Abnormal Elbow
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Trauma
o Dislocation: major trauma
o Avulsion: traction
o Fracture falling- radial head fracture, olecranon
o Radial head Fx
o Excessive force: ligamentous instability- varus/valgus
o Complications: nerve irritation/ damage to ulnar nerve
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Pediatrics radial head OCD
o Osteonecrosis of capitulum/ radial head
o Spontaneous in nature or following excessive compressive force
o Self-limiting, often resolves without intervention
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UCL injury
o Acute valgus overload
o Hyperextension
o Chronic repetitive valgus
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Baseball pitching driving
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Driving tennis serve
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Javelin
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Posterior impingement
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Osteophyte formation
o Increased valgus displacement with loss of UCL function leads to increased
contact forces at olecranon due to decreased contact area
o Increased valgus angle 2-3 deg: decreases contact by 18.5%, increases pressure
12%
o Increased valgus by 7-8deg: decreases contact by 40%, increases pressure by
72%
Pediatrics “pulled” elbow
o Mechanism- sudden sharp traction force
o Radial head slips through annular ligament
o Pain may be at wrist instead of elbow due to malalignment
o “nursemaid’s elbow”
Repetitive force
o Tennis elbow- extensors (lateral epicondylitis)
o Golfers elbow- flexors
 Repeated loading in direction of flexors or extensors
 Strong extensor muscle contraction to resist flexion moment vice versa
 Related to technique
 Eccentric loading required for impulse
o Little league elbow: flexors traction injury to medial apophysis, technique related
to overuse
Intersection syndrome
o Junction of APL, EPL, ECRB, and ECRL
o Tendinitis from direct overlay of tissues and compression
Disease
o Not frequent in elbow: degenerative and inflammatory
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Forearm Fx
o Colles fracture- distal radius/ulna
o Radius carries up to 80% of axial loading
 FOOSH
Neural Radial N.
o Radial nerve: radio capitellar joint fibrous anomaly, RCJ inflammation, ECRB,
supinator
Disease
o OA/DJD
o RA
o Infection
o Joint destruction will lead to necessity for total joint arthroplasty