1. Elbow Injuries

2. 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

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

4. Anatomy

5. Muscles & Movements of the Elbow

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

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

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

9. 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

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

11. 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.

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

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

14. 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)

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

16. 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

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

18. 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

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

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

21. 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

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

23. 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

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

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

26. 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

27. 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.

28. 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

29. Video Clip