摘要:

The elbow joint is a complex structure that provides an important function as the mechanical link in the upper extremity between the hand, wrist and the shoulder. The elbow's functions include positioning the hand in space for fine movements, powerful grasping and serving as a fulcrum for the forearm. Loss of elbow function can severely affect activities of daily living. It is important to recognize the unique anatomy of the elbow, including the bony geometry, articulation, and soft tissue structures. The biomechanics of the elbow joint can be divided into kinematics, stabilizing structures in elbow stability, and force transmission through the elbow joint. The passive and active stabilizers provide biomechanical stability in the elbow joint. The passive stabilizers include the bony articular geometry and the soft tissue stabilizers. The active stabilizers are the muscles that provide joint compressive forces and function. Knowledge of both the anatomy and biomechanics is essential for proper treatment of elbow disorders.

ISSN:1062-8592    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Elbow pain is a common problem in throwing athletes. Because of its unique anatomy, the elbow joint is especially vulnerable to the repeated stresses placed on the upper extremity by the throwing motion. Injuries can be acute or chronic, such as those caused by stress overload or repetitive motion, and may involve osseous or soft-tissue structures or both. Although they have received less attention than lower extremity athletic injuries, elbow injuries can be just as debilitating to athletes involved in sports that require overhead motions, such as baseball players, racquet-sport players, swimmers, and gymnasts. Inadequate treatment can cause permanent disability. The first step in early and appropriate treatment of elbow pain in athletes is establishing the correct diagnosis.

ISSN:1062-8592    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

The ulnar collateral ligament (UCL) is commonly injured in sports that require an overhead motion, such as throwing a ball. This imparts a valgus stress upon the elbow, which is resisted by the UCL. However, repeated or excessive stress to the ligament may result in injury to the ligament. Injury to the UCL may result in secondary injury to other areas of the elbow, including the ulnar nerve, the flexor–pronator musculotendinous unit, the radiocapitellar joint, and the posterior compartment of the elbow, in addition to being the cause of loose bodies within the elbow. This manuscript briefly reviews the anatomy, biomechanics, and pathophysiology of injury to the UCL and injuries to the other structures that are a direct result of UCL injury. Further, this paper discusses the patient's history, examination techniques, and tests that help confirm the diagnosis of UCL injury. Lastly, it discusses the treatment of UCL injury.

ISSN:1062-8592    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Tremendous forces regulated by the elbow during throwing challenge the olecranon putting it at risk for valgus extension overload injuries and olecranon stress fractures. The pathomechanics for these two injuries are similar and include repetitive abutment of the olecranon into the olecranon fossa combined with valgus torques resulting in impaction and shear along the posteromedial olecranon. When the bone and cartilage is overwhelmed, either posteromedial osteophytes and loose bodies develop, or stress fracture occurs. Identifying the location of pain and timing during the pitching phase helps differentiate the 2 injuries. In each disorder, physical examination may demonstrate motion loss, crepitus, and tenderness at the posteromedial olecranon. In valgus extension overload, posteromedial osteophytes and loose bodies within the articulation may be identified on radiographs, computed tomography, or MRI. For stress fractures, radiographs typically show a fracture line with sclerosis, although a bone scan or MRI may be necessary in questionable cases. For valgus extension overload, if initial nonoperative treatment fails, arthroscopic debridement or limited incision arthrotomy to decompress the posterior compartment is indicated. The status of the medial collateral ligament must be accurately assessed and managed because medial collateral ligament insufficiency is often a factor in the development of valgus extension overload. Stress fractures that fail conservative management may be treated with internal fixation and if indicated, bone grafting.

ISSN:1062-8592    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Elbow injuries in the young throwing athlete are common and encompass a wide variety of pathologic problems from acute traumatic failure to repetitive overuse. The unique features of the still developing bony anatomy of the young throwers' elbow result in distinct injury patterns often involving the physis or apophysis. Medial elbow injuries such as medial epicondylar apophysitis, medial epicondyle avulsion and ulnar collateral ligament tear result from excessive tensile forces. Lateral elbow injuries such as Panner's disease and osteochondritis dissecans are the result of compressive forces. When evaluating the young thrower's elbow a specific diagnosis should be made based on the mechanism of injury, clinical symptoms, physical examination, and appropriate imaging studies. The term Little Leaguer's Elbow is a wastebasket term that, in light of improved understanding of those conditions affecting the young thrower's elbow, should be avoided in favor of a specific diagnosis.

ISSN:1062-8592    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Forces generated during the overhead throwing motion make the medial side of the elbow susceptible to tensile injury. Medial elbow pain and neurologic symptoms may represent isolated injury to the ulnar nerve, but more often represent a secondary condition caused by an underlying abnormality, especially valgus instability. A thorough understanding of ulnar nerve anatomy, throwing biomechanics, and clinical acumen are necessary to appropriately care for the overhead athlete with elbow pain. Nonoperative measures may allow the patient to return to throwing but persistent ulnar nerve symptoms often require surgical release. Surgical treatment options for ulnar neuritis include neurolysis, medial epicondylectomy, or anterior transposition (submuscular, intramuscular, or subcutaneous). Anterior subcutaneous transposition stabilized with a fascial sling provides nerve decompression and decreased ulnar nerve tensile forces in the throwing athlete with minimal surgical morbidity. However, the surgeon must adequately diagnose and treat any associated problems (valgus instability) to allow pain-free return to competition.

ISSN:1062-8592    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Injuries to the biceps and triceps tendons around the elbow are rare. They typically follow a history of trauma involving forceful eccentric contraction of the muscle and predictably result in weakness and pain. Biceps tendon rupture is considered the most common acute tendinous injury around the elbow and occurs almost exclusively in men in the fifth and sixth decades of life. Comparatively, triceps tendon ruptures are much less frequent and occur in both men and women of varying ages. Conservative management of both of these injuries is restricted to some partial tears and to patients unfit for surgery. Nonoperative management of complete ruptures results in predictably poor results. Therefore, acute anatomic repair of these injuries is considered optimal. Delayed repair has been described using various grafts for augmentation with results that are good, but less predictable.

ISSN:1062-8592    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Medial epicondylitis of the elbow involves pathologic alteration in the musculotendinous origins at the medial epicondyle. Although commonly referred to as “golfer's elbow”, the condition may in fact be caused by a variety of sports and occupational activities. Accurate diagnosis requires a thorough understanding of the anatomic, epidemiologic, and pathophysiologic factors. Nonoperative treatment involves rest, ice, nonsteroidal anti-inflammatory agents, and possibly corticosteroid injection followed by guided rehabilitation and return to sport. Operative treatment is indicated for debilitating pain after exclusion of other pathologic causes that persists in spite of a well-managed nonoperative regimen spanning a minimum of 6 months. The surgical technique involves excision of the pathologic portion of the tendon, repair of the resulting defect, and reattachment of the origin of the flexor pronator muscle group to the medial epicondyle. Surgical treatment results in a high degree of subjective relief, although objective strength deficits may persist.

ISSN:1062-8592    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Lateral epicondylitis is a diagnostic term that describes a pattern of pain and localized tenderness at the lateral epicondyle of the distal humerus. The disorder was originally termedtennis elbowin 1883. This term remains in use despite the fact that most affected people are not tennis players. The incidence of lateral epicondylitis is equal among men and women. The average peak age distribution is 42 years (range, 30–50 years). Acute onset of symptoms is much more common in young athletes, and the chronic, recalcitrant pattern most often occurs in older people.This paper discusses the pathology, clinical presentation, and treatment of lateral epicondylitis. A brief description of nonoperative treatment is followed by an in-depth discussion of operative techniques for treating this disorder and a concise report on postoperative care, results, and failures.

ISSN:1062-8592    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Posterolateral rotatory instability of the elbow is a recently described condition resulting from insufficiency of both the static lateral collateral ligament complex and the dynamic supporting muscular structures of the elbow. The lateral ulnar collateral ligament is the essential component of the lateral collateral ligament complex, linking the humerus and ulna and acting as the principle static restraint preventing external rotation of the ulna on the humerus, thus preventing posterolateral elbow instability. Ligament insufficiency permits the proximal ulna and the radial head to externally rotate posterior when the forearm is positioned in supination and slight flexion. Recent studies have characterized this condition as posterolateral instability of the elbow, and have portrayed the continuum that exists between posterior lateral rotatory instability and elbow dislocation. For patients whose instability symptoms persist despite conservative measures, repair or reconstruction of the lateral ligament complex may provide significant relief and functional improvement.

ISSN:1062-8592    

出版商:OVID    

年代:2003

数据来源: OVID