Median Elbow

Intravenous formulations are probably the least demanding of all injectates the human vein is quite robust, although venous irritancy is often encountered in clinical trials. A surprising example of this robustness is seen when inducing anesthesia with thiopental sodium (sodium thiopentone). The upper limb veins tolerate these alkaline solutions with impunity, but the solutions are very damaging when administered occasionally and iatrogenically into the cubital fossa a solution at pH 9 can cause serious injury to the structures at the elbow, including the median nerve. 

Injection of a local anesthetic into or around individual peripheral nerves or nerve plexuses produces even greater areas of anesthesia than do the techniques described above. Blockade of mixed peripheral nerves and nerve plexuses also usually anesthetizes somatic motor nerves, producing skeletal muscle relaxation, which is essential for some surgical procedures. The areas of sensory and motor block usually start several centimeters distal to the site of injection. Brachial plexus blocks are particularly useful for procedures on the upper extremity and shoulder. Intercostal nerve blocks are effective for anesthesia and relaxation of the anterior abdominal wall. Cervical plexus block is appropriate for surgery of the neck. Sciatic and femoral nerve blocks are useful for surgery distal to the knee. Other useful nerve blocks prior to surgical procedures include blocks of individual nerves at the wrist and at the ankle, blocks of individual nerves such as the median or ulnar at the elbow, and blocks of sensory cranial nerves. 

Studies Blood chemistries including thyroid and parathyroid tests are normal. Nerve conductions showed severe bilateral dyssdiwannian neuropathy of the median nerves, with prominent conduction block across both wrists. Nerve conductions across the elbow and elsewhere were normal. BMG showed, in both hands, slight-moderate recent denervation in the opponens pollicis and abductor pollicis brevis. Nerve conductions and BMG in the lower limbs were normal. 

Struthers , which joins the anomalous bony process and the medial epicondyle. Clinically, this condition typically affects young sportsmen as a result of intense muscular activity in the elbow and forearm and may start with pain and numbness in the first three fingers and weakness of forearm muscles innervated by the median nerve (Sener et al. 1998). US can demonstrate the relationship of the median nerve with the anomalous bone and ligament. Although not yet reported in the radiological literature, displacement of the nerve by these structures may represent an indicator of entrapment. Therapy includes excision of the ligament of Struthers and ablation of the supracondylar process. The brachial artery can also be compressed by an anomalous insertion of the pronator teres muscle into the supracondylar process (Talha et al. 1987). 

The elbow is traversed by the ulnar, median and radial nerves that cross through its posteromedial, anterior and lateral aspects respectively. In the elbow area, the median nerve is accompanied by the brachial artery, the radial nerve gives off a main motor branch, the posterior interosseous nerve, and the ulnar nerve travels across an osteofibrous tunnel, the cubital tunnel. 

At the elbow, the brachial artery is superficial and courses along the medial border of the biceps muscle and tendon overlying the brachialis (Figs. 8.4b,c,8.5). Then, it passes between the median nerve (medial) and the biceps tendon (lateral) beneath the bicipital aponeurosis to divide, at the proximal forearm, into the radial and ulnar arteries. 

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