Download The Elbow

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The important structures of the
elbow can be divided into several
categories. These include:
•Bones and joints
•Ligaments and tendons
•Capsule
•Muscles
•Nerves
•Blood vessels

There are 3 joints at the elbow:
1- Humeroulnar joint (hinge joint) – between trochlea of humerus and
trochlea notch of ulnar
2- Humeroradial
and radius head
joint
(hinge joint) – between capitilum of humerus
3- Proximal radioulnar joint (pivot joint)- between proximal end of
ulna and proximal end of radius.
is the material that covers
the ends of the bones of any
joint.with functions to
absorb shock and make
motion at the elbow joint
easier.
Ligaments are soft tissue structures that connect
bones to bones. The ligaments around a joint usually
combine together to form a joint capsule.
 Lateral
Collateral Ligament
 Medial Collateral Ligament
(Together these two ligaments connect the humerus to the ulna, to
form the main source of stability for the elbow)
 Annular Ligament: that wraps around the radial head and
holds it tight against the ulna.
 Biceps
tendon
anteriorly (allows
elbow to bend with
force)
 Triceps tendon
posteriorly (allows
elbow to straighten
with force)
 The
articular surfaces are connected
together by a capsule
 Anterior part – from radial and coronoid fossa
of humerus to coronoid process of ulna and
annular ligament of radius
 Posterior part – from capitulum, olecranon
fossa, and lateral epicondyle of humerus to
annular ligament of radius, olecranon of
ulna, and posterior to radial notch.
 The
wrist extensors
originate from the lateral
epicondyle of the
humerus
 The wrist flexors
originate from the medial
epicondyle of the
humerus
The median and ulnar nerve are at risk of injury in:
-Elbow dislocation
- Supracondylar fracture of humerus
It
is the angle at which the humerus and forearm articulate, with the elbow in
full extension, and the palms facing forward
The carrying angle permits the arm to be swung without contacting the hips

The normal carrying
angle of the elbow is
about 15 degrees of
valgus in males and
up to 20 degrees in
females.
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Causes
Supracondylar fractures of
the childhood.
*Function of the elbow
is almost normal.
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Usually indicated for cosmetic reasons;
Consists of removing a bone wedge from the lateral
aspect of supracondylar area.
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Causes:
1- Errors in management of lateral humeral
condyle fracture.
When present at birth it can be a sign of Turner or
Noonan syndrome.
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Clinical features
 Obvious
 Tardy

lateral angulation of the elbow.
Ulnar Nerve Palsy. (most important sequel (
The ulnar nerve is repeatedly stretched behind the medial
epicondyle (for many years)  insidious impairment of the nerve
trunk with ulnar nerve palsy.
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Treatment:
Elbow deformity needs no
treatment, but the nerve palsy
is treated by transposing the
nerve anterior to the elbow.
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The most common pathology in the
elbow.
 Lateral epicondylitis (tennis elbow) is an
overuse injury involving the extensor
muscles that originate on the lateral
epicondylar region of the distal humerus
(any activity involving extension and/or
supination). It is more properly termed a
tendinosis that specifically involves the
origin of the extensor carpi radialis brevis
muscle.

 Occurs
in up to 50% of tennis players
 Cause has been attributed to microscopic
tearing with formation of reparative
tissue (ie, angiofibroblastic hyperplasia)
in the origin of the extensor carpi radialis
brevis (ECRB) muscle
 Patients present with lateral elbow and
forearm pain exacerbated by use
 Typical patient- man or woman between
35-55 years who is a recreational athlete
or who engages in rigorous daily activities
Treatment:
- Rest
- Counterforce brace
- NSAIDs
- Wrist splinting
- Corticosteroid and
injections
- Low level laser therapy
 Approximately
90-95% of patients respond to
conservative measures and do not require
surgical intervention. Patients whose
condition is unresponsive to 6 months of
conservative therapy (including
corticosteroid injections) are candidates for
surgery.
 This
condition is an overuse syndrome that is
characterized by pain at the flexor-pronator
tendinous origin and is seen in sports
activities with repetitive valgus stress,
flexion, and pronation, such as occurs in golf,
baseball, tennis, fencing, and swimming. This
condition is also seen with occupations that
require hand, wrist, and forearm motions.
 Most
common cause of medial elbow pain
but less common than tennis elbow
 Males: females = 2:1
 Presence of microtears in the flexorpronator tendons without inflammation
 Patient presents with achy pain over the
anterior medial epicondyle, usually during
activity, and the patient may describe
weakness in the forearm or hand. In
addition, radiation of the pain may occur
in the shoulder, forearm, or hand.
Treatment:
1- Patient education and golf-swing (or the
relevant activity) modification
2- Nonsteroidal anti-inflammatory drugs
(NSAIDs)
3- Counterforce brace
4- Wrist splints
5 -Corticosteroid injections
Surgical treatment should be considered in
cases in which conservative treatment has
failed after 6-12 months and after all other
pathology has been excluded.
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