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Elbow Problems

Trauma

Dislocation

What is an Elbow Dislocation?

An elbow dislocation occurs when the humerus, or arm bone, is dislodged from its notch in the ulna, a forearm bone.

What causes an Elbow Dislocation?

Elbow dislocations generally result from trauma such as falls or motor vehicle accidents. They can also be seen in contact sports, such as football and wrestling. Associated fractures and ligament tears are common.

What are the symptoms?

The patient will feel a 'pop', followed by immediate pain and loss of use of the arm. Numbness and tingling may be present in the hand. A visible elbow deformity is present in thin patients.

How is an Elbow dislocation diagnosed?

Dislocations are diagnosed clinically. X-rays are obtained to look for fractures which may have occurred at the time of the dislocation.

How is it treated?

The surgeon will put the elbow back into place using gentle pressure on the tip of the ulna. Associated fractures are then addressed. Ligament tears occurring as a result of the dislocation are usually treated non-operatively unless the elbow remains unstable after reduction.

Text supplied by www.arthrex.com and www.orthoillustrated.com

Download Dislocation document.

More info: http://orthoinfo.aaos.org/topic.cfm?topic=A00029

 

Distal Biceps Rupture

What is a Distal Biceps Rupture?

A distal biceps rupture occurs when the biceps tendon tears away from its attachment to the radius, a bone in the forearm. The biceps tendon is responsible for turning the palm face up and for flexing the elbow. Unlike the shoulder, there is only one attachment site for the biceps tendon in the forearm. Therefore, patients with Distal biceps ruptures will have significant loss of strength in rotation of the forearm and elbow flexion.

What causes a Distal Biceps Rupture?

Distal biceps ruptures generally result from heavy lifting, particularly with the elbows bent to around 90 degrees. Tendonitis, or inflammation of the portion of the muscle which attaches to the bone, may precede the rupture.

What are the symptoms?

Often, the patient feels a 'pop' in the elbow, followed by immediate pain and swelling. A bruise forms over the lower arm and elbow. There will be an immediate loss of strength. When the swelling subsides, a deformity will be present in the arm. Because the biceps muscle is under tension, it will retract up into the arm if its distal attachment ruptures. This causes the muscle to appear hollowed out in the lower part of arm, and balled up in the upper part.

How is a Distal Biceps Rupture diagnosed?

Distal biceps ruptures are diagnosed on clinical exam. Tenderness is present in the forearm where the tear occurred. The arm is swollen and painful, and a defect is seen in the lower portion of the muscle. X-rays are normal. MRI will confirm the tear.

How is it treated?

Non-operative

Because of the loss of strength, which is associated with these tears, non-operative treatment is recommended for only those patients who are unable to undergo surgery.

Operative

The surgeon will make an incision just below the crease in the elbow and locate the end of the torn tendon. He will then trim this to fresh, healthy tissue and suture the tip. The attachment site is exposed, and a socket created in the bone. The tendon is inserted into the socket and is held in place using a screw, button or both.

Text supplied by www.arthrex.com and www.orthoillustrated.com

Download Distal Biceps Rupture document.

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More info: http://orthoinfo.aaos.org/topic.cfm?topic=A00376

 

Radial head fracture

What is a Radial Head fracture?

A radial head fracture is a break in the portion of the radius that forms part of the elbow joint. The radial head meets the lateral end of the humerus, called the capitellum. Rotation of the forearm occurs mainly at the radiocapitellar joint.

What causes a Radial Head Fracture?

A fall onto an outstretched hand is the most common cause. Force is transmitted from the ground, through the wrist and forearm and the radial head is impacted on the capitellum causing the fracture. Dislocations or direct blows to the outside of the elbow may also cause fractures of the radial head.

What are the symptoms?

Patients will complain of pain and swelling in the elbow. They will be unable to straighten or fully flex the elbow. Rotation of the forearm will cause substantial pain. A click may be felt with rotation.

How is a Radial Head Fracture diagnosed?

The surgeon will perform a physical exam of the elbow. Swelling inside the elbow joint, combined with a history of trauma, is highly suspicious for a fracture. A palpable click, or pain with palpation of the radial head is another indication of fracture. X-rays will confirm the diagnosis. A CT scan might be obtained to evaluate displacement of the fracture, or for pre-operative planning.

How is it treated?

Non-operative

Non-displaced fractures of the radial head can be treated non-operatively. The patient is immobilized in a sling or splint for approximately ten days. The splint is discontinued and physical therapy is begun. Periodic x-rays are obtained to evaluate displacement of the fracture. Because the adult elbow quickly becomes stiff as a result of inflammation, early physical therapy for range of motion is the key to preventing permanent motion loss.

Operative

Fractures of the radial head, which are displaced more than two millimeters, require operative stabilization. This is performed through an open incision. Screws are placed across the fracture sight, and early therapy is prescribed to prevent motion loss. In cases where the radial head fracture cannot be repaired, it is removed. A radial head replacement may be required if there is a ligamentous injury to the medial elbow or wrist, or if the patient cannot tolerate loss of the radial head fragment.

Text supplied by www.arthrex.com and www.orthoillustrated.com

Download Radial head fracture document.

More info: http://orthoinfo.aaos.org/topic.cfm?topic=A00073