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The Elbow

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					The important structures of the
elbow can be divided into several
categories. These include:


•Bones and joints
•Ligaments and tendons
•Capsule
•Muscles
•Nerves
•Blood vessels
   There are 3 joints at the elbow:

1- Humeroulnar joint (hinge joint) – between trochlea of humerus and
   trochlea notch of ulnar

2- Humeroradial        joint (hinge joint) – between capitilum of humerus
   and radius head

3- Proximal radioulnar joint (pivot joint)- between proximal end of
   ulna and proximal end of radius.
is the material that covers
the ends of the bones of any
joint.with functions to
absorb shock and make
motion at the elbow joint
easier.
Ligaments are soft tissue structures that connect
  bones to bones. The ligaments around a joint usually
  combine together to form a joint capsule.
 Lateral    Collateral Ligament
 Medial Collateral Ligament
   (Together these two ligaments connect the humerus to the ulna, to
  form the main source of stability for the elbow )

 Annular Ligament: that wraps around the radial head and
  holds it tight against the ulna.
 Biceps tendon
  anteriorly (allows
  elbow to bend with
  force)
 Triceps tendon
  posteriorly (allows
  elbow to straighten
  with force)
 The articular surfaces are connected
  together by a capsule
 Anterior part – from radial and coronoid fossa
  of humerus to coronoid process of ulna and
  annular ligament of radius
 Posterior part – from capitulum, olecranon
  fossa, and lateral epicondyle of humerus to
  annular ligament of radius, olecranon of
  ulna, and posterior to radial notch.
 The  wrist extensors
  originate from the lateral
  epicondyle of the
  humerus
 The wrist flexors
  originate from the medial
  epicondyle of the
  humerus
The median and ulnar nerve are at risk of injury in:
-Elbow dislocation
- Supracondylar fracture of humerus
It isthe angle at which the humerus and forearm articulate, with the elbow in
full extension, and the palms facing forward
The carrying angle permits the arm to be swung without contacting the hips




   The normal carrying
    angle of the elbow is
    about 15 degrees of
    valgus in males and
    up to 20 degrees in
    females.



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Causes
Supracondylar fractures of
 the childhood.

*Function of the elbow
is almost normal.




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Usually indicated for cosmetic reasons;

Consists of removing a bone wedge from the lateral
 aspect of supracondylar area.




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Causes:

1- Errors in management of lateral humeral
condyle fracture.


 When present at birth it can be a sign of Turner or
 Noonan syndrome.



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Clinical features

 Obvious    lateral angulation of the elbow.

 Tardy   Ulnar Nerve Palsy. (most important sequel (
      The ulnar nerve is repeatedly stretched behind the medial
       epicondyle (for many years)  insidious impairment of the nerve
       trunk with ulnar nerve palsy.




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Treatment:
Elbow deformity needs no
 treatment, but the nerve palsy
 is treated by transposing the
 nerve anterior to the elbow.



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  The most common pathology in the
  elbow.
 Lateral epicondylitis (tennis elbow) is an
  overuse injury involving the extensor
  muscles that originate on the lateral
  epicondylar region of the distal humerus
  (any activity involving extension and/or
  supination). It is more properly termed a
  tendinosis that specifically involves the
  origin of the extensor carpi radialis brevis
  muscle.
 Occurs  in up to 50% of tennis players
 Cause has been attributed to microscopic
  tearing with formation of reparative
  tissue (ie, angiofibroblastic hyperplasia)
  in the origin of the extensor carpi radialis
  brevis (ECRB) muscle
 Patients present with lateral elbow and
  forearm pain exacerbated by use
 Typical patient- man or woman between
  35-55 years who is a recreational athlete
  or who engages in rigorous daily activities
Treatment:
- Rest
- Counterforce brace
- NSAIDs
- Wrist splinting
- Corticosteroid and
  injections
- Low level laser therapy
 Approximately 90-95%  of patients respond to
 conservative measures and do not require
 surgical intervention. Patients whose
 condition is unresponsive to 6 months of
 conservative therapy (including
 corticosteroid injections) are candidates for
 surgery.
 Thiscondition is an overuse syndrome that is
 characterized by pain at the flexor-pronator
 tendinous origin and is seen in sports
 activities with repetitive valgus stress,
 flexion, and pronation, such as occurs in golf,
 baseball, tennis, fencing, and swimming. This
 condition is also seen with occupations that
 require hand, wrist, and forearm motions.
 Most  common cause of medial elbow pain
  but less common than tennis elbow
 Males: females = 2:1
 Presence of microtears in the flexor-
  pronator tendons without inflammation
 Patient presents with achy pain over the
  anterior medial epicondyle, usually during
  activity, and the patient may describe
  weakness in the forearm or hand. In
  addition, radiation of the pain may occur
  in the shoulder, forearm, or hand.
Treatment:
1- Patient education and golf-swing (or the
  relevant activity) modification
2- Nonsteroidal anti-inflammatory drugs
  (NSAIDs)
3- Counterforce brace
4- Wrist splints
5 -Corticosteroid injections

 Surgical treatment should be considered in
 cases in which conservative treatment has
 failed after 6-12 months and after all other
 pathology has been excluded.

				
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posted:9/30/2011
language:English
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