Elbow Injuries

Question 1

What occurs in a pulled elbow in children?

Answer 1

Head of radius pulls out from under annular ligament

Question 2

What is little leaguers elbow?

Answer 2

• Pitching/throwing injury

- Big valgus force, MCL pulls off medial epicondyle

Question 3

What is an osteochrondral lesion?

Answer 3

• Bone/cartilage is pulled off
• Direct trauma
• Repeated trauma (throwing, lifting weights)

Question 4

What is osteochondritis dessicans (OCD)?

Answer 4

• Spontaneous resorption of bone
• Also happens in knee
• Good recovery in adolescents

Question 5

What is a supracondylar fracture?

Answer 5

• Fracture above the humeral condyles
• Common in children 3-11 yrs
• FOOSH
• Up to 12% involve nerve damage
• Brachial artery can by injured

Question 6

How can nerves & vessels be affected by supracondylar fractures?

Answer 6

• Big nerves close by (radial, ulnar, median)
• Bony fracture can damage nerves
• Inflammation can impinge
• More displacement = more likely vessels involved

Question 7

What are some complications of supracondylar fractures?

Answer 7

• Compartment syndrome
• Gunstock deformity (bone heals in dogleg)
• Hypertrophic ossification

Question 8

What are the treatments for elbow fractures?

Answer 8

• Type 1: Long arm plaster
• Type 2 & 3: Surgery (wires, pins, plates, combination)
• More joint surface involved = more concern

Question 9

What are the different types of elbow fracture severity?

Answer 9

• Type 1: Stable, undisplaced
• Type 2: Stable, displacement of fragments
• Type 3: Displaced, involve 50% joint surface

Question 10

What is involved in radial head fractures?

Answer 10

• FOOSH, usually compressive force
• Often missed
• Don’t usually displace much
• Pain with pronation/supination
• Require X-rays with different views

Question 11

Why are osteochondral lesions common in elbow displacements?

Answer 11

If there’s enough force to displace the elbow, there’s enough force to skin the top of the bone

Question 12

What is one of the advantages of having ORIF?

Answer 12

ROM can be started much earlier

Question 13

What is lateral epicondylitis?

Answer 13

• Tennis elbow
• Degenerative overuse syndrome
• Pain in common extensor origin
• Impingement of nerve
• Pain with wrist extensor RISOM

Question 14

What is medial epicondylitis?

Answer 14

• Golfer’s elbow
• Pain in common flexor origin
• Can involve median nerve

Question 15

What are the principles of treatment for lateral & medial epicondylitis?

Answer 15

• Establish proliferative or degenerative
• Change factors causing degeneration/aggravation
• Optimise potential for healing
• Optimise other tissues & biomechanics

Question 16

What are some of the complexities of chronic elbow injury?

Answer 16

• Neural involvement (double crush syndrome)
• Complexity of involvement between neural, tendon & joint structures
• Treatment often multi-pronged (tape & exercises, joint mobilisation in neural mobilisation positions, MWM)

Question 17

What is radial tunnel syndrome or posterior interosseous nerve syndrome (PINS)?

Answer 17

• Impingement of radial nerve or

- Entrapment of posterior interosseous nerve at annular ligament, leash of henry, arcade of Frohse, ECRB, supinator

Question 18

What are the two chronic elbow not to be missed conditions?

Answer 18

• Ulnar nerve subluxation

- Osteochondritis dissecans