Elbow Pain

1. Elbow Pain
By: Dr. Noshirwan P. Gazder

2. • Elbow joint is a
hinge type of
synovial joint
• It is a compound
joint as its
formed by three
bones.

3. • Upper: Capitulum & Trochlea
of humerus.
• Lower: Upper surface of head
of radius articulates with
capitulum of Humerus.
Trochlear notch of ulna
articulates with trochlea of
humerus.
Articulation of Elbow Joint

4. Function of Elbow
Joint
• Flexion/Extension:
Humeroulnar joint and
Humeroradial joint.
• Supination/Pronation:
Radioulnar joint.

5. Muscles moving elbow
joint
• The chief flexors of elbow
joint are the
Brachialis,Bicep Brachii and
Brachioradialis.
• The chief extensor of elbow
joint is the Triceps Brachii,
especially the medial head.

6. Ligaments of Elbow Joint
• Ulnar collateral ligament.
• Radial collateral ligament.
• Annular ligament.

7. Nerve Supply of Elbow Joint
The elbow joint is
supplied by the:
• Musculocutaneous
• Radial
• Ulnar nerves.

8. Olecranon Bursitis
• Olecranon bursitis occurs when the fluid-filled sac, or bursa, at the tip
of the elbow becomes inflamed.
Can be due to septic or aseptic causes:
• Septic: Insect bites, Cuts/Abrasions, Hematogenous spread.
• Aseptic: Trauma(a hard blow to the tip of the elbow can cause the
bursa to produce excess fluid and swell), Prolonged pressure, Gout.

10. • Signs & Symptoms: Pain,Swelling. Erythema/FebrileSeptic
• Treatment: Cold compressions
Aspirate
• If serous/bloodyInject 40mg steroid +compressive
dressing+elbow extension x 3 days
• If pusRequires I&D
• Recurrent aseptic bursitisSurgery

11. Tennis Elbow
• Also known as Lateral Epicondylitis.
• It’s a condition in which there is inflammation of the tendons of the
outer part of the elbow caused by overuse of the muscles of the
forearm, causing the elbow to become painful and tender.
• Tendon usually involved is the Extensor Carpi Radialis Brevis.
• Histological findings include granulation tissue, microrupture,
degenerative changes, and there is traditionally no inflammation.

12. • Signs and Symptoms: Pain on the outer part of the elbow, Point
tenderness over the lateral epicondyle, Pain from gripping and
movements of the wrist, especially wrist extension.
• Examination: The patient is asked to fully extended the elbow, the
patient feels points of tenderness over the affected point on the
elbow. There is also pain with passive wrist flexion and resistive
wrist extension (Cozen's test).

13. Treatment
• Acute (<4wks)
• Rest.
• NSAIDS.
• Massage.
• Counterforce Bracing.
• Physiotherapy.
• Hand grasping while in supination.
• Avoid pronation movements.

14. • Chronic (>4wks)
• Steroid injection
• 40mg kenalogue +1/2 cc lidocaine.
• If there is a severe case of tennis elbow that doesn't respond
to two to four months of conservative treatment,surgery is
indicated. In the procedure, the damaged section of tendon
usually is removed and the remaining tendon repaired.
Surgery works in about 85%-90% of cases.

15. Golfers Elbow
• Also known as Medial epicondylitis, a condition in which there
is tendinosis of the medial epicondyle on the inside of the elbow.
• Pain is normally caused due to stress on the tendon as a result of the
large amount of grip exerted by the digits and torsion of the wrist
which is caused by the use and action of the cluster of muscles on the
condyle of the ulna.

16. • Examination: Tenderness at medial epicondyle, worse with wrist
flexion or forearm pronation, weak grip.
• Treatment: Conservative management includes
NSAIDS,Massage,Counterforce Brace,Steroid Injection
• If conservative management fails then epicondylar
debridement maybe effective.

17. Cubital Tunnel Syndrome
• Ulnar nerve compression through the cubital fossa.
• Signs & Symptoms: Symptoms occur in a specific anatomic
distribution, affecting the little finger, the ulnar half of the ring finger,
as well as the intrinsic muscles of the hand.
• Froment's sign: Physical examination of the hand to test for palsy of
the ulnar nerve which results in reduced functionality and
muscle weakness of the pinch grip. It tests the strength of the
adductor pollicus of the thumb, which is innervated by the ulnar
nerve and is weakened in ulnar nerve palsy.

18. Treatment
• Mild to Moderate: Night splinting(Avoids elbow hyperflexion),
NSAIDS,Steroid Injection, lifestyle modifications.
• Surgery is recommended for those who are not improved with
conservative therapy or those with serious or progressive
symptoms(such as persistent pain or atrophy)

19. Dislocation of Elbow
• An elbow dislocation occurs when the bones of the forearm (the
radius and ulna) move out of place compared with the bone of the
arm (the humerus).
• Majority dislocations are posterior/posterolateral (90-95%)
• Sign & Symptoms: Ulna and/or radius displaced posteriorly, with
olecranon process sitting posteriorly, swelling, bleeding,extreme pain.

21. Classification
• Simple
• No fracturepurely ligamentous
• Complex
• Associated with fracture
• Radial Headmost common

22. Management
• Immobilize in position you find it.
• Send the patient to the ER.
• Radiographs.

23. Simple Dislocation
Treatment:
• Closed Reduction.
• Long arm splint/cast x 2 weeks.
• Reduction Manouvre:
• Gentle traction,Anterior directed force
on olecranon and Gradual flexion

24. Complex Dislocation
• Splint in situNo reduction
• Refer to an Orthopedic for surgery.

25. Thank You