Elbow Flashcards
elbow joint
describes the articulation between the humerus and the bones of the distal forearm.
It consists of the humero‐ulnar joint (responsible for flexion/extension)
the radio‐ capitallar joint (responsible supination/pronation along with the proximal and distal radioulnar joints).
powers elbow extension
triceps muscle which inserts onto the olecranon process
flex the elbow
the brachialis (inserting onto the coronoid process)
biceps (inserting onto the bicipital tuberosity of the radius) muscles
Supination
performed by the biceps and supinator muscles
pronation
performed by contraction of the pronator teres muscle proximally and the pronator quadratus muscle distally.
common extensor + flexor origins
extensor- arises from the lateral epicondyle
flexor-arises from the medial epicondyle.
The enthesis (attachment) of the common extensor and flexor origins can become painful (known as an enthesopathy).
This gives rise to the conditions of lateral and medial epicondylitis
Tennis elbow
- Lateral epicondylitis
occur as a repetitive strain injury in tennis players and others whom regularly perform resisted extension at the wrist.
also be a degenerative enthesopathy (inflammation of the origin or insertion of a tendon or ligament into bone).
Tennis elbow pathology & clinical features
Pathology demonstrates micro‐tears in the common extensor origin.
Clinical features include a painful and tender lateral epicondyle and pain on resisted middle finger and wrist extension.
Tennis elbow treatment
self‐limiting condition (usually resolves).
treatment involves a period of rest from the activities that exacerbate the pain, physiotherapy, NSAIDs, steroid injections and use of a brace (known as an elbow clasp)
ultrasound therapy is also used but its efficacy is unclear.
rarely, refractory cases may be offered surgical treatment which involves division and/or excision of some fibres of the common extensor origin however has variable results.
Golfer’s elbow
- Medial epicondylitis
a consequence of repeated strain or degeneration of the common flexor origin.
Medial epicondylitis is less common than its lateral counterpart.
Golfer’s elbow treatment
Again this is a self‐limiting condition with physio, rest & NSAIDs the mainstay of treatment.
Injection in this area carries a risk of injury to the ulnar nerve.
Elbow arthritis
Primary OA of the elbow is uncommon.
The elbow is often involved in rheumatoid arthritis and OA can occur after trauma (intra‐articular fractures).
Elbow arthritis treatment
Arthritic change at the radio‐capitellar joint which has failed non-operative management can be treated with surgical excision of the radial head which affords good pain relief with minimal functional limitation.
An elbow severely affected by RA or OA at the humero‐ulnar joint which isn’t satisfactorily treated with conservative management can be treated surgically with a Total Elbow Replacement, which has reasonable long term results.
However, lifting in these patients is restricted to 2.5kg postoperatively
Cubital tunnel syndrome
This involves compression of the ulnar nerve at the elbow behind the medial epicondyle (”funny bone” area).
Cubital tunnel syndrome symptoms
Patients complain of paraesthesiae in the ulnar 1½ fingers and Tinel’s test over the cubital tunnel is usually positive.
Weakness of ulnar nerve innervated muscles may be present including the 1st dorsal interosseous (abduction index finger) and adductor pollicis.
Cubital tunnel syndrome investigation/ diagnosis
Can be assessed with Froment’s test.
Compression can be due to a tight band of fascia forming the roof of the tunnel (known as Osborne’s fascia) or due to tightness at the intermuscular septum as the nerve passes through or between the two heads at the origin of flexor carpi ulnaris.
Nerve conduction studies confirm the diagnosis and the patient may need surgical release of any tight structures.
