elbow

Posterolateral Rotatory Instability

Definition

 

Radius rotates externally in relation to the ulna

- posterior displacement of the radial head relative to the capitellum

- in flexion

 

Posterolateral rotatory Instability

 

Anatomy LCL

 

LCL Elbow

 

MCL Insufficiency

AetiologyTommy John Surgery

 

Throwing injury

- seen in the throwing athlete

- repetitive microtrauma / valgus stress

- develop laxity

 

History

 

Initially

- lose velocity / accuracy

 

Develop medial pain

 

40% ulna nerve symptoms

 

Arthroplasty

Indications

 

RA 

- very good results

- 97% 10 year survival Coonrad-Morrey prosthesis

 

Other Dx 

- OA / post-traumatic arthritis / nonunion

- tend to have worse survival than RA

 

Haemophilia

- elbow joint commonly involved

- 90% of haemophiliacs

 

Acute unreconstructable fracture > 60

 

Myositis Ossificans

 

Elbow Myositis OssificansElbow Myositis Ossificans

 

DDx

 

Parosteal OS

- bone is not continuous with cortex in MO

 

Aetiology

 

3% incidence in elbow joint trauma to some degree

 

Osteoarthritis

Epidemiology

 

Relatively rare

 

Average age 50

 

Men 4:1 Women

 

Usually dominant arm

 

Aetiology

 

Primary

- associated with strenuous manual labour

 

Secondary

- trauma

- OCD

- synovial chondromatosis

- valgus extension overload / MCL insufficiency

 

Hemiplegia

Problems

 

1.  Lower limb

 

All walk

- Ankle > knee > hip

 

Ankle

- most require operations for ankles

 

LLD

- unilateral underdevelopment

- LLD 0-5cm (average 2cm)

 

2.  Lower limb

- one handedness

- decrease movement in swing

- astereogenesis

- usual upper limb contractures

 

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