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THE ELBOW AND FOREARM

THE ELBOW AND FOREARM. DR BAKHTYAR BARAM. ANATOMY. Symptoms. PAIN- localized and radiated like in tennis elbow Or referred e.g . from cervical spine . STIFFNESS- SWELLING INSTABILITY NERVE SYMPTOMS LOSS OF FUNCTION LOOK----------- e.g . deformity ------ feel …………. movement.

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THE ELBOW AND FOREARM

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  1. THE ELBOW AND FOREARM DR BAKHTYAR BARAM

  2. ANATOMY

  3. Symptoms • PAIN-localized and radiatedlike in tennis elbow Or referred e.g. from cervicalspine. STIFFNESS- SWELLING INSTABILITY NERVE SYMPTOMS LOSS OF FUNCTION LOOK-----------e.g. deformity------feel………….

  4. movement IMAGING MAY BE X-RAY AND IN OTHER CASES CT SCANING OR MRI

  5. cubitusvalgus • Normal angei is 5-15 deg. Valgus. • Causes: non-union fracturesof lat. Condyle,promoinant med. Condyle. • Be aware of liability to delayedulnarpalsy. • CUBITUS VARUS • mostlybecause of the supracond. Fracture. • Osteotomy is agoodchoise.

  6. Subluxation of the radial head.ulna is disproporionatelyshortened. • Unreduceddislocation of th head of the radius is acomplication of unreduced of Montegiafracture.

  7. PULLED ELBOW • Downwarddislocationofthe head of radius from the annular lig. Is verycommon. • The elbowfullyextended and the forearmpronated ,anyattemp to supinate the foprearmresisted. • Repositionhappensspontaneously or by supination and flextion.

  8. OsteochondritisDissicans • the capitulum is the most common site, repeatedstress,young male, painespicially by activity.swelling and effusion. • X-ray ,CT OR MRI. • RESOLVE AND HEAL SPONT.,fragmentscanbe removed.

  9. LOOSE BODIES • 1. trauma • 2. osteo. Dissecans. • 3.Syn. Chondromatosis. • 4.OA • X-ray and CT • Symptomaic to removal.

  10. RHUM. ARTHRITIS • More than 50% of rhuma. Pt . Elbowinvolved. • Ulnarbursitis and rhuma. Nodules or joint synovitis with pain and movementrestriction,andulnar nerve symptoms because of compression. • Xray show bone erosion destruction,cysts. • General treatment, cortsoninj. • Operative treatment is synovectomy, exision of radial head, joint replacement. • GOUT and pseudogout,Olec. Bursitisis asignificantplace.

  11. STIFFNESS • Congenital, trauma, infection, inflammation, OA, • May beextrensic or intrinsic. • Normallydailylivingneedflexion 30-130 and pro./supination 50. • Earlymovementafterfracture, exercise and manpilation. • Over 12 monthsdepending on the causelikeosteophyteremoval,capsularrelease, capsulotomy,bonecorrection.

  12. INSTABILTY • Lat. Collat. Ligament rupture,canrepaires by tendonautograft. • Medial is the same and reconstruction gives agoodresult.

  13. TENNIS ELBOW

  14. TENNIS ELBOW • Pain and tenderness over the lat. Epicond. At the bonyinsertion of the commonextens. Tendons., DD from suprasinat. Teninitisand radial tunnel syndrom. • Aggrav. In pouring out tea, turningdoorhandle and shakinghands. • Active extensionagainstresistant in wristaggrav. It • Xray normal • Resolvespontanously, tennis elbow bandage, analgesic, cortisonlocalinj., or operation by removing of synovium or by detaching of commonextensormuscles..

  15. GOLFER`S ELBOW,in the pronatororigion in the med. Epicondyl, lesscommon and surgeryoutcomelesseffective. • AVULSION of the distaltendon of biceps, on the biceps tuberosity of radius.repairmostly for cosmoticreason.

  16. OLECRANON BURSITIS Inflammation or infection. Contin. Friction or pressure, or maybe part of otherdisease. Conservativereatment or localcortisoneinj. Or operation. In case of infectionoperation,needbursectomy with drainage ,pus to c/s and antibiotic.sometimesneedacute operation beforeseptisemiaand toxic.

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