Elbow

Question 1

In immature athletes, where is the proximal and distal attachment sites of the UCL?

Answer 1

proximal = extra-articular, unfused medial humeral apophysis

distal = tubercle of ulna

Question 2

Through what arc of motion do the soft tissues of the elbow provide 1 degree of stability?

Answer 2

20-120 degrees (arc where throwing occurs)

Question 3

What are the 8 common elbow injuries in the throwing athlete?

Answer 3

• UCL tears
• Ulnar neuritis
• Flexor-pronator strain / tear / tendonitis
• Medial epicondyle apophysitis or avulsion
• Olecronon osteophytes
• Olecronon stress fractures
• OCD of capitellum
• Loose bodies

Question 4

At the medial elbow, what is placed on tensile stress with a valgus load?

Answer 4

UCL, flexor-pronator mass, medial epicondyle apophysis, and ulnar nerve

Question 5

In the posterior compartment, what occurs with shear stress during a valgus load?

Answer 5

There will be impingement of the medial aspect of the olecranon and medial olecranon fossa/trochlea

Question 6

In the lateral compartment, what is affected by compression stress during a valgus load?

Answer 6

The radial head and capitellum

Question 7

What pathologies result from near-tensile failure loads during throwing due to tension (2), shear (2), and compression (1)?

Answer 7

Tension: microtrauma to anterior band of UCL>ligament attenuation + flexor-pronator mass tendonitis, ulnar neuritis, medial epicondyle apophysitis

Shear: olecranon tip osteophytes + “kissing lesion” (posteriomedial trochlea articular damage due to olecranon osteophyte)

Compression: loose bodies in radiocapitellar joint

Question 8

What does the anterior bundle of the UCL resist?

Answer 8

valgus forces

Question 9

What places tensile stresses on the anterior bundle of the UCL?

Answer 9

The acceleration phase of throwing

Question 10

Where does medial laxity increase loads?

Answer 10

The lateral and posterior compartments

Question 11

The most common lesions in baseball players leading to surgical intervention are what? (2)

Answer 11

olecranon osteophytes (shear) and loose bodies (compression)

Question 12

How do you manage/treat OCD of the radiocapatellar joint?

Answer 12

With intact cartilage = immobilization, ROM, strengthening, and gradual return to throwing (no throwing for 6 months)

Question 13

What are the indications for surgery at the elbow?

Answer 13

loose bodies/fragmentation or persistent pain after period of immobilization

Question 14

What could a deficient UCL lead to in an adult? (3)

Answer 14

(1) osteochondral fractures
(2) loose body formation
(3) OA

Question 15

What is Little League Elbow?

Answer 15

It is medial apophysitis secondary to repetitive valgus stress

Question 16

What is Panner’s Disease?

Answer 16

Disease of the lateral elbow that affects the growth plate of capitellum in children under age of 11

Question 17

What is OCD of the elbow?

Answer 17

Condition similar to Panner’s Disease, but occurs in adolescence/adults and doesn’t involve the growth plate and instead involves the articular cartilage and subchondral bone

Question 18

Which pitches are recommended to use and which to avoid?

Answer 18

Good = fastball and change-up

Bad = curveball and slider

Question 19

What is the “shear range”?

Answer 19

The ROM that causes pain while the elbow is being extended with valgus stress

Question 20

When is surgery indicated or considered for UCL tears?

Answer 20

When there is (1) a complete tear of the anterior bundle of UCL (+ history, PE, and imaging studies) and desire to return to sport (2) partial thickness tears after 3 months of nonoperative treatments that’s unsuccessful

Question 21

What are the 5 principles of Tommy John Rehabilitation?

Answer 21

1 Avoid motion loss