THE ELBOW AND FOREARM

DR BAKHTYAR BARAM

ANATOMY

Symptoms

• PAIN-localized and radiated like in tennis elbowOr referred e.g. from cervical spine.STIFFNESS-SWELLINGINSTABILITYNERVE SYMPTOMSLOSS OF FUNCTIONLOOK-----------e.g. deformity------feel………….

movement

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

cubitus valgus

• Normal angei is 5-15 deg. Valgus.• Causes: non-union fractures of lat.

Condyle,promoinant med. Condyle.• Be aware of liability to delayed ulnar palsy.

• CUBITUS VARUS• mostly because of the supracond. Fracture.• Osteotomy is agood choise.

• Subluxation of the radial head.ulna is disproporionately shortened.

• Unreduced dislocation of th head of the radius is acomplication of unreduced of Montegia fracture.

PULLED ELBOW

• Downward dislocation ofthe head of radius from the annular lig. Is very common.

• The elbow fully extended and the forearm pronated ,any attemp to supinate the foprearm resisted.

• Reposition happens spontaneously or by supination and flextion.

Osteochondritis Dissicans

• the capitulum is the most common site, repeated stress,young male, pain espicially by activity.swelling and effusion.

• X-ray ,CT OR MRI.• RESOLVE AND HEAL SPONT.,fragments can be

removed.

LOOSE BODIES

• 1. trauma• 2. osteo. Dissecans.• 3.Syn. Chondromatosis.• 4.OA

• X-ray and CT• Symptomaic to removal.

RHUM. ARTHRITIS

• More than 50% of rhuma. Pt . Elbow involved.• Ulnar bursitis and rhuma. Nodules or joint synovitis

with pain and movement restriction,and ulnar nerve symptoms because of compression.

• Xray show bone erosion destruction,cysts.• General treatment, cortson inj.• Operative treatment is synovectomy, exision of radial

head, joint replacement.• GOUT and pseudogout,Olec. Bursitis is asignificant

place.

STIFFNESS

• Congenital, trauma, infection, inflammation, OA,• May be extrensic or intrinsic.• Normally daily living need flexion 30-130 and

pro./supination 50.• Early movement after fracture, exercise and

manpilation.• Over 12 months depending on the cause like

osteophyte removal,capsular release, capsulotomy,bone correction.

INSTABILTY

• Lat. Collat. Ligament rupture,can repaires by tendon autograft.

• Medial is the same and reconstruction gives agood result.

TENNIS ELBOW

TENNIS ELBOW• Pain and tenderness over the lat. Epicond.

At the bony insertion of the common extens. Tendons., DD from suprasinat. Teninitis and radial tunnel syndrom.

• Aggrav. In pouring out tea, turning doorhandle and shaking hands.

• Active extension against resistant in wrist aggrav. It

• Xray normal• Resolve spontanously, tennis elbow

bandage, analgesic, cortison local inj., or operation by removing of synovium or by detaching of common extensor muscles..

• GOLFER`S ELBOW,in the pronator origion in the med. Epicondyl, less common and surgery outcome less effective.

• AVULSION of the distal tendon of biceps, on the biceps tuberosity of radius.repair mostly for cosmotic reason.

OLECRANON BURSITIS

Inflammation or infection.Contin. Friction or pressure, or may be part of other disease.Conservative reatment or local cortisone inj. Or operation.In case of infection operation,need bursectomy with drainage ,pus to c/s and antibiotic.sometimes need acute operation before septisemia and toxic.