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Elbow sports injuries

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Elbow sports injuries

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Elbow sports injuries

  1. 1. www.handsurgery.gr Elbow Sports Injuries Aaron Venouziou Orthopaedic Surgeon Thessaloniki
  2. 2. www.handsurgery.gr Elbow Sports Injuries Posterior Triceps tendinopathy / rupture Valgus extension overload syndrome Posteromedial impingement Inflammation Chondromalacia Loose bodies Osteophyte formation Olecranon stress fractures Medial MCL Flexor pronator tendons Ulnar nerve Medial epicondyle stress injury Lateral Extensors tendons PRLI Plica syndrome OCD Radiocapitellar arthropathy Radial tunnel syndrome PIN Anterior Biceps tendinopathy Biceps tear Median nerve AIN
  3. 3. www.handsurgery.gr Biomechanics Ulnohumeral Joint < 20o / > 120o VALGUS VARUS MCL 20o - 120o LCL 20o - 120o
  4. 4. www.handsurgery.gr Pathomechanics Overhead throwing
  5. 5. www.handsurgery.gr Pathomechanics Weightlifting
  6. 6. www.handsurgery.gr Pathomechanics tensile loads compressive loads shear loads extremely high valgus stresses
  7. 7. www.handsurgery.gr Pathomechanics Tensile loads Medial side pathology • MCL • Flexor tendons • Ulnar nerve
  8. 8. www.handsurgery.gr Pathomechanics compressive loads Lateral side pathology • LCL • OCD • Radiocapitellar arthropathy
  9. 9. www.handsurgery.gr Pathomechanics shear loads Posterior side pathology • Valgus extension overload syndrome • Posteromedial impingement • Inflammation • Chondropathy • Osteophyte / spur formation • Loose bodies • Olecranon stress fractures
  10. 10. www.handsurgery.gr Medial Elbow Instability MCL injury • Attenuation to complete rupture • Overhead athletes • Loss of velocity, accuracy • Pain w/ palpation over MCL (50o- 70o flexion)
  11. 11. www.handsurgery.gr Medial Elbow Instability MCL examination • Valgus stress test • 30o of elbow flexion and forearm pronation • Opening of the medial joint space +/- pain
  12. 12. www.handsurgery.gr Medial Elbow Instability MCL examination • Milking maneuver • 90o elbow flexion • Grabbing the affected thumb with the opposite hand passed under the affected arm • Pulling to stress the medial elbow
  13. 13. www.handsurgery.gr Medial Elbow Instability MCL examination • Moving valgus stress test • Shoulder in ABD and ER • The examiner holds the thumb and supports the elbow • Elbow flexion-extension + valgus stress • Pain between 80o and 120o => positive test
  14. 14. www.handsurgery.gr Medial Elbow Instability MCL imaging
  15. 15. www.handsurgery.gr Medial Elbow Instability MCL injury / tear • Usually do not respond to conservative treatment • Surgical treatment indications: • Acute ruptures • Chronic pain • Instability
  16. 16. www.handsurgery.gr Medial Elbow Instability MCL reconstruction • Jobe et al. JBJS Am 1986 Tommy John's procedure Free tendon graft Figure- eight fashion through bone tunnels 63% return to sports (10 out of 16 athletes) Hamstrings tendon grafts
  17. 17. www.handsurgery.gr Medial Elbow Instability MCL reconstruction • Docking technique • Azar et al. AJSM 2010 79% (78 pts) return to sports (10 months) • Rohrboughet al. AJSM 2002 95% (31 pts) return to sports
  18. 18. www.handsurgery.gr PosteroLateral Rotatory Instability Pathomechanics • Valgus force • Axial load • Supination
  19. 19. www.handsurgery.gr PosteroLateral Rotatory Instability Ulnar lateral collateral lig. injury
  20. 20. www.handsurgery.gr PosteroLateral Rotatory Instability PLRI tests • Posterolateral rotary apprehension test / lateral pivot-shift test • Stand up test
  21. 21. www.handsurgery.gr PosteroLateral Rotatory Instability Imaging
  22. 22. www.handsurgery.gr PosteroLateral Rotatory Instability Treatment • Reconstruction with palmaris longusvs. hamstrings
  23. 23. www.handsurgery.gr OsteoChondritis Dissecans • Radiocapitellar joint tenderness • 15o to 20o extension lag • Active compression test
  24. 24. www.handsurgery.gr OsteoChondritis Dissecans Treatment • Open vs. arthroscopic • Fragment fixation • Removal of loose cartilage • Abrasion chondroplasty • Microfractures • Mosaic plasty • 70-90% return to sports • Rush et al. Arthroscopy 1998 • Baumgarten et al. AJSM 1999
  25. 25. www.handsurgery.gr Valgus Extension Overload Syndrome • Posteromedial impingement • Chondropathy • Osteophyte formation • Loose bodies
  26. 26. www.handsurgery.gr Valgus Extension Overload Syndrome • Loss of full extension • Crepitus / locking • Arm bar test
  27. 27. www.handsurgery.gr Valgus Extension Overload Syndrome Imaging
  28. 28. www.handsurgery.gr Valgus Extension Overload Syndrome VEO Syndrome Treatment • Open vs. arthroscopic debridement • Reddy et al. Arthroscopy 2000 85% return to sports (55 athletes) • Blonna et al. AJSM 2010 91% return to sports (24 athletes)
  29. 29. www.handsurgery.gr Conclusions Elbow injuries are the result of biomechanical forces on the elbow during throwing motion tensile forces medially compressive forces laterally shear forces posteriorly Prognosis for return to competition is very good
  30. 30. www.handsurgery.gr Ευχαριστώ

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