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ElbowSportsInjuries

AaronVenouziouOrthopaedic Surgeon

Thessaloniki

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ElbowSportsInjuries

PosteriorTricepstendinopathy /rupture

ValgusextensionoverloadsyndromePosteromedialimpingement

InflammationChondromalacia

LoosebodiesOsteophyteformation

Olecranonstressfractures

MedialMCLFlexorpronator tendonsUlnarnerveMedialepicondylestressinjury

LateralExtensorstendons

PRLIPlicasyndrome

OCDRadiocapitellararthropathy

Radialtunnel syndromePIN

AnteriorBicepstendinopathyBicepstearMediannerveAIN

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Biomechanics

UlnohumeralJoint<20o />120o

VALGUS VARUS

MCL20o - 120o

LCL20o - 120o

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Pathomechanics

Overheadthrowing

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PathomechanicsWeightlifting

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Pathomechanics

tensileloads compressiveloads

shearloads

extremelyhighvalgusstresses

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Pathomechanics

Tensileload

s

Medialsidepathology

• MCL

• Flexortendons

• Ulnarnerve

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Pathomechanicscom

pressiveloads

Lateralsidepathology

• LCL

• OCD

• Radiocapitellar

arthropathy

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Pathomechanics

shearloads

Posteriorsidepathology

• Valgusextensionoverloadsyndrome

• Posteromedialimpingement

• Inflammation

• Chondropathy

• Osteophyte /spurformation

• Loosebodies

• Olecranon stressfractures

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MedialElbowInstability

MCLinjury• Attenuationtocompleterupture• Overheadathletes• Lossofvelocity,accuracy• Painw/palpationoverMCL(50o-70o flexion)

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MedialElbowInstability

MCLexamination

• Valgusstresstest

• 30o ofelbowflexionandforearmpronation

• Openingofthemedialjointspace+/- pain

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MedialElbowInstability

MCLexamination

• Milkingmaneuver

• 90o elbowflexion

• Grabbingtheaffectedthumbwiththeoppositehandpassedundertheaffectedarm

• Pullingtostressthemedialelbow

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MedialElbowInstability

MCLexamination

• Movingvalgusstresstest

• ShoulderinABDandER

• Theexaminerholdsthethumbandsupportstheelbow

• Elbowflexion-extension+valgusstress

• Painbetween80oand120o=>positivetest

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MedialElbowInstability

MCLimaging

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MedialElbowInstability

MCLinjury/tear

• Usuallydonotrespondtoconservativetreatment

• Surgicaltreatmentindications:• Acuteruptures• Chronicpain• Instability

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MedialElbowInstability

MCLreconstruction

• Jobe etal.JBJSAm1986TommyJohn'sprocedureFreetendongraftFigure- eightfashionthroughbonetunnels63%returntosports(10outof16athletes)

Hamstringstendongrafts

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MedialElbowInstability

MCLreconstruction

• Dockingtechnique

• Azar etal.AJSM201079%(78pts)returntosports(10months)

• Rohrboughetal.AJSM200295%(31pts)returntosports

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PosteroLateral RotatoryInstability

Pathomechanics

• Valgusforce

• Axialload

• Supination

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PosteroLateral RotatoryInstability

Ulnarlateralcollaterallig.injury

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PosteroLateral RotatoryInstability

PLRItests• Posterolateral rotaryapprehensiontest/lateralpivot-shifttest• Standuptest

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PosteroLateral RotatoryInstability

Imaging

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PosteroLateral RotatoryInstability

Treatment• Reconstructionwithpalmaris longus vs.hamstrings

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OsteoChondritis Dissecans

• Radiocapitellar jointtenderness

• 15o to20o extensionlag

• Activecompressiontest

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OsteoChondritis Dissecans

Treatment

• Openvs.arthroscopic• Fragmentfixation• Removalofloosecartilage• Abrasionchondroplasty• Microfractures• Mosaicplasty

• 70-90%returntosports• Rushetal.Arthroscopy1998• Baumgarten etal.AJSM1999

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ValgusExtensionOverloadSyndrome

• Posteromedialimpingement

• Chondropathy

• Osteophyteformation

• Loosebodies

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ValgusExtensionOverloadSyndrome

• Lossoffullextension

• Crepitus/locking

• Armbartest

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ValgusExtensionOverloadSyndrome

Imaging

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ValgusExtensionOverloadSyndrome

VEOSyndromeTreatment

• Openvs.arthroscopicdebridement

• Reddyetal.Arthroscopy200085%returntosports(55athletes)

• Blonna etal.AJSM201091%returntosports(24athletes)

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Conclusions

Elbowinjuriesaretheresultofbiomechanicalforcesontheelbowduringthrowingmotion

tensileforces mediallycompressiveforces laterallyshearforces posteriorly

Prognosisforreturntocompetitionisverygood

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