This document provides an overview of common elbow disorders presented by Dr. Farouq Makkie Alyouzbaki. It discusses the anatomy of the elbow joint and various conditions affecting the elbow including cubitus varus, cubitus valgus, pulled elbow, osteochondritis disse cans, lateral epicondylitis (tennis elbow), medial epicondylitis (golfer's elbow), and olecranon bursitis. For each condition, it describes the causes, signs, symptoms, management options including both conservative and surgical treatments. The goal is to educate on evaluating and managing a variety of elbow disorders.

1. ELBOW DISORDERS
DR.FAROUQ MAKKIE ALYOUZBAKI
ORTHOPEDIC SPECIALIST
NINEVAH MEDICAL COLLEGE
5TH STAGE LECTURE

2. Learning objectives
• 1-ELBOW JOINT ANATOMY AND EXAMINATION .
• 2-ELBOW DEFORMITY (CUBITUS VARUS,,CUBITUS
VALGUES,,CUBITUS RECURVATUM).
• 3-PULLED ELBOW MANAGEMENT.
• 4-OSTEOCHONDRITIS DISSECANS MANAGEMENT.
• 5-LATERAL EPICHONDYLITIS (TENNIS ELBOW)MANAGEMENT.
• 6-MEDIAL EPICHONDYLITIS (GOLFER ELBOW)MANAGEMENT.
• 7-OLECRANON BURSITIS CAUSES AND TREATMENT.

3. JOINTS AND BONES AT THE ELBOW
• THERE ARE THREE JOINTS
• 1-Humeroulnar joint (hinge joint):between the
trochlear of the huemerus and the trochlear joint of
the ulna
• 2-Humeroradial joint :between the capitellum of the
humerus and the radial head.
• 3-Proximal radioulnar joint(pivot joint):between the
radial head and radial notch on proximal ulna

4. ELBOW JOINT
• The function of the upper extremity relies on elbow motion .if a
person elbow motion decreases by 50%upper extremity impairment
increases by as much as 80%.
• The elbow controls pronation supination, flexion, and extension of
the forearm
• The elbow joint ability to flex and extend depend on ulno humeral
joint.pronation and supination depend on radiocapitar joint.

5. NERVES AND BLOOD VESSELS

6. THE CARRYING ANGLE

7. SYMPTOMS
• Pain: diffuse or localized (eg lateral epicondyle of the
humerus in tendinitis).
• Referred pain from cervical spine.
• Stiffness:
• Limited flexion; cannot reach the mouth.
• Limited extension; cannot reach the perineum.
• Deformity: eg.
• Malunited supracondylar fractures; cubitus varus, cubitus
valgus.
• Rheumatoid arthritis.

8. SIGNS
• LOOK :
• Expose both upper limbs.
• Examine from front and behind.
• Also examine neck shoulders and hands.
• Look:
• Skin; scars, sinuses,swelling.
• Deformity; cubitus varus, cubitus valgus,..

9. Cubitus varus and cubitus valgus
((GUN STOCK deformity)

10. FEEL
• Three bony land marks :meial and lateral epicondyle and olecranon
• Warmth…septic arthritis
• Nodules; rheumatoid arthritits, bursitis,…
• Tender points; eg, over lateral epicondyle in tennis elbow.
• Medial epicondyle tenderness in golfer elbow.

11. Move
• Flexion and extension

12. Move
• Pronation and supination

13. Radiologic assessment

14. If you want something well done do it by
your self

15. CUBITUS VARUS
• cubitus varus is the most common complication
following supracondylar
• current thinking is that it stems from
malreduction of frx, with medial displacement,
internal rotation, and extension of the distal
fragment
• this then permits distal fragment to tilt into varus;
• cubitus varus produces a cosmetic deformity
but little function deficit

16. CUBITUS VARUS
• Treatment of sever cases by supracondylar wedge osteotomy

17. CUBITUS VALGUS
• Cubitus valgus is a deformity in which the forearm is angled out
away from the body when the arm is fully extended. When it affects
both arms, it’s known as cubitus valgus bilateral.
•
When your palm is facing upward and your arm is extended, you
may have cubitus valgus if your carrying angle, or the degree to
which your arm is angling away from your body, exceeds 15
degrees.
• Most common cause lateral humeral condyle fracture malunion

18. CUBITUS VALGUS
• Complication :
• 1-tardy ulnar nerve palsy
• 2-cosmotic deformity
Trratment :
By supracondylar osteotomy

19. CUBITUS RECURVATUM
• IT OCCUR NORMALLY
• IN PATIENT WITH
• LIGAMENT LAXITY

20. PULLED ELBOW
• Nursemaid's elbow is a common injury of early childhood
that results in subluxation of the annular ligament due to a
sudden longitudinal traction applied to the hand
• treatment is usually closed reduction with either a
supination or a hyperpronation technique.
•
• most common in children from 1 to 4 years of age
• average age is 28 months
• rare after 5 years of age
• slightly more common in females

21. PULLED ELBOW
• mechanism of injurysudden, longitudinal traction applied to the
hand with the elbow extended and forearm pronated
• may also be caused by a fall
• History
• a click may be heard or felt by the person pulling the child's arm
• Symptoms
• child refuses to use the affected limb
• holds the elbow in slight flexion and the forearm pronated
• Physical Exam
• pain and tenderness localized to the lateral aspect of the elbow

22. PULLED ELBOW..TREATMENT

23. OSTEOCHONSDRITIS DISSECANS OF
ELBOW
•A localized injury and subsequent separation of articular cartilage
and subchondral bone of the capitellum
•Epidemiology
•boys more common than girls
•location
•typically located in capitellum of dominant upper
extremity
•risk factors
•repetitive overhead and upper extremity weight bearing
activities
• gymnasts and throwing

24. CLINICAL FEATURES OF OCD
• Symptoms
• elbow pain
• insidious, activity-related onset of lateral elbow pain in
dominant arm
• mechanical symptoms
• loss of extension
• early sign
• catching / locking / grinding
• late signs if loose bodies present

25. RADIOLOGIC FEATURES OF
OSTEOCHONDRITIS DISSECANS
• Plain radiograph
• non-specific findings
• mostly normal
• may show irregularities and fragmentation
of capitellum

26. TREATMENT OF OCD OF THE ELBOW
• 1-cessation of activity +/- immobilization
• 2-arthroscopic microfracture or drilling of capitellum
• 3-fixation of lesion
• 4-arthroscopic debridement and loose body excision

27. TENNIS ELBOW
(LATERAL EPICONDYLITIS)
• Overuse injury involving eccentric overload at
origin of common extensor tendon leads to
tendinosis and inflammation at origin of
ECRB
• most common cause for elbow symptoms in
patients with elbow pain
• affects 1-3% of adults annually
• commonly in dominant arm
• non-operative treatment effective in up to
95% of cases

28. CLINCAL FEATURES
• pain with resisted wrist extension
• pain with gripping activities
• decreased grip strength
• point tenderness at ECRB insertion into lateral
epicondyle few mm distal to tip of lateral
epicondyle

29. TENNIS ELBOW
• PROVOCATIONS TESTS
• resisted wrist extension with elbow fully extended
• resisted extension of the long fingers

30. TREATMENT OF TENNIS ELBOW
• CONSERVATIVE TREATMENT :
• Activity modification, ice, NSAIDS,
• physical therapy
• steroid injections (up to three)
• extracoproeal shock wave therapy

31. TENNIS ELBOW
• SURGICAL TREATMENT:
• if prolonged nonoperative (6-12 months) fails
• release and debridement of ECRB origin
• Of unhealthy tendon.

32. MEDIAL EPICONDYLITIS
GOLFER’S ELBOW
• An overuse syndrome of the flexor-pronator mass originmore
difficult to treat than lateral epicondylitis
• 5 to 10 times less common than lateral epicondylitis
• dominant extremity in 75% of cases
• age 30s to 60s, most commonly in 30s to 40s.
• Pathoanatomy : micro-trauma to insertion of flexor-pronator mass
caused by repetitive activities

33. Clinical features
• insidious onset pain over medial
epicondyle
• tenderness 5-10 mm distal and anterior to
medial epicondyle
• PROVOCATION TEST:
• pain with resisted forearm pronation and
wrist flexion

34. IMAGING
• ULTRASOUND EXAMINATIONS
• >90% sensitivity, specificity, positive and negative predictive values
• allows dynamic examination
• MRI :for evaluation of other causes of medial elbow pain

35. Treatment of medial epicondylitis
• rest, ice, activity modification
• PT (passive stretching), bracing, NSAIDS
• extracorporeal shockwave therapy (ESWT)
• corticosteroid injections into peritendinous tissue
• Surgical treatment:
• open debridement of PT/FCR, reattachment of flexor-pronator
group

36. OLECRANON BURSITIS
• Bursitis is a painful condition that affects
the joints. Bursae are fluid-filled sacs that
act as a cushion between bones, tendons,
joints, and muscles. When these sacs
become inflamed it is called bursitis.

37. OLECRANON BURSITIS
• Traumatic: continued pressure or friction (student’s
elbow).
• Non-traumatic: gout, rheumatoid arthritis.
• Treatment: large bursa needs excision.

38. THANK YOU