1. Anatomy of the Elbow

2. Bones of the Elbow
Humerus
Radius
Ulna

4. Joints of the elbow Humeral-Ulnar joint – main hinge action of joint
Proximal Radio-ulnar joint – Pronation & Supination of forearm
Humeral-Radial joint – part of hinge action

7. Functional Anatomy
Elbow ROM = flexion, extension, pronation and supination
145 degrees of flexion
90 degrees of supination and pronation
Stable joint: protection from overuse and traumatic injuries
Bony limitations, ligamentous support, and muscular stability at the elbow help to
Carrying angle due to distal projection of humerus
Normal in females is degrees, males 5 degrees
Critical link in kinetic chain of upper extremity

8. Elbow X-ray Basic views: AP & lateral Fat pad sign or “sail sign”
In kids, be aware of the apophyses

11. Elbow X-ray - AP

12. Elbow X-ray - Lateral

13. Elbow Fat Pads
Fat is normally present within the joint capsule of the elbow, but outside the synovium
Typically "hidden" in the concavity of the olecranon and coronoid fossae
Injuries that produce intra-articular hemorrhage cause distension of the synovium forcing the fat out of the fossa producing triangular radiolucent shadows anterior and posterior to the distal end of the humerus – the FAT PAD SIGNS
Synovial membrane then outside that is fibrous joint capsule (fat btwn the 2) (synovial membrane – fat – fibrous joint capsule)

14. Fat Pad Sign

15. Fat Pad Sign
Normal
The Sail Sign

16. Fat Pad Sign
Posterior fat pad sign – ALWAYS abnormal

17. Fat Pad Sign Pearls X-rays Think occult fracture No visible fracture
Positive fat pad sign
Think occult fracture
Kids: supracondylar fracture
Adults: radial head fracture

18. Ossification Centers There are 6 ossification centers around the elbow
Always appear in same order: C-R-I-T-O-E
Capitellum
Radius
Internal or medial epicondyle
Trochlea
Olecranon
External or lateral epicondyle
Age of appearance is highly variable but as general guide remember years

19. Elbow Anatomy - Ossification
C = capitelum
1 y
R = radial head
3 y
I = medial epicondyle
5 y
T = trochlea
7 y
O = olecranon
9 y
E = lateral epicondyle
11 y
This is only a rough guide. Girls may develop ossification centres earlier than boys.

20. Elbow Anatomy - Ossification

21. Ossification Centers

22. Ossification Centers
Radial & Lateral epi usually last to close; so if have closure of lat & radial but see a widened area along the medial epicon then most likely an avulsion of the apophysis & not a normal unfused growth plate

23. Ossification Centers Age of closure is between ages 14-16
Radial & the lateral epicondyle are generally last to close

24. Anterior Humeral line Should bisect the capitellum
If capitellum displaced posteriorly:
Extension supracondylar #
If capitellum displaced anteriorly:
Flexion supracondylar #

25. Radio-capitellar line
Should bisect the capitellum
Can be used on any view
Disruption represents radial head #/dislocation

26. Fracture Types: Supracondylar: Type 1 Type 2 Type 3
Type 1 non displaced may be occult. Splint with back slab at 90 degrees

27. Fracture Types: Supracondylar: Type 1 Type 2 Type 3
Type 2 is hinged. Posterior cortex is intact. Closed reduction plus immob

28. Fracture Types: Supracondylar: Type 1 Type 2 Type 3
Displaced. Closed reduction and then ORIF with ORTHO. Can have neurovascular issues because fragment can displace in 3 different directions

29. Case 11 y.o. RH year round baseball player Concerns?
pitches on 3 different teams
medial sided Rt elbow pain
no acute injury
Concerns?

30. Little League Elbow Medial epicondyle apophysitis Overuse injury
Common cause of medial sided
elbow pain in throwing athletes
X-rays: normal or widening
of the apophysis
Need comparison views
No lateral epicon apophysis yet so widening could just be normal unfused growth plate so need hx, PE, x-rays including of the other elbow

31. Case
Fracture dislocation
Olecranon fracture

32. Case
5yo F FOOSH. Type 2 supracondylar #

33. Case Fat pads. Occult fracture
Abnormal anterior humeral line. Extension supracondylar