The Injured ElbowDavid Moss, MD

Washington Orthopaedics & Sports Medicine, PA

overview

• Anatomy

• Fractures

• Olecranon

• Radial head

• Tenodonopathies

• Lateral epicondylitis

• Medial epicondylitis

• Biceps tear/rupture

• Nerve compression

• Cubital tunnel

anatomy

Elbow fractures

Olecranon fracture

• Usually result from eccentric muscle contracture

after a fall onto outstretched hand, or direct trauma

• Results in loss of active elbow extension

• Best treated with surgery

• Outpatient

• Takes about 1 ½ hours

Radial head fractures

• Usually result from a fall

onto outstretched hand

• Painful elbow

• Can cause loss of forearm

rotation

• Turning door handles

• Turning keys

• Screwdriver

treatment

Splint &/or sling

surgery

tendonopathies

“Tennis elbow”

• Lateral epicondylitis

• Pain on the “outside”

of the elbow

• Inflammation and

microtears of

common extensor

tendon origin

• Rarely a result of

playing tennis!

Signs & symptoms

• Elbow pain with gripping

• Shaking hands

• Lifting heavy objects

• Turning door handles

• Brushing teeth

Physical exam

• Tender at lateral elbow

• Pain with resisted wrist

extension

• Pain with resisted

supination

treatment

• Anti-inflammatory medication

• Wrist splint

• Forearm strap

• Physical therapy

Cortisone injection

• Immediate pain relief

• Lasts 2-3 months

• Does not “cure” the

underlying problem

PRP

• Platelet-rich plasma

• Uses your own blood

• New technology

• Safe

• Unproven long-term

track record

surgery• For recalcitrant pain

• Good track record

• “In & out” surgery

• Open

• Arthroscopic

• Takes about an hour

“golfer’s elbow”

• Medial epicondylitis

• Pain on the “inside” of the

elbow

• Inflammation and

microtears of common

flexor tendon origin

• Rarely a result of playing

golf!

Treatment

• Similar to treatment of

lateral epicondylitis

• NSAIDs

• Splints & straps

• Physical therapy

• Cortisone injection

• PRP

• Surgery

Biceps rupture

• Usually men >40 years old

• Chronic tendon breakdown weakens tendon fibers

• Heavy lifting “pop”

• Lifting furniture

• Water skiing

Presentation & exam

• Deformity anterior elbow

• Bruising

• Swelling

• Hook test

• Weakness in supination

• Screw driver, keys, etc.

• NOT elbow flexion

weakness!

treatment• Observation

• Results in loss of

supination and flexion

strength

• Surgical repair for active

• “In & out” surgery

• Takes about an hour

• Multiple fixation techniques

Cubital tunnel syndromeCompression of the ulnar nerve at the elbow

presentation

• Numb/pain small finger and

ring finger

• Hand/grip weakness

• Numb worsens with elbow

flexion

• Holding the phone to ear

• Driving

• Claw hand

• Muscle wasting

Treatment

• Elbow extension splint

• EMG

• Surgical release

Thank youDavid Moss, MD

Washington Orthopaedics & Sports Medicine, PA

-Sibley Medical Office Building

-The Barlow Building, Chevy Chase

-2021 K Street, NW