The elbow

Outline Anatomy Cubitus varus Cubitus valgus

Anatomy Bones and joints Ligaments and tendons Capsule Muscles Nerves Blood vessels

Bones and Joints: 3 joints: Humeroulnar joint (hinge joint) – between trochlea of humerus and trochlea notch of ulnar Humeroradial joint (hinge joint) – between capitilum of humerus and radius head Proximal radioulnar joint (pivot joint)- between proximal end of ulna and proximal end of radius.

Articular cartilage Covers the ends of the bones of any joint. Absorb shock Make motion easier

Ligaments and Tendons: 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 These 2 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.

Tendons: Biceps tendon anteriorly (allows elbow to bend with force) Triceps tendon posteriorly (allows elbow to straighten with force)

Capsule: 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.

Muslces: The wrist extensors originate from the lateral epicondyle of the humerus The wrist flexors originate from the medial epicondyle of the humerus

Nerves: The median and ulnar nerve are at risk of injury in: Elbow dislocation Supracondylar fracture of humerus

Blood vessels: ThE bRartery splits into two branches just below the elbow: the ulnar artery and the radial artery

Carrying Angle: It is the 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 Up to 20 degrees in females www.icareunit.com

Cubitus varus & cubitus valgus

Cubitus Varus: “ bow-elbow” Causes Supracondylar fractures of the childhood. *Function of the elbow is almost normal. Treatment Usually indicated for cosmetic reasons Consists of removing a bone wedge from the lateral aspect of supracondylar area. www.icareunit.com

Cubitus Valgus: Causes: Errors in management of lateral humeral condyle fracture. When present at birth it can be a sign of Turner Noonan syndrome 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. Treatment: Elbow deformity needs no treatment, but the nerve palsy is treated by transposing the nerve anterior to the elbow. www.icareunit.com

Tennis Elbow (Lateral Epicondylitis) : The most common pathology in the elbow. 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 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 Patients whose condition is unresponsive to 6 months of conservative therapy (including corticosteroid injections) are candidates for surgery.

Golfer’s Elbow (Medial Epicondylitis): 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. 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 Patient education and golf-swing or the relevant activity modification NSAIDs Counterforce brace Wrist splints 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.