Elbow sports injuries
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Transcript of Elbow sports injuries
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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
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
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
PLRItests• Posterolateral rotaryapprehensiontest/lateralpivot-shifttest• Standuptest
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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
VEOSyndromeTreatment
• Openvs.arthroscopicdebridement
• Reddyetal.Arthroscopy200085%returntosports(55athletes)
• Blonna etal.AJSM201091%returntosports(24athletes)
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Conclusions
Elbowinjuriesaretheresultofbiomechanicalforcesontheelbowduringthrowingmotion
tensileforces mediallycompressiveforces laterallyshearforces posteriorly
Prognosisforreturntocompetitionisverygood