hinge joint formed between the distal end of the humerus in the upper arm and the proximal ends of the ulna and radius in the forearm The elbow allows for the
Download Presentation The PPT/PDF document "" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
Elbow joint
The elbow joint is a complex hinge joint formed between the distal end of the humerus in the upper arm and the proximal ends of the ulna and radius in the forearm. The elbow allows for the flexion and extension of the forearm relative to the upper arm, as well as rotation of the forearm and wrist.
Slide2TENNIS ELBOW (LATERAL EPICONDALGIA)
Pain and tenderness over the lateral epicondyle of the elbow (or, more accurately, the bony insertion of the common extensor tendon) is a common complaintamong
tennis players
– but even more common in non-players who perform similar activities involving forceful repetitive wrist extension. It is the extensor
carpi
radialis
tendon (which automatically extends the wrist when gripping) which is pathological in tennis elbow.
Slide3Like
supraspinatus tendinitis, it may result in small tears, fibrocartilaginous
metaplasia
, microscopic
calcification
and a painful
vascular reaction in the tendon fibres close to the lateral epicondyle.
Slide4Clinical features
The patient is usually an active individual of 30 or 40 years. Pain comes on gradually, often after a period of unaccustomed activity involving forceful gripping and wrist extension. It is usually localized to the lateral epicondyle, but in severe cases it may radiate widely.
It is aggravated by movements such as pouring out tea, turning a stiff
doorhandle
, shaking hands or lifting with the forearm
pronated
.
Slide5On examination The elbow looks
normal, and flexion and extension are full and painless. Characteristically there is localized tenderness at or just below the lateral epicondyle; pain can be reproduced by passively stretching the wrist extensors (by the examiner acutely flexing the patient’s wrist with the forearm pronated
) or actively by having the patient extend the wrist with the elbow straight.
Slide6X-ray is usually normal, but occasionally shows calcificationat the tendon origin.
Slide7Treatment
Many methods of treatment are available but the benefits of most are unclear; it is well to remember that 90 per cent of ‘tennis elbows’ will resolve spontaneously within 6–12 months.The first step is to identify, and then restrict, those activities which cause pain. Modification of sporting style may solve the problem.
The role of
physiotherapy
and manipulation is
uncertain
.
Slide8Injection of the tender area with
corticosteroid and local anaesthetic relieves pain but is not curative.
Slide9OPERATIVE TREATMENT
Some cases are sufficiently persistent or recurrent for operation to be indicated. The origin of the common extensor muscle is detached from the lateral epicondyle. Surgery is successful in about 85 per cent of cases.
Slide10
OLECRANON
BURSITIS
There
are two types :
1-Traumatic
bursitis
:-as a result
ofpressure
or friction.
2-non
traumatic bursitis
:- its painful and due to
infection,gout
or rheumatoid arthritis.
Gout
is suspected if there is a history of previous
attacks,bilateral
with tophi or if the x-ray shows calcification in the bursa which mimic acute infection unless pus is aspirated.
Rheumatoid
arthritis
causes both swelling and nodularity over the olecranon with typical symmetrical poly arthritis, in late
stages,erosion
of elbow may cause marked in stability .
Slide11
OLECRANON BURSITIS
Slide12
Treatment
we
must treat the underling
causes.septic
bursitis may need local
drainage,occasionally
achronic enlarged bursa need to be excised.
Other causes of
painfull
elbow are osteoarthritis, rheumatoid
arthritis,gout
and
and
infection like TB.
Slide13
CUBITUS VALGUS
The normal carrying angle of the elbow is 5–15 degrees of valgus; anything more than this is regarded as a
valgus
deformity, which is usually quite
obvious when the patient stands with arms to the sides and palms facing forwards.
The
commonest cause is longstanding non-union of a fractured lateral condyle; the deformity may be associated
with marked prominence of the medial condylar outline. The importance of cubitus
valgus
is the
liability to delayed
ulnar
palsy
; years after
the causal
injury the patient notices weakness of the
hand, with
numbness and tingling of the
ulnar
fingers.
TREATMENT
:The
deformity
itself needs no treatment, but for
delayed
ulnar
palsy the nerve should be transposed to
the front
of the elbow.
Slide14CUBITUS VALGUS
Slide15CUBITUS VARUS (‘GUN-STOCK’ DEFORMITY
The deformity is most obvious when the elbow is extended and the arms are elevated. The most common cause is malunion of a
supracondylar
fracture.
The deformity can be corrected by a
wedge
osteotomy of the lower humerus but this is best left until
skeletal maturity.
Slide16CUBITUS VARUS
Slide17‘PULLED ELBOW’
the annular ligament is a fairly common injury in children under the age of 6 years. There may be a history of the child being jerked by the arm and subsequently complaining of pain and inability to use the arm. The limb
is held more or less immobile with the
elbow fully
extended and the forearm
pronated
; any attempt to supinate the forearm is resisted. The diagnosis is essentially clinical, though x-rays are usually obtained in order to exclude a
fracture. The radial head can be forcibly pulled out of the noose of the annular ligament only when the forearm is pronated; even then the distal attachment of the
ligament is
sometimes
torn.
TREATMENT:
If
the history and clinical picture are suggestive,
an attempt
should be made to reduce the
subluxation
or dislocation
. While the child’s attention is diverted,
the elbow
is quickly
supinated
and then slightly
flexed; the
radial head is relocated with a snap. (This
sometimes happens
‘spontaneously’ while the
radiographer is
positioning the arm!)
Slide18Pulled elbow
Slide19STIFFNESS OF THE ELBOW
Stiffness of the elbow may be due to 1-congenital abnormalities (various types of synostosis, or arthrogryposis).2-Aquired abnormalities
like infection, inflammatory arthritis, osteoarthritis or
the late effects of
trauma.
Slide20POST-TRAUMATIC STIFFNESS
the elbow is particularly prone to post-traumatic stiffness. The more obvious causes (as with other joints) are either:1-extrinsic (e.g. soft-tissue contracture or heterotopic bone formation).2- intrinsic (e.g. intra-
articular
adhesions
and
articular
incongruity), or a combination ofthese.
Slide22Clinical features
Clinical assessment should include examinationof all the joints of the upper limb as well as an evaluation of the functional needs of the particular patient. Most of the activities of daily living can be managed with a restricted range of elbow motion
: flexion from
30 to 130 degrees and
pronation
and
supination of 50 degrees each.
Any greater loss is likely to be disabling.
Slide23NON-OPERATIVE TREATMENT
The most effective treatment is prevention, by early active movement through a functional range. If movement is restricted and fails to improve with exercise, serial splintage
may help; aggressive passive manipulation may aggravate more than help.
Slide24OPERATIVE TREATMENT
The indication for operative treatment is failure to regain a functional range of movement at 12 months after injury.If there is heterotopic ossification
, it is important to wait until the bone is ‘mature’, i.e. showing clear cortical margins and
trabecular
markings on x-ray. There is no point in a soft tissue
release if the x-ray or CT shows that bone incongruity is blocking movement.
Slide25The objectives are determined by the type of
Pathology:1-Heterotopic bone can be excised,2-Capsularrelease or capsulectomy (open or arthroscopic) may restore a satisfactory range of movement. 3-Intra-articular procedures include fixing of ununited fractures or correction of
malunited
fractures.
Slide26Post-traumatic radio-
ulnar synostosis sometimes follows internal fixation of fractures of the radius and ulna. It is treated by resection when the synostosis has matured (this takes about one year) followed by diligent physiotherapy.