Elbow Flashcards
(21 cards)
In immature athletes, where is the proximal and distal attachment sites of the UCL?
proximal = extra-articular, unfused medial humeral apophysis
distal = tubercle of ulna
Through what arc of motion do the soft tissues of the elbow provide 1 degree of stability?
20-120 degrees (arc where throwing occurs)
What are the 8 common elbow injuries in the throwing athlete?
- UCL tears
- Ulnar neuritis
- Flexor-pronator strain / tear / tendonitis
- Medial epicondyle apophysitis or avulsion
- Olecronon osteophytes
- Olecronon stress fractures
- OCD of capitellum
- Loose bodies
At the medial elbow, what is placed on tensile stress with a valgus load?
UCL, flexor-pronator mass, medial epicondyle apophysis, and ulnar nerve
In the posterior compartment, what occurs with shear stress during a valgus load?
There will be impingement of the medial aspect of the olecranon and medial olecranon fossa/trochlea
In the lateral compartment, what is affected by compression stress during a valgus load?
The radial head and capitellum
What pathologies result from near-tensile failure loads during throwing due to tension (2), shear (2), and compression (1)?
Tension: microtrauma to anterior band of UCL>ligament attenuation + flexor-pronator mass tendonitis, ulnar neuritis, medial epicondyle apophysitis
Shear: olecranon tip osteophytes + “kissing lesion” (posteriomedial trochlea articular damage due to olecranon osteophyte)
Compression: loose bodies in radiocapitellar joint
What does the anterior bundle of the UCL resist?
valgus forces
What places tensile stresses on the anterior bundle of the UCL?
The acceleration phase of throwing
Where does medial laxity increase loads?
The lateral and posterior compartments
The most common lesions in baseball players leading to surgical intervention are what? (2)
olecranon osteophytes (shear) and loose bodies (compression)
How do you manage/treat OCD of the radiocapatellar joint?
With intact cartilage = immobilization, ROM, strengthening, and gradual return to throwing (no throwing for 6 months)
What are the indications for surgery at the elbow?
loose bodies/fragmentation or persistent pain after period of immobilization
What could a deficient UCL lead to in an adult? (3)
(1) osteochondral fractures
(2) loose body formation
(3) OA
What is Little League Elbow?
It is medial apophysitis secondary to repetitive valgus stress
What is Panner’s Disease?
Disease of the lateral elbow that affects the growth plate of capitellum in children under age of 11
What is OCD of the elbow?
Condition similar to Panner’s Disease, but occurs in adolescence/adults and doesn’t involve the growth plate and instead involves the articular cartilage and subchondral bone
Which pitches are recommended to use and which to avoid?
Good = fastball and change-up
Bad = curveball and slider
What is the “shear range”?
The ROM that causes pain while the elbow is being extended with valgus stress
When is surgery indicated or considered for UCL tears?
When there is (1) a complete tear of the anterior bundle of UCL (+ history, PE, and imaging studies) and desire to return to sport (2) partial thickness tears after 3 months of nonoperative treatments that’s unsuccessful
What are the 5 principles of Tommy John Rehabilitation?
1 Avoid motion loss
