result of movements in which the wrist is bent and a sweep is made, such as golf, baseball and logging. In both cases, there is pain and swelling of the affected area. Rest and painkillers promote recovery.
Dislocation of the elbow
Among children and teenagers is a dislocated elbow for many, especially if they catch a fall by stretching a hand. The bones of the joint in their place to be printed, causing the joint to lock in place. By the blow This causes pain and swelling. A dislocated elbow should be immediately hospitalized and examined and treated. The doctor can immediately put the joint in place or first make a few x-rays before he / she makes a decision about treatment.
Elbow Fracture
All the bones in the elbow joint to break after a fall or injury, but a break in the part of the humerus is most just above the epicondyle. Before,This is because this part is the narrowest and most fragile. Such a break may be the result of a fall on an outstretched hand. The treatment of this fracture depends on the severity and the extent to which one or more bits are shifted. The treatment can also vary from only a plaster cast (with simple fractions) to surgery (with compound fractures).
Arthritis of the elbow
Arthritis is an inflammatory disease of the articular surfaces of the bones. Many types of arthritis (e.g., rheumatoid arthritis, psoriatic arthritis, gout and osteoarthritis) can affect the elbow joint. In all these conditions there is pain, swelling and stiff joints, often the patient's joint is not fully extend or bend. Treatment depends on the cause. Pain is controlled with painkillers. Physical therapy can help, it should also get plenty of rest the joint. In some cases, surgery may be considered.
Complications
A possible complication after an elbow fracture is that the nerves and blood vessels are damaged around the elbow joint. Generally the ulnar nerve (the nerve behind the medial epicondyle), which runs to parts of the hand, the fingers and the inside of the forearm. May become completely paralyzed. In severe damage
Wrist:
A common complaint is carpal tunnel syndrome:
What is Carpal Tunnel Syndrome?
Do you experience tingling and / or numbness in your hand, especially at night? If these symptoms less if you shake your hand? Do you feel may be in the address of an object that you feel awkward or sometimes a stabbing pain pulling up to your shoulder? These symptoms could fit carpal tunnel syndrome.
The carpal tunnel is located at the height of the transition from the forearm to the hand and is a "pass through". The tunnel is formed by 8 in a U-shape sized metacarpal (carpalia). Between the legs of the "U" is a solid ligament biased thereby forming a tunnel. Through this tunnel walk nine tendons and one nerve. The tendons, which are surrounded by a membrane, the foothills of the forearm muscles which are located in and take care of the movement of the wrist and the fingers. The nerve (the median nerve) innervates (stimulates) some small muscles in the hand and provides the feel and touch the hand of the thumb, index finger, middle finger and half of the ring finger.
Due to circumstances, the fleece is built around the tendons around (synovium) may swell. This is the space in the tunnel is relatively smaller and the nerve is pressed against the ligament that the tingling, numbness, clumsiness and can cause pain. You can compare it to a temporal bone. When sitting with legs crossed long one has ever numbness and tingling in the lower leg and then a nerve, which is located in the knee, pinched. A big difference from the carpal tunnel syndrome is that one is not in a position to pick up. The pressure of the nerve
Is it common?
Carpal tunnel syndrome is one of the most common nerve crushing. How often it occurs exactly is not known exactly. In the vicinity of Maastricht is a large study in which nine of the 100 women a greater or lesser extent have symptoms of carpal tunnel syndrome. So you're not alone. The symptoms usually occur between the 40 th and 60 th year of life and regularly on both hands. Women are 3 times more likely that they will get carpal tunnel syndrome as men.
All structures that occupy space in the tunnel and thereby trapping the nerve can cause symptoms. This sounds simple, but in the vast majority of cases, one does not know what the cause is. Below are a number of causes that could play in getting carpal tunnel syndrome, a role:
- repetitive movements of the wrist especially if there is power needed
- broken wrist where the metacarpal shift
- hormonal changes as occur during pregnancy and menopause
- inflammatory symptoms such as rheumatoid arthritis
- delayed function of the thyroid gland
- diabetes
How does the doctor diagnose?
Your doctor will ask a number of things and test before he / she will be able to establish the diagnosis of carpal tunnel syndrome:
- there are complaints of tingling and numbness of the fingers, especially at night, you will wake up the complaints, you can see the symptoms disappear, clumsiness of the fingers, have you ever pains from the wrist of the arm, are you pregnant or do you have a particular disease
- you feel an electric current when the doctor gently with his finger right on your nerve
- you get the same symptoms as the doctor your wrist bends and hold 60 seconds
- the EMG (electromyogram) is positive, this is a study in which people with very small streams measure the conduction velocity of a nerve, with a pinched nerve conduction velocity, this lower
On the basis of the above questions and tests can be a diagnosis. May also be an assessment of the severity of the symptoms. With these data, the treatment chosen.
What can you do?
Depending on your symptoms, the most appropriate treatment will be chosen. In mild symptoms often started giving a polsspalkje or brace.This will be worn at night in the line. The splint ensures peace and keep the wrist in a position such that the pressure on the nerve is the least. The complaints are more serious than one can try to take a syringe with medicine to inject. Within the carpal tunnel release pressure on the nerve About the usefulness of these opinions are divided. Often one sees that the symptoms come back. The injection of drugs into the carpal tunnel is therefore primarily used on patients with complaints of transient appear to be, such as in pregnant women is often the case.
Are symptoms better treatments listed, then it may be necessary to operate. It is the ligament which is stretched cut between the metacarpal bones, causing back room for the nerve and the symptoms will disappear. There are basically two surgical techniques. The conventional method in which an incision of 5 cm length in the palm is made and the connective tissue band.
There is also a technique in which use is made of a tube (of the endoscope), and whereby a camera is operated. This tube, in which a slot in it, is slid over the two slices of 1 cm below the tissue to cut through tape. Through the slot in the tube, one can see the band of connective tissue and cut. For this technique, the patient must, however, to a number of requirements, and this technique is thus not suitable for a number of patients.
Both operations can take place in the line or in an outpatient day case and you can go home the same day. The symptoms usually disappear within a few days. Despite being a relatively small operation, it will be a few weeks and sometimes months before charges you will be able to do everything again. Should it come then please contact your doctor with your questions.
