the painful stiff elbow - lakeview private hospital · 2018-12-07 · the elbow changes the radius...
TRANSCRIPT
THE PAINFUL STIFF ELBOWDR MANISH GUPTA
SPECIALIST SURGEON
SHOULDER ELBOW WRIST
anatomy & function
the elbow changes the radius of the sphere of reach of the hand
need an arc of 30-130 degrees
flexion <120 exceeds positional adaptation of neck shoulder and wrist
prono-supination arc 100 degrees
highly congruent system of 3 joints within a single synovial cavity
close relationship of the joint to its ligaments and muscles
causes and classification of stiffness
intrinsicarticular malalignment/
incongruity
loss of articular cartilage
loose bodies
extrinsiccapsule/ ligaments
heterotopic ossification
mixed
primary
men, heavy exposure
early- end range impingement, late- pain through mid range
secondary
even trivial pathologies can lead to stiffness
5% of simple dislocations lead to functional stiffness
clinical assessmentpain at end range- osteophyte impingement
pain mid range- severe joint degeneration, or joint incongruence
pain with forearm rotation-radial head involvement
locking/ catching- loose bodies
ulnar nerve
shoulder
functional enquiry
lifting things at homecarrying shopping washing and hygienedressing
sleep disturbance
work & everyday activities
leisure and recreation
imaging
x-ray usually sufficientgrade 1: ulnotrochlear
involvementgrade2: ulnotrochlear
and radiocapitellar grade 3: radiocapitellar
subluxation
maturity of heterotopic ossification
CT scan
(nerve conduction testing/ EMG)
goals of treatment
increase range of motion
without increasing pain and
without creating instability
non surgical treatment
splints
serial casting
physiotherapy
effective for extrinsic
soft tissue
causes of stiffness
surgery?
non operative treatment failed or not indicated
soft tissue equilibrium
options
arthroscopy
open debridement/ release
interposition +- ligament reconstruction
total replacement arthroplasty
arthroscopysimple stiffness
mild/moderate loss of movement
minimal previous surgery
includes primary osteoarthritis, OCD, rheumatoid
open debridement
“column procedure”
open debridement
“medial over the top procedure”
interposition
dynamic external fixation+- ligament reconstruction
total elbow replacement
patient
younger active older low demand
simple stiffness complex stiffness
arthroscopy
joint congruent joint incongruent/ severe degeneration
total elbow replacement
column procedure interposition +- ligament reconstruction dynamic external fixation
column procedure
Dr Manish Guptashoulder elbow wrist specialist
tel: 9687 8344email: [email protected]
web: www.mgorthopaedics.com.au