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THE PAINFUL STIFF ELBOW - Lakeview Private Hospital · 2018-12-07 · the elbow changes the radius...
Transcript of THE PAINFUL STIFF ELBOW - Lakeview Private Hospital · 2018-12-07 · the elbow changes the radius...
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THE PAINFUL STIFF ELBOWDR MANISH GUPTA
SPECIALIST SURGEON
SHOULDER ELBOW WRIST
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anatomy & function
the elbow changes the radius of the sphere of reach of the hand
need an arc of 30-130 degrees
flexion <120 exceeds positional adaptation of neck shoulder and wrist
prono-supination arc 100 degrees
highly congruent system of 3 joints within a single synovial cavity
close relationship of the joint to its ligaments and muscles
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causes and classification of stiffness
intrinsicarticular malalignment/
incongruity
loss of articular cartilage
loose bodies
extrinsiccapsule/ ligaments
heterotopic ossification
mixed
primary
men, heavy exposure
early- end range impingement, late- pain through mid range
secondary
even trivial pathologies can lead to stiffness
5% of simple dislocations lead to functional stiffness
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clinical assessmentpain at end range- osteophyte impingement
pain mid range- severe joint degeneration, or joint incongruence
pain with forearm rotation-radial head involvement
locking/ catching- loose bodies
ulnar nerve
shoulder
functional enquiry
lifting things at homecarrying shopping washing and hygienedressing
sleep disturbance
work & everyday activities
leisure and recreation
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imaging
x-ray usually sufficientgrade 1: ulnotrochlear
involvementgrade2: ulnotrochlear
and radiocapitellar grade 3: radiocapitellar
subluxation
maturity of heterotopic ossification
CT scan
(nerve conduction testing/ EMG)
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goals of treatment
increase range of motion
without increasing pain and
without creating instability
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non surgical treatment
splints
serial casting
physiotherapy
effective for extrinsic
soft tissue
causes of stiffness
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surgery?
non operative treatment failed or not indicated
soft tissue equilibrium
options
arthroscopy
open debridement/ release
interposition +- ligament reconstruction
total replacement arthroplasty
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arthroscopysimple stiffness
mild/moderate loss of movement
minimal previous surgery
includes primary osteoarthritis, OCD, rheumatoid
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open debridement
“column procedure”
open debridement
“medial over the top procedure”
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interposition
dynamic external fixation+- ligament reconstruction
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total elbow replacement
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patient
younger active older low demand
simple stiffness complex stiffness
arthroscopy
joint congruent joint incongruent/ severe degeneration
total elbow replacement
column procedure interposition +- ligament reconstruction dynamic external fixation
column procedure
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Dr Manish Guptashoulder elbow wrist specialist
tel: 9687 8344email: [email protected]
web: www.mgorthopaedics.com.au