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Dr 8a

Vague elbow pains, locked up joint, entrapment?

Hi dr 8a! Starting two years ago I have suffered from a vague and hard to describe elbow condition. It first appeared as a piercing pain when extending the elbow rapidly from a very contracted position, eg pushing my daughter on the swing, or when very deep in a push-up. This started from "nowhere", ei without any initial trauma. It has gradually grown to include other symptoms. My elbow may sometimes"lock up", for example if I am carrying a heavy suit case and extend my arm to set it down. If I push through this "lock" it becomes extremely painful. I also feel pain if I overextend the elbow rapidly (eg a sloppy tennis backhand). Until recently, I have been free of pain unless I provoke any of the above, but during the last few weeks I have woken up with a strong ache in the elbow. Getting up and moving the arm a bit and taking a light pain killer has gotten me back to sleep. This happens every night now. I suspect it has to do with poor blood supply to the nerve when inactive. X-ray has shown nothing. I am awaiting MRI results as I write this. When the first symptoms appeared two years ago I stopped climbing for a few months, but experienced no improvement. A doctor suggested some form of nerve entrapment of the Ulnaris, so I have avoided getting pump, in order to let the forearm muscles get a bit flabby. I am a trad climber with small children, so I don´t climb a whole lot anyway and rarely on overhanging rock. I still climb and kayak, and have no problems when I am active. Apart from the entrapment theory, someone has proposed that I have some loose structure, eg a piece of bone or something, moving around in the joint, causing inflammation and the "locking" sensation. This could have arisen in a serious climbing accident four years ago, but it seems unlikely to me since I experienced no elbow problems when using crutches for three months after the incident. Any input would be helpful! Thanks John
Hi John The locking sensation would hardly come from nerve entrapment. The symtoms you are describing fits nicely with a loose body (cartilage would not show on ordinary x-ray) and , as a result of joint surface dammage, a slight arthrosis of the elbow joint (rather uncommon but quite possible after a trauma). I would exspect the Mr to confirm this and if it does ; a endoscopial op with removal of the free body and a "shaving" of the joint surfaces would do the job. A different/ complementary strategy would be to inject a combination of cortison and hyaleronic acid (joint stabiliser) into the joint. I guess you have tried antiinflammotory drugs and I would suggest you add Glukosamine tabletts to that:.Remember - most important - I can only make an educated guess - you should get a sports medicine trained MD to examine and diagnose your injury - this will avoid loosing a lot of time trying remedies for something you actually don't have Best of luck Björn
Thank you for a thorough analysis! So you think a loose body could be the result of previous accident (a crater from 8 m), even though I experienced no elbow problems immediately after the accident? I´ll pass your thoughts on to my doctor and see what the MR says. I´ll get back on the forum when I have the results! John
Yes , this is how if actually most often works -that the free body will start to give problem a long time after the actual incident good luck björn
Hi Björn! Ok, so I got the MR results, which are puzzling. They show nothing abnormal. I quote: "No synovitis or free body in joint. Normal cartilage. Normal tendons around joint." That´s it. Unfortunatley no comment about how the nerves look. The result is puzzling because it gives no clue as to what is wrong. It is also puzzling because an acquaintance with many years as specialist in MR says loose boodies is the one thing MR may sometimes miss. Any opinion about that? Right now frustrated because every doctor in Göteborg seems to be on vacation, elbow is getting worse, and the once-a-year climbing road-trip to Norway is coming up. :-( Should I avoid climbing, even though climbing does not give any direct symptoms? Regards John
Hi John I think you should climb and after summer try to do an athroscopy there are severeral really good sportsmdicine specialized orthopaedics in Gothenborg so you should be able to get hold of one
Hi again! Climbing this summer has been ok, but elbow is not better (possibly slightly worse). Now awaiting a CT next week to see if it gives any new clues. As you say, next stop would be some kind of arthroscopy, but I want to test all other options before resorting to surgery. A bit worried about the risks and the recovery time. I guess even with arthroscopy they´d need to use some violence to get into the joint. What would you say about that? (I´ve got 3 months in Ton Sai planned from january, so I´d hate to not be recovered.) BTW, can you recommend any colleagues in Gothenburg that know what they´re doing? Will keep you posted, in case this turns out to be of interest to others... John
Hi Arthroscopy makes for a fast recovery, try finding Jon Karlsson an excellent ortopaedic surgeon in Gothenburg Good Luck Björn
Hello! Was finally scheduled for arthroscopy, but I had my doubts and went for a second opinion (a bit risky to loose your right arm when you are home with two small children...) The new doctor tried injecting local anasthaetic into the elbow joint, to see if this would remove the pain. It did not. Hence, not likely that there is any loose body in the joint, or other problem there. I decided to cancel the operation in the last moment. The same doctor confirms earlier signs of irritation of Ulnaris. So now we´re back looking at the nerve itself. One theory is that the Anconeus muscle may be involved in some kind of compression of the Ulnaris. Do you have any experience of this with climbers? John
Hi yes but it has allways been more of a problem that the ulnaris nerve has beeen unstable in it position round the elbow and thus roled round the elbow bone causing pain and discomfort. In litterature however I have seen this beeing discussed. Is your doctor considering surgical intervention? Björn