1. The elbow

2. Outline
Anatomy
Cubitus varus
Cubitus valgus

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

4. 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.

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

7. 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.

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

10. 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.

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

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

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

14. 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

15. Cubitus varus & cubitus valgus

16. 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.

17. 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.

18. 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 years who is a recreational athlete or who engages in rigorous daily activities

20. 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.

21. 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.

22. 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.