By Dr. Eric W. Edmonds
Elbow injuries are not uncommon in young throwing athletes. In fact, a similar amount of torque and pressure can be seen in the child’s elbow that participates in overhead striking sports, such as volleyball and tennis. But, one injury could be more the result of anatomic bad luck. About 16 percent of children and teenagers have a “funny bone” (actually a nerve) that can jump out of its track inappropriately, and cause pain and tingling that limits sports participation.
What exactly is a “funny bone”?
The “funny bone” is no bone at all, and most people know that it is not really that funny. Most everyone knows where to point if you ask them where this mystical structure is on their elbow; but few realize that it is actually a nerve, called the ulnar nerve, which provides sensation to the outer portion of the hand as well as control of hand muscles. When the nerve is struck behind the elbow it causes immediate tenderness at the elbow, but often can elicit tingling sensations in the hand. These changes in sensation are usually seen predominately in the pinkie and ring fingers.
In nearly one fifth of the population (including children), the ulnar nerve can bounce around the inside corner of the elbow without trauma. It’s something that a child is born being able to do and it will usually happen with just flexing the elbow up. Normally it does not hurt or cause any symptoms associated with the “funny bone.” This is why many people do not even realize that their nerve jumps out of position.
Occasionally, people start to develop symptoms that include tenderness, finger numbness and even hand weakness. Sports and physical activity can exacerbate these symptoms. The problem is not always that the nerve is jumping out of place; instead, it can be due to scar tissue around the nerve or other anatomic constraints that compress the nerve and cause the irritation.
If the irritation is not limited, then the continued injury to the nerve can result in permanent damage that will lead to long-term hand weakness and numbness.
Your physician will often employ nonsurgical treatments as the primary options. These could include rest from the offending activities, splinting the elbow, anti-inflammatory medications and ice therapy. Sometimes, physical therapy can be helpful to work on core muscle strengthening to restore mechanics of throwing or overhead striking.
If a child fails to improve with these measures, then there is a surgical solution that can be entertained. Depending on the exact source of irritation, your surgeon could take pressure off the nerve or even permanently move the “funny bone” to live in the front of the elbow, rather than the back of the elbow, to protect it from injury and from jumping track.
To prevent an injury to this nerve, it is important to monitor any discomfort that your child reports concerning the elbow and athletic participation. Any evidence of numbness or sensation changes related to elbow pain should warrant a visit with your doctor and at least temporary cessation of the offending activity.
These injuries can develop and worsen with overuse, so it should be remembered that repetitive injuries can be prevented by preventing or limiting the repetition.
You should contact your doctor if there is an obvious deformity of the elbow, any joint swelling, no improvement in pain after two weeks of rest or the pain is associated with a fever.
Dr. Eric W. Edmonds is a pediatric and adolescent orthopedic sports medicine specialist at Rady Children’s Hospital San Diego and an assistant professor of orthopedics at UC San Diego. He can be reached at sports@rchsd.org.