ARM CONTUSION, RADIAL NERVE |
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General Information
DEFINITION--Injury from a direct blow to the area over the radial nerve in the upper arm, close to the elbow. Contusions cause bleeding from ruptured small capillaries that allow blood to infiltrate nerves, muscles, tendons or other soft tissue.
BODY PARTS INVOLVED
Radial nerve.
Blood vessels, muscles, tendons, covering to bone (periosteum) and connective tissue.
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SIGNS & SYMPTOMS
Swelling at the contusion site--either superficial or deep.
Pain and tenderness at the elbow.
Shocking, tingling sensation with numbness in the wrist and hand.
Dropped wrist and loss of some movement in the fingers and thumb.
Feeling of firmness when pressure is exerted at the injury site.
Discoloration under the skin, beginning with redness and progressing to the characteristic "black and blue" bruise.
Restricted elbow activity proportional to the extent of injury.
CAUSES
Direct blow to the elbow and radial nerve from a blunt object.
Falling on an elbow.
RISK INCREASES WITH
Contact sports such as football, hockey or baseball, especially when elbows and arms are not adequately protected.
Medical history of any bleeding disorder such as hemophilia.
Poor nutrition, including vitamin deficiency.
HOW TO PREVENTWear appropriate protective gear and equipment, such as elbow pads, during competition or other athletic activity if there is risk of an elbow or radial-nerve contusion.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Doctor's care unless the contusion is quite small.
Surgery (sometimes) to treat the contused nerve. This usually involves transferring and transplanting the nerve into muscle, where it is sutured in place.
Self-care for minor contusions or for serious nerve contusions during rehabilitation after surgery.
Physical therapy following surgery.
DIAGNOSTIC MEASURES
Your own observation of symptoms.
Medical history and physical exam by a doctor for all except minor injuries.
X-rays of the elbow to assess total injury to soft tissue and to rule out the possibility of underlying fracture. The total extent of injury may not be apparent for 48 to 72 hours.
POSSIBLE COMPLICATIONS
Permanent damage to the radial nerve, leading to disability in the forearm and hand.
Prolonged healing time if usual activities are resumed too soon.
Infection if skin over the contusion is broken.
PROBABLE OUTCOMEHealing time varies greatly with the extent of injury and whether surgery is required or not. Healing is usually complete within 2 months, but in a few cases, symptoms never disappear.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AIDUse instructions for R.I.C.E., the first letters of REST, ICE, COMPRESSION and ELEVATION. See Appendix 1 for details.
CONTINUING CARE
Support the arm in a sling.
Wrap an elasticized bandage over a sponge- rubber donut on the injured area. Keep the area compressed for about 72 hours.
Continue ice massage. Fill a large Styrofoam cup with water and freeze. Tear a small amount of foam from the top so ice protrudes. Massage gently over the injured area in a circle about the size of a softball. Do this for 15 minutes at a time, 3 or 4 times a day, and before workouts or competition.
Apply heat instead of ice when skin warmth over the injury becomes the same as for the non-injured areas. Use heat lamps, hot soaks, hot showers, heating pads, heat liniments or ointments, or whirlpool treatments.
Massage gently and often to provide comfort and decrease swelling.
MEDICATION
For minor discomfort, you may use:
Acetaminophen or ibuprofen.
Topical liniments and ointments.
Your doctor may prescribe stronger medicine for pain.
ACTIVITYBegin activities slowly and stop exercise as soon as pain begins. Increase activity as healing progresses.
DIETEat a well-balanced diet that includes extra protein, such as meat, fish, poultry, cheese, milk and eggs. Your doctor may prescribe vitamin and mineral supplements to promote healing.
REHABILITATION
Begin daily rehabilitation exercises when supportive wrapping is no longer needed.
See section on rehabilitation exercises.
CALL YOUR DOCTOR IF
You have symptoms of a radial-nerve contusion.
Any of the following occur after surgery:
Increased pain, swelling, redness, drainage or bleeding in the surgical area.
Signs of infection: headache, muscle aches, dizziness, fever, or a general ill feeling.
Nausea or vomiting.
Constipation.
New, unexplained symptoms develop. Drugs used in treatment may produce side effects.
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