Elbow Injuries

Objectives Identify the major articulations of the elbow Explain the movements of the elbow Identify and explain common elbow injuries Demonstrate and identify treatment steps for the management of elbow injuries

Anatomy Hinged joint formed by radius, humerus and ulna produces flexion and extension Rotation producing pronation and supination from radial head and humerus

Anatomy

Muscles & Movements of the Elbow

Examination Initially upon inspecting the elbow you should examine the following criteria: Inspection Palpation - swelling Movements Neurovascular status

Inspection Position Swelling Deformity Compare to counterpart Swollen elbow always semi-flexed Swelling Deformity Compare to counterpart

Palpation Tenderness Crepitus- cracking/grinding sensation Fluid (ex.bursitis) Heat

Most Common Injuries Supra-Condylar fracture UCL Injury Pitcher’s Elbow/Little League Elbow Radial head fracture Olecranon fracture Dislocation Fracture dislocation Lateral and Medial Epicondylitis “Tennis/Golfer Elbow” Olecranon Bursitis Pulled elbow Nerve Related Injuries

Supra-Condylar Fracture Usually from fall onto elbow when flexed More common in children Often displaced/angulated Generally swollen restricted movement Look for complications

Supra-Condylar fracture Complications vascular complications: brachial artery median nerve palsy Management: may require manipulation if displaced Long Long arm cast fixation, possibly surgery depending on how the bone heals.

Radial head fractures Fall onto outstretched hand More common in female than male 20% all elbow injuries Associated with 10% dislocations

Signs and symptoms Pain on outside of elbow Swelling in elbow joint Unable to fully flex or extend Pain pronation/supination

Fracture of Radial Head Fracture may not be visible on initial x-rays- look for effusions Type 1: fractures un-displaced treated with collar and cuff Type 2: fractures slightly displaced treated conservatively may require surgery if large pieces Type 3: fractures communited causes poor healing may require excision radial head/prosthesis (surgery with artificial repair)

Fracture Over Olecranon Mechanism -fall on point of elbow -sudden triceps contraction Don’t forget epiphyses

Olecranon fractures Hairline and un-displaced fractures can be treated in long arm cast for 3-4 weeks in children and 6-8 weeks in adults If the fragment is large/displaced will require fixation e.g. tension band wiring

Elbow dislocation Usually fall onto outstretched hand Severe pain at elbow and swelling Minimal movement Check sensation or for pulses

Dislocation of elbow Common Dislocation is posterior lateral dislocation reduction Use pain killers/sedation to put bone back into place Check x-ray for possible fractures Crepe bandages and sling 2 weeks

Elbow Dislocations BEWARE ASSOCIATED FRACTURES BEWARE COMPLICATIONS such as: Nerve injury Ulna nerve injury Brachial artery injury

Lateral Epicondylitis Commonly known as “tennis elbow” Occurs in mostly 30-50 years age group Due to degeneration of the tendon fibres over the lateral epicondyle which are involved in wrist extension

Symptoms Severe burning pain on outside of elbow Pain worse on gripping or lifting objects and with direct pressure over lateral epicondyle Pain may radiate down forearm

Medial Epicondylitis Commonly called “Golfer’s elbow” Similar to Tennis elbow Most common in men 20-50 years Pain medial elbow may radiate down inner forearm Pain worse when you make a fist/shake hands

Treatment Mostly self limiting Anti Inflammatory ICE & Rest Avoid activities which produce symptoms BRACE/Wrap Should improve in 6-8 weeks if not consider steroid injection Physical Therapy Surgery

Olecranon Bursitis Infection and/or inflammation of bursa Causes: Trauma Prolonged pressure Infection Medical conditions e.g.rheumatoid arthritis/gout

Symptoms/Treatment Swelling Pain Erythema (redness or rash) Heat if infected Infection may spread R.I.C.E. Antibiotics Aspirin Surgery

Remember Children’s Elbow C-capitulum 2yrs R-radial head 4yrs I-internal(medial epicondyle) 6yrs T-trochlea 8yrs O-olecranon 10yrs L-lateral epicondyle 12yrs ABOVE are how the bones develop and try[pical ages that are associated with devlopment

Pulled Elbow Usually aged 18months-4years History of pulling Won’t use arm Not usually very distressed Pronation/supination +/- flexion/extension causes a click Wait 10 minutes – play area If not settled, think about x-ray.

Little League Elbow Is a separation of the epiphysis at the med aspect of the humerus in younger athletes. Typically occurs between the ages of 9 to 12 (can be in older children) Results from repetitive throwing & improper form Treatment: rest, ice application and support. Decrease the amount of throwing REFER TOLITTLE LEAGUE ELBOW ARTICLE

Video Clip http://www.5min.com/Video/How-to-Prevent-Elbow-Injuries-in-Youth-Baseball-Pitchers-132478022