Should the Broncos Worry About DeMarcus Ware's Elbow Injury, Nerve Surgery?

Dave Siebert, M.D.@DaveMSiebertFeatured ColumnistMarch 14, 2014

SAN DIEGO, CA - SEPTEMBER 29:  Defensive end DeMarcus Ware #94 of the Dallas Cowboys looks on prior to the start of the game against the San Diego Chargers at Qualcomm Stadium on September 29, 2013 in San Diego, California.  (Photo by Jeff Gross/Getty Images)
Jeff Gross/Getty Images

Last month, former Dallas Cowboys and now Denver Broncos defensive lineman DeMarcus Ware underwent elbow surgery to repair a recurring nerve injury.

According to Cowboys columnist Mickey Spagnola, the operation also addressed loose bodies within the joint, and it apparently went very well:

"Already feels better, can tell the difference," Ware said as he managed to sign footballs, pointing out he had been wearing basically an elbow pad used by hockey players all season long since injuring the elbow in training camp.

Spagnola also writes that doctors realigned Ware's ulnar nerve.

While nerve re-alignment surgery sounds complex—and it certainly is—the concept is actually quite simple. Believe it or not, it all starts with one seemingly innocent problem: a bad case of the funny bones.

Yes, really.

Let's take a closer look.

Inside the elbow, the bones of the forearm—the radius and ulna—meet the humerus, or the bone of the upper arm. When the elbow bends, cartilage and ligaments within the joint stabilize and coordinate the three bones as they move about each other.

The radius, ulna and humerus meet at the elbow.
The radius, ulna and humerus meet at the elbow.Wikimedia Commons with edits by the author.

Many different structures run down the upper arm and through the elbow to reach the hand, such as nerves.

To move one's hand or fingers, electrical nerve signals must travel "downstream" from the brain, into the spinal cord, out to the shoulder, down the arm and through the elbow.

On the other hand, "upstream" signals—those that move back toward the brain from the hand—allow for sensation.

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Any interruption along the path can cause symptoms in either direction.

Upon interruption of the downstream path, muscle control signals are lost, leading to weakness past the break. Conversely, upstream symptoms include severe pain, numbness and tingling in the area of skin the nerve in question supplies.

Several types of conditions can lead to signal interruption.

For example, an injury—such as a deep laceration or bone fracture—can sever a nerve outright. Additionally, pressure from an outside structure—such as swelling within the elbow's joint space—can compress it.

In the case of the ulnar nerve, or "funny bone," direct blows from the outside are to blame—something Ware knows all too well. Spagnola notes in his column that the lineman equated the sensation to that of being stung by bees.

Yet why did such a condition arise?

Unfortunately, the ulnar nerve lacks the type of protection that surrounds many of the other nerves in the body.

Bending the elbow only serves to further that vulnerability.

When the elbow bends, the structures within it must move and stretch to accommodate the new landscape. While the large blood vessels and other nerves stay protected during this process, the ulnar nerve slips behind the end of the humerus and comes to rest between it and the surface of the skin.

Then, if a hit to the inside of the elbow comes at exactly the wrong moment, it can sharply compress the nerve between the outside blow and the bone, leading to the eye-crossing, shooting pain most people—not just Ware—experience from time to time during everyday life.

In Ware's case, it seems his preseason elbow injury put his nerve in a precarious state, one that left it in an even more exposed position than normal upon bending of the elbow.

The surgery he underwent should correct the problem.

Though medical details are not available to the public, Spagnola writes that doctors dissected out Ware's nerve and physically moved it into a new, better-protected location between two muscles. By doing so, they added additional soft tissue barriers between the nerve and the outside world. It will also now stretch less each time the elbow bends.

Assuming Ware's nerve remains in place—and there is no reason to think it won't—he should be able to take more significant hits to the elbow without experiencing symptoms.

Additionally, as long as no muscle wasting took place—a complication of long-standing nerve compression and damage—with enough time and physical therapy, he should recover any strength he possibly lost during the season.

Nevertheless, Ware's rehab will take time. Yet judging from his new contract with the Broncos, it looks like doctors expect nothing less than a full recovery.

According to ESPN's Adam Schefter, Ware agreed on Wednesday to a three-year, $30 million deal—with $20 million in guarantees—pending a physical exam. The official Broncos Twitter account announced the deal as official shortly thereafter:

With his nerve problems hopefully in the past, Ware looks primed—both physically and financially—for a bounce-back year.

Dr. Dave Siebert is a resident physician at the University of Washington who plans to pursue fellowship training in Primary Care (nonoperative) Sports Medicine.


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