Elbow injuries www.fisiokinesiterapia.biz
Objectives Revise a wee bit anatomy Learn elbow movements Know common injuries Know management of those injuries
Anatomy
Examination Inspection Palpation Movements Neurovascular status
Inspection Position Swollen elbow always semi-flexed Swelling Deformity
Palpation Tenderness Crepitus Fluid eg bursitis Heat
Movements Extension (to 0 degrees) Gravity plus triceps Flexion (145 degrees) Biceps and brachialis Pronation (75 degrees) Pronator teres and pronator quadratus Supination (80 degrees) Biceps and supinator
Most common injuries Supra-condylar fracture Radial head fracture Olecranon fracture Dislocation Fracture dislocation Pulled elbow
Supra-condylar fracture Usually from fall onto elbow when flexed More common in children Often displaced/angulated Generally swollen restricted movement Look for complications
Supra-condylar fracture Complications vascular complications: brachial artery Volkmann s ischaemic contracture median nerve palsy Management some may require manipulation if displaced arterial obstruction off-ending of fracture <50% bony contact Long arm plaster fixation
Radial head fractures Fall onto outstretched hand Female>male 20% all elbow injuries Associated with 10% dislocations
Signs and symptoms Pain on outside of elbow Swelling in elbow joint Unable to fully flex or extend Pain pronation/supination
Fracture radial head Fracture may not be visible on initial x-raysx rays- look for effusions Type 1 fractures undisplced treated with collar and cuff Type 2 fractures slghtly displaced treated conservatively may require surgery if large pieces Type 3 fractures comminuted causes poor healing may require excision radial head/prothesis
Fracture over olecranon Mechanism -fall on point of elbow -sudden triceps contraction Don t t forget epiphyses
Olecranon fractures Hairline and undisplaced fractures can be treated in long arm cast for 3-43 4 weeks in children and 6-86 8 weeks in adults If fragment large/displaced will require fixation e.g. tension band wiring
Elbow dislocation Usually fall onto outstretched hand Severe pain at elbow and swelling Minimal movement Check sensation/pulses
Dislocation of elbow Posterior lateral dislocation reduction by traction in line of the limb under analgesia and sedation Check x-rayx Crepe bandages and sling 2 weeks Fracture clinic
Elbow Dislocations BEWARE ASSOCIATED FRACTURES BEWARE COMPLICATIONS Median nerve injury Ulna nerve injury Brachial artery injury
Supra-condylar fracture Usually from fall onto elbow when flexed More common in children Often displaced/angulated Generally swollen restricted movement Look for complications
Lateral Epicondylitis Commonly known as tennis elbow Occurs in mostly 30-50 years age group Due to degeneration of the tendon fibres over the lateral epicondyle which are involved in wrist extension
Symptoms severe burning pain on outside of elbow Pain worse on gripping or lfting objects and with direct pressure over lateral epicondyle Pain may radiate down forearm
Medial Epicondylitis Commonly called Golfer s elbow Similar to Tennis elbow Most common in men 20-50 years Pain medial elbow may radiate down inner forearm Pain worse when make fist/shake hands
Treatment Mostly self limiting Analgesia -NSAIDS Avoid activities which produce symptoms Orthotics Should improve in 6-86 8 weeks if not consider steroid injection Physiotherapy Surgery
Olecranon Bursitis Infection/inflammation of bursa Causes- Trauma Prolonged pressure Infection Medical conditions e.g.rheumatoid arthritis/gout
Symptoms/Treatment Swelling Pain Erythema/heat if infected Infection may spread R.I.C.E. NSAIDS?Antibiotics?Aspiration?Surgery
Remember kids C-capitulum 2yrs R-radial head 4yrs I-internal(medial epicondyle) ) 6yrs T-trochlea 8yrs O-olecranon 10yrs L-lateral epicondyle 12yrs
Pulled Elbow Usually aged 18months-4years History of pulling Won t t use arm Not usually very distressed Pronation/supination +/- flexion/extension causes a click Wait 10 minutes play area If not settled, think about x-ray. x