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Elbow Disorders


Elbow Dislocations

  • Usually posterior
  • Neuropraxia in 20% (ulnar & median nerves - usually AIN)
  • Usually stable once reduced, since bony stability is good.
  • If instability occurs in 30 deg of flexion, then place forearm in maximum pronation (which tensions lateral soft tissues crossing the elbow).
  • Main problem is stiffness, thus go for early ROM
  • Complex injury = with associated fractures:
    1. Radial head fracture causing instability then replace radial head (silastic or titanium implant)
    2. MCL is always damaged to variable degrees. May be fracture of Medial epicondyle = ORIF
    3. Coronoid fractures:
      • due to avulsion by brachialis when elbow is hyperextened
      • Type I: avulsion of the tip of the coronoid process  - closed reduction and early motion
      • Type II: involving less than 50% of the process - closed reduction and early motion
      • Type III: involving > 50% of process - = high redislocation rate & requires ORIF - there may be an associated valgus instability since MCL inserts onto the fracture fragment. 
    4. Terrible Triad = radial head + coronoid + MCL 


Radial Head Dislocation


  • Posterior
  • Often have little functional deficit
  • Capitellum is dysplastic
  • Therefore relocation is not successful
  • Develop OA of ulnohumeral joint in adulthood


  • Reduce
  • Look very carefully for Monteggia fracture of ulna
  • If unstable - reconstruct annular ligament (may need triceps sling)


  1. Trauma
  2. Arthritis
  3. Miscellaneous - infection, burns, haemophilia
  4. Arthrogryposis


= tendinosis of the lateral epicondyle


  • Pain over lat epicondyle exacerbated by gripping and forearm rotation
  • Tenderness
  • Pain reproduction on resisted wrist dorsiflexion (Mills' Test)
  • middle finger test = pain on resisted extension of MCPJ of middle finger (because ECRB inserts into the base of the 3rd MC) 


  1. Trauma:
    • usually in throwing athletes & can follow direct trauma
  2. Constitutional factors:
    • Same patients develop other tendonoses - e.g. impingement syndrome of the shoulder, carpal tunnel syndrome, deQuervain's tenosynovitis, trigger finger, Achilles tendinitis.
    • = 'Mesenchymal syndrome'

PathologyAnatomy of Extensors - from McGrouther, Primal Pictures CD

  • Degenerative changes in the origin of ECRB 
  • Hyaline degeneration, fibroblasts & vascular granulation tissue - 'angiofibroblastic tendonosis'


Always Non-operative initially, since most settle down:

= rest; activity modification; NSAIDs; physiotherapy; clasp; steroid injections.

Surgery is reserved for those that fail to respond to the above.


  1. Extensor origin release
  2. Release of portion of the annular ligament
  3. ECRB lengthening in the distal forearm [Picture] [Powerpoint Presentation]
  4. Localised denervation of the lateral epicondyle
  5. PIN decompression

Results of surgery = 85% complete relief, 5% no benefit & 10% some improvement

No one form is significantly better than the others.

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Adult elbow injuries
Elbow Anatomy & Biomechanics
Elbow Disorders
Elbow injuries in Children - introd...
Elbow injuries in Children - other
Supracondylar Fractures in Children...
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