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10 Things You Might Not Know About the Elbow

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The human body is an amazing thing. For each one of us, it's the most intimate object we know. And yet most of us don't know enough about it: its features, functions, quirks, and mysteries. Our series The Body explores human anatomy, part by part. Think of it as a mini digital encyclopedia with a dose of wow.

Unless you bang your funny bone or regularly play tennis, it's unlikely you spend a lot of time thinking about your elbow. But without this crucial joint, many daily activities would be impossible, explains Anand Murthi, attending orthopedic surgeon and chief of shoulder and elbow surgery at MedStar Union Memorial Hospital, in Baltimore, Maryland.

1. THE ELBOW IS MORE COMPLEX THAN IT MAY SEEM.

The elbow may seem small, but it requires three bones to make its simple hinging action possible. The humerus is a long bone that runs from the shoulder socket to the radius and ulna. (And yes, there's a school of thought that believes your "funny bone"—actually your ulnar nerve—is named as a play on the word humorous.) The radius is one of the two forearm bones, running down from the elbow to the thumb side of the wrist. Lastly, the ulna stretches away from the pinkie side of the wrist. Thanks to those three bones, your arm can hinge—making it possible to do a bicep curl, lift a bag, or rotate your hand.

2. IT'S ALL HELD TOGETHER BY A KEY LIGAMENT, AS INJURED ATHLETES KNOW WELL …

The bones of the elbow are connected by numerous tendons and ligaments, including the ulnar collateral ligament, a fibrous tissue that connects the humerus to the forearm bones. This tendon is both important and vulnerable. When it ruptures or tears, you feel severe pain and can sometimes even see bruising on the inside of your arm. It's a surprisingly common sports injury, plaguing players of baseball, football, ice hockey, and golf. The other major ligament in the joint is called the radial collateral ligament. Located on the outside of the elbow, it prevents excessive extension of the elbow, and is less prone to injury.

3. … BUT THAT'S NOT THE ONLY VULNERABLE PART OF YOUR ELBOW.

At the lower end of the humerus are two rounded protrusions called epicondyles, which flare out from the bone. This is where muscles attach. The upper end of the ulna also has two protrusions, called the olecranon—which forms the pointy part of the elbow—and the caronoid process, a projection from the front of the ulna. Bone fractures, especially in children, often occur at these epicondyles, and are the most common short-term injuries of the elbow. Certain kinds of arthritis, especially in older patients with osteoarthritis, can also cause such severe degeneration here that an elbow replacement is necessary. (Since bones become more brittle as we age, it's wise to take steps to prevent falling or stumbling, as elbows are among the most likely casualties.)

4. TRAMPOLINES ARE COMMON ELBOW-BREAKERS.

Children love the thrill of a jump on the trampoline, but Barbara Bergin, an orthopedic surgeon in Austin, Texas, tells Mental Floss that she sees numerous fractures around the elbow in kids from doing just that. It's so common to break elbows and wrists this way, the American Board of Pediatrics warns against trampolines.

5. TWENTY-THREE MUSCLES GIVE YOUR ELBOW STABILITY AND FLEXIBILITY.

But the major muscles involved in bending your arm are the triceps—on the back of your arm—and biceps, on the front of your arm. Your many smaller flexor and extensor muscles allow you to move your wrists and fingers and rotate your forearm.

6. YOU DON'T HAVE TO PLAY TENNIS TO GET TENNIS ELBOW.

One of the most common conditions of the elbow is called "tennis elbow"—or lateral epicondylitis. Tennis players are prone to it, but it can be caused by any repetitive bending and flexing of the elbow, says Bergin. It's a painful degeneration of the tendons that attach to the bone on the outside of the elbow. It's so common, she says, "I probably see tennis elbow every day in my office." If the condition should strike you, Bergin says, "It's critical to stop doing whatever hurts. It will not get better if you continue to participate in whatever activity is causing pain." Full and total healing is required before you can return to the activities that gave you the condition in the first place.

7. IF IT GETS BAD ENOUGH, YOU MAY NEED "TOMMY JOHN" SURGERY.

When major league pitcher Tommy John injured his ulnar collateral ligament in 1974, his doctor opted to try a unique surgery to replace the deteriorated ligament with a tendon from somewhere else. Though the surgery can require a full year's recovery time—in Tommy John's case, it was nearly two and a half years and two surgeries—it's since become a time-tested method to repair this damaged ligament. Murthi tells Mental Floss, "New research on repairing the medial collateral ligament (versus reconstructing it) may lead to earlier recovery for Tommy John surgery. Also new treatments for articular cartilage damage, ligament reconstruction, and joint sparing techniques are evolving."

8. BUT IT'S HARD TO OPERATE ON YOUR ELBOW.

The elbow's close proximity to important blood vessels and nerves in your hand and arm make it a challenge to perform surgery on, Murthi says: "Careful, precise surgery is required to provide a good outcome. Often, rehabilitation with a skilled therapist is crucial to a good recovery." Currently, many operations are performed arthroscopically, so that surgeons can see all the various components as they make delicate maneuvers.

9. IF YOU HAVE TO GET AN AMPUTATION, HOPE FOR ONE BELOW THE ELBOW.

Should you have the misfortune of losing part of an arm, it's better to lose the parts below the elbow, Bergin says. This helps you maintain a range of motion and allows you to better manipulate a prosthesis. Fortunately, upper extremity amputations are rare and almost always result from accidents, as compared to lower arm amputations, which are often caused by some form of vascular disease.

10. EVEN JUST READING A BOOK CAN CAUSE AN ELBOW CONDITION.

While you may be tempted to read that latest hefty bestseller late into the night, if you're keeping your elbows bent in a sitting position for too long, you can get a case of ulnar neuritis, inflammation of the ulnar nerve—which can lead to numbness or weakness of the fingers and hand. Bergin warns, "It's much more common now than it used to be because we sit around for hours at a time on our phones." If you experience a "little tingly feeling in the pinky and fourth finger," she says, you've probably got a case. Her recommendation is to take as many breaks with your arms straight out as you can. Switch to a kindle or laptop that you can prop up to read at night. Be conscious of your ergonomics when you drive, type, and use your electronics.

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Pierluigi Luceri, Flickr // CC BY-NC-ND 2.0
Two Human Toes Were Stolen From an Anatomy Exhibit
Pierluigi Luceri, Flickr // CC BY-NC-ND 2.0
Pierluigi Luceri, Flickr // CC BY-NC-ND 2.0

A 28-year-old New Zealand man walked into an anatomy exhibition with 10 toes and walked out with 12. We don't know why or how he did it, but the man stole two human toes from a Body Worlds display in Auckland last month, The New Zealand Herald reports.

The unnamed man appeared in court Monday and pleaded guilty to improperly interfering with the corpse "of an unknown person" and purloining two toes, which alone are valued at about $3800. The motivation for the human remains heist wasn't stated. (Fulfilling a dare seems a likely explanation, or maybe he's just a fan of The Big Lebowski.)

Whatever the reason may be, the story has a happy ending, at least: The digits have since been returned to their rightful place in the "Vital" exhibit, which explores the human body in motion. "Vital," which will remain open in Auckland until July 13, is one of several traveling exhibitions curated by Body Worlds. Two other Body Worlds exhibits are currently on view in the U.S., including "RX" (showcasing the effects of disease) in Toledo, Ohio, and "Animal Inside Out" (an "anatomical safari") in Richmond, Virginia.

The bodies, all of which are donated for exhibition purposes, are preserved via plastination, a process that "replaces bodily fluids and soluble fat in specimens with fluid plastics that harden after vacuum-forced impregnation," according to the Body Worlds website. More than 16,000 people around the world have signed up to donate their bodies after their deaths.

[h/t The New Zealand Herald]

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Illustration by Mental Floss / Images: iStock
11 Facts About the Appendix
Illustration by Mental Floss / Images: iStock
Illustration by Mental Floss / Images: iStock

Despite some 500 years of study, the appendix might be one of the least understood structures in the human body. Here's what we know about this mysterious organ.

1. THE ANCIENT EGYPTIANS CALLED IT THE "WORM" OF THE BOWEL.

The human appendix is small, tube-shaped, and squishy, giving ancient Egyptians, who encountered it when preparing bodies for funerary rites, the impression of a worm. Even today, some medical texts refer to the organ as vermiform—Latin for "worm-like."

2. THE APPENDIX SHOWS UP IN LEONARDO DA VINCI’S DRAWINGS.

The earliest description of a human appendix was written by the Renaissance physician-anatomist Jacopo Berengario da Carpi in 1521. But before that, Leonardo da Vinci is believed to drawn the first depiction of the organ in his anatomical drawings in 1492. Leonardo claimed to have dissected 30 human corpses in his effort to understand the way the body worked from mechanical and physiological perspectives.

3. IT'S ABOUT THE SIZE OF A PINKY FINGER.

The appendix is a small pouch connected to the cecum—the beginning of the large intestine in the lower right-hand corner of your abdomen. The cecum’s job is to receive undigested food from the small intestine, absorb fluids and salts that remain after food is digested, and mix them with mucus for easier elimination; according to Mohamad Abouzeid, M.D., assistant professor and attending surgeon at NYU Langone Health, the cecum and appendix have similar tissue structures.

4. CHARLES DARWIN THOUGHT IT WAS A VESTIGIAL ORGAN …

The appendix has an ill-deserved reputation as a vestigial organ—meaning that it allegedly evolved without a detectable function—and we can blame Charles Darwin for that. In the mid-19th century, the appendix had been identified only in humans and great apes. Darwin thought that our earlier ancestors ate mostly plants, and thus needed a large cecum in which to break down the tough fibers. He hypothesized that over time, apes and humans evolved to eat a more varied and easier-to-digest diet, and the cecum shrank accordingly. The appendix itself, Darwin believed, emerged from the folds of the wizened cecum without its own special purpose.

5. … BUT THE APPENDIX PROBABLY EVOLVED TO HELP IMMUNE FUNCTION.

The proximity and tissue similarities between the cecum and appendix suggest that the latter plays a part in the digestive process. But there’s one noticeable difference in the appendix that you can see only under a microscope. “[The appendix] has a high concentration of the immune cells within its walls,” Abouzeid tells Mental Floss.

Recent research into the appendix's connection to the immune system has suggested a few theories. In a 2015 study in Nature Immunology, Australian researchers discovered that a type of immune cells called innate lymphoid cells (ILCs) proliferate in the appendix and seem to encourage the repopulation of symbiotic bacteria in the gut. This action may help the gut recover from infections, which tend to wipe out fluids, nutrients, and good bacteria.

For a 2013 study examining the evolutionary rationale for the appendix in mammal species, researchers at Midwestern University and Duke University Medical Center concluded that the organ evolved at least 32 times among different lineages, but not in response to dietary or environmental factors.

The same researchers analyzed 533 mammal species for a 2017 study and found that those with appendices had more lymphatic (immune) tissue in the cecum. That suggests that the nearby appendix could serve as "a secondary immune organ," the researchers said in a statement. "Lymphatic tissue can also stimulate growth of some types of beneficial gut bacteria, providing further evidence that the appendix may serve as a 'safe house' for helpful gut bacteria." This good bacteria may help to replenish healthy flora in the gut after infection or illness.

6. ABOUT 7 PERCENT OF AMERICANS WILL GET APPENDICITIS DURING THEIR LIFETIMES.

For such a tiny organ, the appendix gets infected easily. According to Abouzeid, appendicitis occurs when the appendix gets plugged by hardened feces (called a fecalith or appendicolith), too much mucus, or the buildup of immune cells after a viral or bacterial infection. In the United States, the lifetime risk of getting appendicitis is one in 15, and incidence in newly developed countries is rising. It's most common in young adults, and most dangerous in the elderly.

When infected, the appendix swells up as pus fills its interior cavity. It can grow several times larger than its average 3-inch size: One inflamed appendix removed from a British man in 2004 measured just over 8 inches, while another specimen, reported in 2007 in the Journal of Clinical Pathology, measured 8.6 inches. People with appendicitis might feel generalized pain around the bellybutton that localizes on the right side of the abdomen, and experience nausea or vomiting, fever, or body aches. Some people also get diarrhea.

7. APPENDECTOMIES ARE ALMOST 100 PERCENT EFFECTIVE FOR TREATING APPENDICITIS.

Treatment for appendicitis can go two ways: appendectomy, a.k.a. surgical removal of the appendix, or a first line of antibiotics to treat the underlying infection. Appendectomies are more than 99 percent effective against recurring infection, since the organ itself is removed. (There have been cases of "stump appendicitis," where an incompletely removed appendix becomes infected, which often require further surgery.)

Studies show that antibiotics produce about a 72 percent initial success rate. “However, if you follow these patients out for about a year, they often get recurrent appendicitis,” Abouzeid says. One 2017 study in the World Journal of Surgery followed 710 appendicitis patients for a year after antibiotic treatment and found a 26.5 percent recurrence rate for subsequent infections.

8. AN INFECTED APPENDIX DOESN’T ACTUALLY BURST.

You might imagine a ruptured appendix, known formally as a perforation, being akin to the "chestbuster" scene in Alien. Abouzeid says it's not quite that dramatic, though it can be dangerous. When the appendix gets clogged, pressure builds inside the cavity of the appendix, called the lumen. That chokes off blood supply to certain tissues. “The tissue dies off and falls apart, and you get perforation,” Abouzeid says. But rather than exploding, the organ leaks fluids that can infect other tissues.

A burst appendix is a medical emergency. Sometimes the body can contain the infection in an abscess, Abouzeid says, which may be identified through CT scans or X-rays and treated with IV antibiotics. But if the infection is left untreated, it can spread to other parts of the abdomen, a serious condition called peritonitis. At that point, the infection can become life-threatening.

9. SURGEONS CAN REMOVE AN APPENDIX THROUGH A TINY INCISION.

In 1894, Charles McBurney, a surgeon at New York's Roosevelt Hospital, popularized an open-cavity, muscle-splitting technique [PDF] to remove an infected appendix, which is now called an open appendectomy. Surgeons continued to use McBurney's method until the advent of laparoscopic surgery, a less invasive method in which the doctor makes small cuts in the patient's abdomen and threads a thin tube with a camera and surgical tools into the incisions. The appendix is removed through one of those incisions, which are usually less than an inch in length.

The first laparoscopic appendectomies were performed by German physician Kurt Semm in the early 1980s. Since then, laparoscopic appendectomies have become the standard treatment for uncomplicated appendicitis. For more serious infections, open appendectomies are still performed.

10. AN APPENDIX ONCE POSTPONED A ROYAL CORONATION.

When the future King Edward VII of Great Britain came down with appendicitis (or "perityphlitis," as it was called back then) in June 1902, mortality rates for the disease were as high as 26 percent. It was about two weeks before his scheduled coronation on June 26, 1902, and Edward resisted having an appendectomy, which was then a relatively new procedure. But surgeon and appendicitis expert Frederick Treves made clear that Edward would probably die without it. Treves drained Edward's infected abscess, without removing the organ, at Buckingham Palace; Edward recovered and was crowned on August 9, 1902.

11. THE WORLD'S LONGEST APPENDIX MEASURED MORE THAN 10 INCHES.

On August 26, 2006, during an autopsy at a Zagreb, Croatia hospital, surgeons obtained a 10.24-inch appendix from 72-year-old Safranco August. The deceased currently holds the Guinness World Record for "largest appendix removed."

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