COMMON CONDITIONS AFFECTING THE ELBOW AND HAND.

The 4 most common non traumatic conditions affecting the arm are inflammatory conditions affecting the tendons and nerves. These conditions can occur with any direct cause or due to overuse activity.

1. Nerve Irritations:

The most common condition seen is carpal tunnel syndrome which is an inflammation of the median nerve in the wrist area of the hand.

Carpal tunnel is more common in females than males and presents with the typical symptoms of needles and pins a numbness in the thumb and adjacent two fingers. Those symptoms typically occur at night time. This is due to compression of the median nerve in the carpal tunnel.

The second most common nerve inflammation is cubital tunnel syndrome with the typical symptoms of needles and pins and numbness in the ring finger and 5^th finger. These symptoms increase with bending of the elbow.

If these conditions occur in both arms and especially simultaneously the patient should have screening test for diabetes, Thyroid conditions and Rheumatological arthritis.

These following conditions are warning signs that needs urgent attention;

1. Severe needles and pins that is continuous
2. Permanent sensation fall out.
3. Weakness in handgrip
4. Symptoms lasting longer than 3 months despite treatment.

When above occur it is normally an indication for surgical release.

Treatment:

The initial treatment for both carpal tunnel and cubical tunnel syndrome is conservative treatment consisting pain medication, Vitamin B12 and nerve glide exercises given by the hand therapist.

If no improvement after 6 weeks of above treatment the patient needs a nerve decompression. This is done under a local anaesthetic and sedation in a day hospital.

Recovery after the procedure;

1. Wound healing 7 to 10 days.
2. Nerve recovery can take up to 6 months to recover.

2.) Tendon Inflammatory conditions around the elbow.

The other 2 most common conditions affecting th

e elbow are tendon inflammation on the outside of the elbow causing the classic Tennis Elbow or on the inside of the elbow causing Golfers Elbow.

Both conditions are most commonly cause by overuse of the muscles of the wrist in extending or flexing the wrist. In the elbow it normally presents with pain on bending the wrist upwards or downwards.

The patient typically complaints of pain on the outside of the elbow or the inside of the elbow on waking up in the morning or while carrying a weight in the hand like a grocery bag.

Although this occurs often in people playing racket sports like tennis or paddle this can also occur during activity that is not done on regular basis.

Most cases of overuse tendonitis around the elbow clears with conservative treatment that can take up to 6 months to fully recover.

Conservative treatment consist of;

1. Refraining from the overuse activity
2. Night splinting of the wrist
3. Physiotherapy
4. Cortisone infiltration of the area of tenderness.
5. Changing the grip of the racket to a thicker grip.

Most of the Golfer and Tennis Elbows will recover with above treatment, but if symptoms persist 6 months after above treatment an operation is required to release the tendons off the bone and to reattach it to encourage tendon healing. This can also be done in a Day Hospital under a local block.

Recover from above surgery varies between 3 to 6 months and it is thus recommended only if conservative treatment fails.

DR CPJ LOURENS
WINELANDS UPPER LIMB UNIT