Elbow joint injuries and its treatment.pptx

Elbow injuery and treatment

1. ELBOW injuries A ssessment and Treatment By : A lfa care team

2. بسم الله الرحمن الرحيم سَنُرِيهِمْ آيَاتِنَا فِي الآفَاقِ وَفِي أَنْفُسِهِمْ حَتَّى يَتَبَيَّنَ لَهُمْ أَنَّهُ الْحَقُّ أَوَلَمْ يَكْفِ بِرَبِّكَ أَنَّهُ عَلَى كُلِّ شَيْءٍ شَهِيدٌ (53) صدق الله العظيم.

3. Anatomy and biomechanics initio

4. De finition Joints within the elbow are: humeroulnar between the trochlea of the humerus and the trochlear notch of the ulnar; humeroradial between the capitulum of the humerus and the superior surface of the head of the radius; superior radioulnar between the circumference of the head of the radius and the fibro-osseous ring formed by the radial notch of the ulna and the annular ligament.The distal radioulnar articulation formed between the head of ulna and the ulnar notch on the lower extremity of radius .

5. r ight ulna and radius in supination and pronation ant view:

6. Abduction and adduction Abduction occurs during extension. A dduction occurs during flexion.

7. Carrying angle:

8. Lateral elbow pain: 1- Tennis elbow 2- Radiohumeral artharitis 3-Osteochondritis dissicans

9. Tennis elbow: a- def : Overuse and repetitive movements that overload the extensor and supinator tendons can lead to microtrauma and small tears of the extensor tendons, particularly the extensor carpi radialis brevis . In athletes, lateral epicondylitis is also called tennis elbow, occurring as a result of poor backhand technique, incorrect grip size, and/or excess string tension.

10. B-Assessment : Mill’s test Cozen’s test

11. Imaging/Diagnostic Evaluation Radiographs : ULTRASONOGRAPHY AND MRI

12. C- Treatment : 1- acute phase : a- RICE b- NSAIDs c- Counterforce brace d- Pulsed Ultrasound e - Taping f- Strain counterstrain g- DTF ( grade 1 )

13. 2- post acute phase : a- soft tissue release DTF

14. B- mobilization: Dorsal glide head of the radius to increase elbow extension;volar glide to increase flexion.

15. Humeroulnar Distal Glide Indication To increase flexion.

16. Proximal Radioulnar Joint, Dorsal/Volar Glides Dorsal glide to increase pronation; volar glide to increase supination.

17. Distal Radioulnar Joint, Dorsal/ Volar Glides Dorsal glide to increase supination; volar glide to increase pronation

18. 2- MWM:

19. 3- Mill’s Manip

20. 4- stretching and strengthening exercises :

21. Technique correction :

22. 2- Radiohumeral artharitis 1-After capitellar fx 2-After radial head fracture – Failure of fracture management – Failure of prosthetic implant 3-Condylar malalignment 4-Degenerative arthritis almost exclusively in men usually with repetitive heavy use or overuse of elbow. Carpenters, weightlifters, throwing athletes .

23. Management : 1- radial head arthroplasty 2- arthroscopy : debridment 3- total elbow arthroplasty 4- elbow arthrodesis

24. 3- osteochondritis dissicans a condition that develops in joints, most often in children and adolescents. It occurs when a small segment of bone begins to separate from its surrounding region due to a lack of blood supply. As a result, the small piece of bone and the cartilage covering it begin to crack and loosen.

25. Treatment 1- Rest 2- Immoilization 3- Surgical treatment

26. 2- Medial elbow pain: 1- Golfer’s elbow 2- Ulnar neuritis

27. 1- definition: Medial epicondylitis involves predominantly the forearm muscles of flexion and pronation, including the flexor carpi radialias , palmaris longus , pronator teres , and occasionally the flexor carpi ulnaris and flexor digitorum superficialis , at their origin at the humeral anterior medial epicondyle Medial epicondylitis occurs secondary to repetitive overuse most often from throwing motions with the arm overhead or serving motions as in golf and tennis.

28. 2- Assessment :

29. Imaging/Diagnostic Evaluation: Although no imaging techniques are diagnostic, AP and lateral elbow radiographs can evaluate any associated bony pathology .MRI will reveal integrity of the collateral ligaments and surrounding soft tissue. Nerve conduction studies and electromyography can be useful if the ulnar nerve is involved .

30. 3- Treatment : a- acute phase : as tennis elbow

31. 2- post acute phase : same as tennis elbow but MFR ,stretching and strengthening to the flexor group

32. Ulnar neuritis ( cubital tunnel syndrome):   Inflammation of the ulnar nerve in the arm that results in numbness or weakness in the hand caused by repetitive motion at the elbow or activities that place constant pressure against the ulnar nerve wrist Diagnose by : EMG and NCS

33. Treatment : 1- Rest 2- NSAIDS 3- Surgical treatment

34. 3- problems in the volar aspect: 1- Biceps tendinitis 2- pronator syndrome: median nerve intrapment through pronator heads 3- Distal humeral appophysitis : Because of the timing of ossification in children, traction apophysitis is the most common elbow injury in young children .

35. 4-problems in dorsal aspect 1- triceps tendinitis throwing athletes (especially javelin) and weight-lifters.

36. 2- triceps bursitis : leaning on the elbow for a prolonged period (student’s elbow), or from a direct fall onto the point of the elbow .

37. Post operative rehabilitation : Lat. Epicondylectomy , ECRB release: Indications : 1- cont. pain more than 12 months 2- fail of conservative treatmen 3- fail of corticoids injections 3 times

38. Thank you 