5. Elbow pain may be due toGeneralized causesORLocalized
causes
6. EP As a part of generalized causes: Arthritis RA. Septic.
Hemophilic OA. Crystal induced.(gout or pseudo gout) Enteropathic
arthropathy. Traumatic. Neoplasm. Bones. Muscles. Synovial
membrane.etc
7. ORLocalized causes for EP
8. MEDIAL EPICONDYLITISSynonyms Golfers elbow Little leaguers
elbow (children)Medial epicondylitis:Inflammation of the common
flexor tendon.Little leaguers elbow: (children)Hypertrophy of the
medial epicondyle withmicro tearing and fragmentation of the
medialepicondylar apophysis.
9. MEDIAL EPICONDYLITISMechanismA repetitive valgus stress
commonly seen inthe throwing motion. The back and downward motion
of a golfswing just prior to the impact of the ball.Clinical
presentation:Tenderness over the medial epicondyle. Pain may be
reproduced with wrist flexionand pronation.
10. Treatment: Conservative: Rest, ice, NSAIDs, immobilization.
Surgical pinning: Reserved for an unstable elbow joint.
11. LATERAL EPICONDYLITISSynonyms :Tennis elbow Mechanism
:Overuse and overload of the extensor andsupinator tendons seen in
Sports or Workthat require repetitive extension
elbowmovements.Pathology:Micro-tearing of the extensor carpi
radialis brevismuscle.
12. LATERAL EPICONDYLITISCLINICAL:1. Tenderness just distal to
the lateral epicondyleat the common extensor origin.2. Pain and
weakness in hand grip strength.3. Pain can be produced by Cozens
test.
13. Cozens testPassive extension of the elbowwith forced
flexion of the wristmay precipitate pain at thelateral
epicondyle
14. Cozens testThe examiner stabilizesthe elbow with a
thumbover the lateralepicondyle.Pain in the lateralepicondyle is
seen withpatient making afist, pronating theforearm,
radiallydeviating andextending the wristagainst resistanceby the
examiner.
15. Cozens testThe test may be more sensitivewhen done in full
extension at theelbow.
16. LATERAL EPICONDYLITISTreatmentConservative: Relative rest,
ice, NSAIDs for 1014 days Physical therapy (modalities) Splinting,
bands Local Corticosteroid injection Correct improper
techniqueOperative: ECRB debridement
18. OLECRANON BURSITISMechanism Repetitive trauma, Inflammatory
disorder (gout, pseudogout,RA)Pathology Inflammation of the bursa
located between theolecranon and skinClinical Swelling, pain, and a
decreased range of motion in theposterior aspect of the elbow A
hot, erythematous elbow may indicate infection
19. Treatment Conservative: Rest, NSAIDs,elbow padding.
Aspiration of fluid and send itfor culture if indicated
20. DISLOCATION OF THE ELBOWGeneral The most common type of
dislocationin children and the second mostcommon type in adults
followingshoulder dislocation. Sports activities account for
almost50% of these injuries
21. DISLOCATION OF THEELBOWMechanism:Fall on the Outstretched
hand.
22. DISLOCATION OF THE ELBOWClinical Dislocation can be
anterior or posterior withposterior being the most common,
occurring98% of the time . Associated injuries include fracture of
the radialhead, injury to the brachial artery and mediannerve.
23. DISLOCATION OF THE ELBOWSymptoms Inability to bend the
elbow. Pain in the shoulder and wristOn physical exam:The most
important part of the exam is theneurovascular evaluation of the
radial artery, andmedian, ulnar and radial nerves Plain AP and
lateral radiographs
24. DISTAL BICEPS TENDONITISMechanismOverloading of the biceps
tendon commonly due torepetitive elbow flexion and supination or
resistedelbow extension.PathologyMicro tearing of the biceps tendon
distally.
25. DISTAL BICEPS TENDONITISComplication Biceps tendon
avulsionClinical Insidious onset of pain in the ante-cubitalfossa
usually after an eccentric overload Audible snap with an obvious
deformity,swelling, and ecchymosis if an avulsion issuspected
27. TRICEPS TENDON AVULSIONMechanismTendonitis:Overuse syndrome
secondary to repetitive tricepsextensionAvulsion:A decelerating
counterforce during active elbowextension
28. TRICEPS TENDONITIS/AVULSIONClinical Posterior elbow pain
with tenderness at theinsertion of the triceps tendon Pain with
resistive elbow extension orsudden loss of extension with a
palpabledefect in the triceps tendon (avulsion)Imaging Plain films
to rule out other causes, ifindicated
30. VALGUS EXTENSION OVERLOADSYNDROME OF THE
ELBOWSynonymsBoxers elbow
31. Boxers elbowMechanismAn overuse disorder caused by
repetitive anduncontrolled valgus forces demonstratedduring the
throwing motion, especially in lateacceleration and
deceleration.Also may be seen in boxers.PathologyOsteophyte and
loose body formation occurssecondary to a repetitive friction of
theolecranon against the fossa.
32. Boxers elbowClinical Posterior elbow pain with lack of full
extension Catching or locking during elbow extensionImaging Plain
films: AP/lateral may show a loose body orosteophyte formation at
the olecranonTreatment Conservative Surgical: Removal of the loose
body
33. ULNAR COLLATERAL LIGAMENTSPRAINMechanism A repetitive
valgus stress occurring acrossthe elbow during the acceleration
phase ofthrowing.Pathology Inflammation to the anterior band of
theulnar collateral ligament.
34. ULNAR COLLATERAL LIGAMENT SPRAINClinical Significant medial
elbow pain occurring after thethrowing motion A pop or click may be
heard precipitating the pain Medial pain or instability on valgus
stress with theelbow, flexed 2030 if the UCL is torn.Provocative
Test Valgus stress test:Tenderness over the medial aspect of the
elbow whichmay be increased with a valgus stress.
35. Imaging Plain films may reveal calcification and spurring
alongthe UCL Valgus stress radiographs demonstrating a 2 mmjoint
space suggestive of UCL injuryTreatmentConservative1. Rest, ice,2.
NSAIDs3. Rehabilitation program for strengthening and
stretchingSurgical reconstruction if needed
36. RADIAL COLLATERAL LIGAMENT (RCL)SPRAINMechanism Elbow
dislocation from a traumatic eventClinical Recurrent locking or
clicking of the elbow withextension and supination Lateral pain or
instability on varus stress with the elbowflexed 2030 if the RCL is
tornProvocative test Varus stress testTenderness over the lateral
aspect of the elbow, whichmay be increased with a varus
stress.
37. Imaging Varus stress radiographs demonstrating a 2 mm
jointspace suggestive of RCL injuryTreatmentConservative: Rest,
ice, NSAIDs Rehabilitation program for strengthening and stretching
Establishing return to play criteriaSurgical reconstruction if
needed.
38. PRONATOR SYNDROMEClinical1. Dull aching pain in the
proximal forearm just distal to theelbow2. Numbness in the median
nerve distribution of the hand3. Symptoms exacerbated by
pronation
39. PRONATOR SYNDROMEMechanismMedian nerve compression at the
elbow by thefollowing structures:1. Ligament .2. Supracondylar
spur.3. Fibrosis.4. Pronator teres muscle.5. Between the two heads
of the flexordigitorum superficialis (FDS).
40. PRONATOR SYNDROMEImagingPlain films: Rule out
spurEMG/NCSTreatmentConservative Modification of activities Avoid
aggravating factors Stretching and strengthening
programSurgical:Release of the median nerve at the location of
thecompression
41. ENTRAPMENT OF THE ULNARNERVESynonymsCubital tunnel
syndrome
42. Cubital tunnel syndromeClinical An aching pain with
paraesthesias, which may radiate distally tothe fourth and fifth
digits Positive Tinels sign at the elbow Weakness in the ulnar
musculature of the hand, demonstratedby a weak grip strength and
atrophy and poor hand coordination.Mechanism A hyper mobility of
the ulnar nerve, excessive valgus force orloose body/osteophyte
formation, which aggravates the integrityof the ulnar nerve at the
elbow.Pathology Hyperirritability of the ulnar nerve
43. Cubital tunnel syndromeEMG/NCSAbove and below the
elbowTreatmentConservativeRelative rest, NSAIDs, elbow
protection(splinting) and technique modification
44. OSTEOCHONDROSIS DISSECANSOF THE ELBOWSynonymsPanners
disease.(involving epiphysial aseptic necrosis of
thecapitellum)
45. OSTEOCHONDROSISDISSECANS OF THE ELBOW
46. FRACTURES FRACTURE OF THE HUMERAL SHAFT FRACTURE OF THE
DISTALHUMERUS RADIAL HEAD FRACTURE FRACTURE OF THE OLECRANON