LESSON 1: SHOULDER AND ELBOW

COMPLEX
REVIEW OF SHOULDER AND ELBOW
ANATOMY

Bones Humerus
Clavicle
Scapula
Sternum

Joints Glenohumeral Jt.

Acromioclavicular Jt.
Sternoclavicular Jt.

Ligaments GH Joint:
Coracohumeral
Glenohumeral

AC Joint:
Coracoacromial
Sup. acromioclavicular
Coracoclavicular
[Trapezoid and
Conoid] Static and Dynamic Stabilizers of the Scapula
and Glenohumeral Joint
Scapula
Weight of upper extremity creates downward
rotation and protraction moment on the
scapula

Static Stabilizers - Cohesive forces

of subscapular
bursa, SC and AC
joint ligaments
- Scapulothoracic
fascia

Muscular Scapulothoracic
Stabilizers musculature, especially
upper, middle, and lower
trapezius, serratus
anterior, levator scapula,
and rhomboids

Glenohumeral Joint
In dependent position:
if scapula is in normal alignment, weight of arm
creates an inferior translation moment on the
humerus

Static Stabilizers - Superior capsule,

superior GH
ligament, and
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 coracohumeral Fossa at the Elbow Cubital Fossa
ligament are taut
- Adhesive and
cohesive forces of GLENOHUMERAL ARTHROPLASTY
synovial fluid and The most common surgical procedure used to
negative joint treat advanced shoulder joint pathology.
pressure hold
surfaces together Pathologies causing advanced joint
- Slight upward destruction:
inclination of ● Late-stage osteoarthritis (OA)
glenoid and ● Rheumatoid arthritis (RA)
labrum deepens ● Traumatic arthritis
fossa and ● Cuff tear arthropathy
improves ● Osteonecrosis (avascular necrosis) of the
congruency; acts head of the humerus
as inferior barrier ○ result of a fracture of the
anatomical neck of the humerus
Muscular Rotator cuff, deltoid, long
○ long-term use of steroids for
Stabilizers head of biceps brachii,
systemic disease
pectoralis major,
latissimus dorsi, and
Goals of surgery and post-op rehab:
teres major
● Relieve pain
● Improve shoulder mobility or stability
Glenohumeral Joint: ● Restore or improve strength and function
When the humerus is elevating and the use of the UE
scapula is rotating upward
Factors that can affect goals:
Static Stabilizers - Tension placed on ● Participation in rehab
static restraints by ● Distinguishing features and severity of
the rotator cuff pathology
- Glenohumeral ● The prosthetic design and surgical
ligaments limit techniques
excessive ● Integrity of the rotator cuff mechanism
translations of and other soft tissue
humeral head ● Age
● Overall health
Muscular - Rotator cuff and ● Anticipated activity level of the patient
Stabilizers deltoid; elbow
action brings in INDICATIONS FOR SURGERY
two-joint muscle
Primary Indications Persistent and
support
incapacitating pain (at
- Long head of
rest or with activity)
biceps stabilizes
secondary to GH joint
against humeral
destruction
elevation
Secondary Loss of shoulder
REVIEW OF ELBOW COMPLEX Indications mobility or stability
and/or loss of upper
Joint Type Hinge Joint extremity strength
with an inability to
Articulations Humeroulnar
perform functional
Humeroradial
tasks
Radioulnar

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CATEGORIES:
1. Total Shoulder Arthroplasty (TSA)
a. Both glenoid and humeral surfaces
are replaced
2. Hemireplacement arthroplasty
(hemiarthroplasty)
a. Only the humeral head is replaced
3. Reverse total shoulder arthroplasty
(rTSA)
a. used when rotator cuff integrity is
compromised
4. Interpositional and resurfacing
arthroplasties
a. Less extensive bone removal
TOTAL SHOULDER ARTHROPLASTY (TSA)
- Late-stage primary OA
- GH joint exhibits loss or thinning of
the articular cartilage of the head
of the humerus and the posterior
portion of the glenoid fossa.
Rotator cuff is intact in
approximately 90-95% of these
patients.
Current-day TSA hardware
a. Glenoid Component
i. Composed of a high density
polyethylene (usually all plastic)
b. Humeral Component
i. Modular inert metal
The designs of total shoulder replacements,
ranging from unconstrained, semiconstrained and
constrained.
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PARTIAL SHOULDER ARTHROPLASTY /
HEMIARTHROPLASTY
- Late-stage primary OA
- GH joint exhibits loss or thinning of
the articular cartilage of the head
of the humerus and the posterior
portion of the glenoid fossa.
Rotator cuff is intact in
approximately 90-95% of these
patients.
- Indicated when there is sufficient bone
stock for fixation of a glenoid implant
- Used when the articular surface
and underlying bone of the
humeral head have deteriorated,
but the glenoid fossa is reasonably
intact
- Example: osteonecrosis of
the head of the humerus
REVERSE TOTAL SHOULDER
ARTHROPLASTY (rTSA)
- Used when there is severe, chronic pain
and loss of function as the result of a
massive, irreparable cuff tear and
subsequent development of a cuff tear
arthropathy
- refers to deterioration and eventual
collapse of the head of the
humerus,
- debilitating long-term result of a
primary, massive, and irreparable
tear of the rotator cuff
 - Chronic deficiency of the rotator
Postoperative mechanical
cuff mechanism - superior
Complications (aseptic)
migration of the head of the
loosening,
humerus in the fossa
premature wear,
- rTSA was developed to
or fracture of the
overcome this complication
polyethylene
by eliminating translation
glenoid implant
between the glenosphere
- Most often seen
and humeral articular
in a rotator
surface
cuff-deficient
shoulder
Benefits of rTSA Limitations of rTSA - Due to excessive
- Reduces - Decrease in stresses at the
forces on the GH ROM bone-prosthesis
glenoid interface
component - Low incidence
- Inherent with
stability unconstrained
designs but
COMPLICATIONS SPECIFIC TO GH higher with
ARTHROPLASTY early-generation
Intraoperative - Insufficient constrained
Complications lengthening of a designs
tight - Loosening of the
subscapularis humeral
- Intraoperative prosthesis after
damage to the hemiarthroplasty
axillary or
suprascapular
nerves SHOULDER INSTABILITIES
- Fx of humerus SHOULDER DISLOCATIONS
Anterior Dislocation
Soft - Re-tearing a - most frequently occurs
Tissue-Related repaired rotator - Posteriorly directed force to the ar,
Postoperative cuff mechanism - Position: Elevation, ER and Horizontal
Complications - Postoperative Abduction
disruption of the - In this position, stability is
repaired provided by the:
subscapularis - Subscapularis
- Chronic instability - GH ligaments (ant band of
or dislocation of inferior ligament), Long
the GH joint head of the biceps
- Incidence of - A significant force to the arm may
dislocation is damage these structures, along
higher after rTSA with the attachment of the anterior
than TSA capsule and glenoid labrum
- Progressive - 2° to ligament laxity
erosion of the - Incompetent structures
articular surface - Muscle imbalance
of the glenoid
fossa (after
hemiarthroplasty)

Implant-Related - After TSA

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Types of Lesions
1. Bankart
a. Anterior dislocation; avulsion
fracture or tear of the anterior
labrum
i. Example: late cocking
phase, backstroke

2. Hill Sach
a. Anterior dislocation; compression
fracture of the posterolateral
humeral head
i. Example: late cocking
phase, baseball

3. Bennett
a. Posterior dislocation; tear of the
posterior labrum
b. MOI: FADIR, FOOSH and
deceleration in baseball

Posterior Dislocation
- Less common
- MOI is usually a force applied to the arm
when the humerus is positioned in flexion,
adduction and IR (FADIR)
- Example: FOOSH
- Injured person complains of symptoms
4. SLAP
when doing activities such as push-ups,
a. Traction injury of superior labrum
bench press or a follow-through on a golf
b. MOI: FABER → relocate FADIR
swing
(Kocher’s position)
- 2° to ligament laxity; neuromuscular (CVA)
c. MC damaged nerve: Axillary Nerve
- Special Tests: Sulcus/Distraction Test and
Feagin Test

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Common Activity Limitations and Participation
Restrictions
Anterior restricted ability in sports
Dislocation activities such as throwing,
swimming, overhead serving
and spiking

DRESSING: Putting on a
shirt/jacket
SELF-GROOM: Combing the Related pathologies and MOI:
back of hair - Cause of rotator cuff disease is often
SLEEP: Pain on involved side multifactorial, involving both structural
and mechanical factors
Posterior Restricted ability in sports - Classification:
Dislocation activities, such as a. Intrinsic - Rotator cuff disease
follow-through in pitching b. Extrinsic - Mechanical
and golf Compression of Tissues
i. Primary (anatomical or
Restricted ability in pushing biomechanical factors)
activities, such as pushing ii. Secondary (mechanical
open a heavy door or compression of the
pushing one’s self up from a suprahumeral tissues)
chair iii. Internal (elevation,
horizontal abduction, and
SLAP (SUP. LABRUM ANT & POST) maximum external rotation,
- The top (superior) part of the labrum is primarily in throwing
injured athletes)
- MOI: Fall on lateral aspect of shoulder - Symptoms from cuff tendinopathy -
(FOOSH) excessive or repetitive overhead activities
- Special Tests: Nerve Compression of Primary 1. Anatomical
O’Brien a. structural
variations in the
Grading of SLAP acromion or
humeral head,
I Fraying of Labrum hypertrophic
degenerative
II Avulsion of Labrum (MC) changes of the AC
joint, or other
III Bucket handle tear of sup. labrum
trophic changes in
IV III + extends to biceps tendon the
coracoacromial
V Bankart lesion extending to biceps arch or humeral
tendon head
2. Biomechanical
VI Unstable tear of labrum a. altered orientation
of the clavicle or
VII Tear extends to GH Lig. (middle) scapula during
movement
ROTATOR CUFF REPAIRS
I. Impingement Syndrome Secondary due to hypermobility or instability
- Mechanical compression and irritation of of the GH joint and increased
soft tissues in the superior humeral space translation of the humeral head.
- MC cause of shoulder pain This instability may be

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multidirectional or unidirectional
and can occur with
compromised static restraints
(GH ligaments) or with dynamic
Rotator Cuff Tear Categories:
rotator cuff insufficiency (force
imbalances or fatigue).
Internal This position and a
posterior-superior shift of the
humeral head on the glenoid
results in a mechanical
entrapment of the posterior
supraspinatus tendon between
the humeral head and the
labrum. Internal impingement is
associated with a combination of
posterior GH capsule tightness
and scapula kinematic
alterations.
Classifications of the acromion by shape:
A. Type 1 - Flat
B. Type 2 - Curved
C. Type 3 - Hooked
**Rotator cuff pathology is often associated with
types II and III—but not type I—acromial shapes
Common Impairments:
Based on Degree or Stage of Pathology of
the Rotator Cuff (Neer’s Classification of
Rotator Cuff Disease)
Stage I Edema, hemorrhage (patient
usually <25 years of age)
Stage II Tendonitis/bursitis and fibrosis
(patient usually 25 to 40 years of
age)
Stage III Bone spurs and tendon rupture
(patient usually >40 years of age)
II. Intrinsic Impingement: Rotator Cuff Disease
Intrinsic factors compromising structural integrity
of muscles:
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- Vascular changes in rotator cuff tendons
- Tissue tension overload
- Collagen disorientation and degeneration
1. Partial-thickness tears
a. extends inferiorly or superiorly
through only a portion of the
tendon from either the acromial
(bursal) or humeral (articular)
surface of the tendon
2. Full-thickness tears
a. a complete tear, extending
between the superior and inferior
surfaces of the tendon
Impingement Syndromes:
Definition of Terms
Tendinosis Degeneration of tendon;
happens between tendon
and bone
Tendonitis Inflammation with microtear
of tendon (ex. Supraspinatus
Tear)
Tenosynovitis Inflammation of tendon
sheath (covering of
tendon-sheath)
Tenovaginitis Thickening of tendon (trigger
finger)
➔ Pain at the musculotendinous junction of
the involved muscle
➔ Positive impingement sign and painful arc
➔ Impaired posture
➔ Muscle imbalances
➔ Hypomobile posterior GH joint capsule
➔ Hypomobile cervical and/or thoracic spine
mobility
➔ Faulty kinematics during humeral
elevation
➔ With a complete rotator cuff tear, inability
to abduct the humerus against gravity
➔ When acute, pain referred to the C5 and
C6 reference zones
Common Activity Limitations and Participation - Associated with active inflammatory
Restriction processes and may be localized to one or
➔ In the acute stages, pain may interfere more specific tissues
with sleep, particularly when rolling onto
the involved shoulder.
Supraspinatus - Lesion is near the
➔ Pain with overhead reaching, pushing, or
Tendonitis musculotendinous
pulling.
junction, resulting in
➔ Difficulty lifting heavy loads.
pain in overhead
➔ Inability to sustain repetitive shoulder
reaching
activities (such as reaching, lifting,
- Overuse syndrome
throwing, pushing, pulling, or swinging the
2° to repetitive
arm).
injury- resulting in a
➔ Difficulty with dressing, particularly
painful arc with
putting a shirt on over the head.
overhead reaching
- Swimmer’s
Indications for Surgery
shoulder; rotator
➔ Partial-thickness or full-thickness tears of
cuff tendinitis
the rotator cuff tendons with irreversible,
- MOI: FADIR;
degenerative changes in soft tissues.
freestyle or butterfly
➔ Acute, traumatic rupture of the rotator cuff
tendons that may be combined with Bicipital - Lesion involves
avulsion of the greater tuberosity, labral Tendonitis long tendon in the
damage, or acute dislocation of the GH bicipital groove
joint in individuals with no known history beneath or just
of prior cuff injury distal to the
transverse ligament
Procedures: Type of Repair - •lesion involves the
The type of cuff repair is typically classified by long tendon in the
the surgical approach and techniques used. bicipital groove
There are three categories of repair: beneath or just
a. Arthroscopic Approach distal to the
i. performed arthroscopically and transverse humeral
requires only a few small skin ligament
incisions for inserting surgical - MOI: Shoveling
instruments - Special Test:
Speeds, Yergason
b. Mini-open (arthroscopically assisted)
approach Bursitis When acute, the symptoms
i. There are two variations of this (subdeltoid or of bursitis are the same as
type of procedure, both of which subacromial) those seen with
involve arthroscopic subacromial supraspinatus tendonitis.
decompression and a deltoid
splitting approach
IV. Frozen Shoulder / Adhesive Capsulitis /
Periarthritis
c. Traditional open approach
- Females > Males around 40-60 y.o.
i. An anterolateral incision is made
- “Diabetic Periarthritis”- Type 1 DM
that extends obliquely from the
middle one-third of the inferior
Types:
aspect of the clavicle, across the
● 1° Idiopathic
coracoid process, and to the
● 2° Trauma, immobilization, arthritis, DM
anterior aspect of the proximal
humerus.

III. Tendonitis/Bursitis

MAGALONA, NAPALLATAN BSPT3

 V. AC Joint Dysfunction
MOI: Fall on lateral aspect of GH; direct trauma

Painful Arc:
● GH 60°-120°
● AC 120°-180° (170°-180°)

Special Tests:
● Crossbody/Crossover/Horizontal
Stage I - Gradual onset of pain
Adduction Test
‘Nocturnal’ that increases with
● Fountain Sign- (+) swelling of AC joint
< 3 months movement and present
at night
- Loss of external
rotation motion with
intact rotator cuff
strength is common

Stage II - Pain by persistent and

‘Freezing’ more intense pain even
3-9 months at rest.
- Motion is limited in all
directions and cannot
be fully restored with
an intra-articular
injection

Stage III - Pain only with

‘Frozen’ movement, significant
9-15 months adhesions, and limited FRACTURES
GH motions. - Structural loss of continuity of the bone
- Excessive caused by forces exceeding the elasticity
scapulothoracic that can be absorbed by the body
movement is a typical - The energy imposed on the body must be
compensation. absorbed by non-injury producing
- Atrophy of the deltoid, materials (lengthening cxn of muscles &
rotator cuff, biceps, protective gear)
and triceps brachii - (>10-20x of the body weight)
muscles may be noted. - Males = Females
- Occurs between 9 and - Greenstick fracture- MC in children
15 months after onset. - Pathological fracture- MC in elderly
(>60-70 y.o)
Stage IV - Minimal pain and no
‘Thawing’ synovitis but significant
> 15 months capsular restrictions
from adhesions.
- Motion may gradually
improve during this
stage.
- Lasts from 15 to 24
months after onset,
although some patients
never regain normal
ROM.

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Clavicular Fracture Radius and Ulna
- MC fracture 2° to FOOSH
Monteggia fx of the proximal ulna with
- Middle 1/3 (posterosuperior 2° to the
radial head dislocation 2° to
SCM)
FOOSH
- Lateral (inferomedially)
Galeazzi’s fx of radius with ulnar head
dislocation → distal RU jt d/t
(Reverse Monteggia)

Nightstick Ulna (midshaft) without

dislocation

Colle’s - Dorsal displacement

[FOOSH] of radius and volar
angulation of wrist
- “Silverfork”, “dinner
fork” deformity, wrist
in extension

Smith’s - Volar displacement of

[FOOSH] radius and dorsal
angulation of wrist
Humerus - “Garden spade”
- Proximal Humerus deformity; wrist in
flexion

Classification
According to Completeness:
INCOMPLETE [does not affect the whole
cross-sectional area]
a. Greenstick
b. Torus/Buckle
i. mainly compression; MC distal ¼
of radius
c. Fissured
i. More split of bone without
displacement of fragments
d. Perforating
Scapular Fracture i. (+) hole; 2° to gunshot
e. Depressed
i. (+) depression; affects cranial/flat
bones

COMPLETE [(+) separation; affects the whole

cross-sectional area of the bone]
a. Simple (closed)
i. Does not communicate with skin/
external environment
b. Compound (open)
i. (+) wound; always complete
c. Impacted
i. Compressed; broken bone ends
are driven to each other; (+)
approximation
d. Comminuted
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 i. Multiple pieces
e. Complicated
i. Injury to the organ
f. Compression
i. Axial loading; short bones
(vertebrae, tarsal bones); T8-L3
According to Appearance/Force Applied:
a. Spiral Fracture
i. Rotational/torsional forces
ii. Widened surface contact →
decrease in non-union → fastest
healing Specific Classifications
Gustilo-Anderson Classification (for open
b. Oblique wounds)
i. Slanted/diagonal force Grade I ➔ Clean skin opening < 1cm,
ii. Fragments may easily displace usually from inside to
outside
c. Transverse ➔ Minimal mm contusion
i. Fracture line is at a right angle to ➔ Simple transverse or short
the longitudinal axis of the bone oblique fractures
ii. 2° to shearing force
iii. Complete/incomplete Grade II ➔ Laceration >1cm long,
with extensive soft tissue
d. Avulsion (periosteum) damage
i. 2° to pull of muscle ➔ Minimal to moderate
crushing component
e. Pathological Fracture ➔ Simple transverse or short
i. 2° to underlying conditions oblique fractures fractures
ii. Abnormal fragility and calcium with minimal comminution
metabolism
Grade III ➔ Extensive soft tissue
f. Stress fracture damage, including
i. Repetitive microtrauma muscles, skin and
ii. March fracture → 5th MT → shaft neurovascular structures
affected ➔ Often a high energy injury
with severe crushing
According to Position of Fragments component

Undisplaced: Displaced: Grade IIIA ➔ Extensive soft tissue

- Remains at - Out of laceration
anatomical anatomical ➔ Adequate bone coverage
position position ➔ Segmental fractures,
- ALL open gunshot injuries, minimal
fractures are periosteal stripping
displaced
Grade IIIB ➔ Extensive soft tissue injury
with periosteal stripping
and bone exposure
requiring soft tissue flap
closure
➔ Usually associated with
massive contamination

Grade IIIC ➔ Vascular injury requiring

repair [circulatory

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 problems]
*Grades III A-C are predisposed to infections

Salter-Harris Classification
S I Epiphyseal plate fracture only

A II Epiphyseal plate + metaphysis

L III Epiphyseal plate + epiphysis

Fracture Anomalies
T IV Epiphyseal plate + epiphysis + a. Delayed
metaphysis ● Longer than normal duration of
healing
R V Crushed- comminuted fracture ● 2° to interrupted blood circulation;
(epiphyseal plate) infection
● Insufficient vitamins and minerals
VI Injury to peripheral portion of the
● Normal:
epiphyseal plate
○ UE- 10 weeks
VII Isolated injury to the epiphysis ○ LE- 20 weeks
○ Hands- 5 weeks
VIII Isolated injury to the metaphysis ○ With ligament- 6-8 weeks

IX Injury to the periosteum b. Malunion

● Union on time + shortening or
angulation of the bone
● 2° to mobilization + trauma

c. Non-union
● Failure of 2 bony segments to
unite
● Ex: Femoral neck or distal 1/3 of
tibia (bone graft-surgical
treatment)

Stage of Bone Healing

I. Impact/ Accident Stage
II. Inflammation Stage
A. Hematoma formation
III. Early Reparative
A. Start of callus formation; soft
callus formation
IV. Late Reparative
A. Hard callus formation → casting
will be removed → clinical union
V. Remodeling
A. Up to 7 years; trabeculae/
cancellous becomes thicker
B. Fracture healing is complete
Principles of Fracture Treatment
a. Reduction
i. Replacement/ realignment of the
fracture ends in to a near normal
anatomical position
ii. Manipulation or angulation
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 iii. Can either be:
BEA
1. Open Reduction - with Very Short 0-35%
alignment; surgical Short 30-50%
intervention Long >55-90%
2. Closed Reduction -
MCP Disarticulation
manipulation → under
anesthesia Phalangeal >55-90%
Disarticulation

b. Maintenance of reduction/fixation
i. Traction- adhesive tapes with
elastic bandage
ii. Fixation
1. External - casting,
splinting, bandaging
2. Internal → stability → nails
(intramedullary nails), rods,
screw

c. Preservation of Function
i. ROM, balance, gait

AMPUTATION
- Surgical removal of a joint/some
overgrowth of the body
- LE > UE (PVD, trauma, compound
fractures, gunshot/stab wound)
- Leads to functional loss

Level of Amputation
Upper Extremity
Forequarter Portion of the
scapula, clavicle
and whole UE

Shoulder Level of GH joint

Disarticulation

AEA
Humeral Neck 0-30%
Short 30-50%
Long 50-90%

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TOTAL ELBOW ARTHROPLASTY
- older individual (over 60 to 65 years of
age) with debilitating, late-stage elbow
arthritis whose physical demands are
relatively low
- considered a preferred surgical alternative
to open reduction and internal fixation for
management of severely comminuted,
intra-articular distal humeral fractures
sustained by elderly patients.
INDICATIONS FOR SURGERY
➔ Debilitating pain and loss of functional
use of the upper extremity as the result of
moderate to severe joint pain and articular
destruction of the HU and HR joints
➔ Gross instability of the elbow
➔ Acute comminuted, intra-articular fracture
and nonunion fracture of the distal
humerus
➔ Failed interposition arthroplasty or radial
head resection
➔ Marked bilateral limitation of motion of the
elbows
PROCEDURE
Background: Implant design and selection
considerations
Early designs were hinged (linked, articulated)
and fully constrained metal-to-metal humeral and
ulnar implants that allowed only flexion and
extension of the elbow joint.
Contemporary designs: provide 5° to 10° of
varus and valgus and a small degree of rotation.
- The designs of total elbow replacement
can be classified into two broad
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categories: linked (articulated) and
unlinked (non-articulated).
Background: Materials and fixation
A stemmed titanium humeral component that has
a cobalt-chrome alloy articulating surface
interfaces with a high-density polyethylene
articulating surface of a stemmed ulnar
component.
Operative Overview
- A longitudinal incision is made at the
posterior aspect of the elbow, either
slightly lateral or medial to the olecranon
process.
- The ulnar nerve is isolated, temporarily
displaced, and protected throughout the
procedure.
- The distal attachment of the triceps is
detached and reflected laterally with a
triceps-reflecting approach or split
longitudinally and retracted along the
midline with a triceps-splitting approach.
- The more recently developed
triceps-sparing (triceps-preserving)
approach is also an option. It involves
incisions on the medial and lateral
aspects of the elbow joint. This approach
preserves the attachment of the triceps
tendon on the olecranon but makes
insertion of the implants more technically
challenging.
- As the procedure progresses, ligaments
and other soft tissues are released as
necessary; the posterior aspect of the
capsule is incised and retracted; and the
joint is dislocated
- In preparation for the implants, small
portions of the distal humerus and
proximal ulna are resected
 - The available ROM and stability of the
prosthetic joint are checked
intraoperatively and x-rays are taken to
confirm proper alignment of the implants.
The components are then cemented in
place, and the capsule and any ligaments
that had ruptured prior to surgery or were
released during the procedure are
repaired to the extent possible or
necessary based on the design of the
prosthesis and the quality of the
structures. If detached or split, the
extensor mechanism is securely
reattached or meticulously repaired.
Following possible anterior transposition
and careful placement of the ulnar nerve
in a subcutaneous pocket, the incision is
closed, and a sterile compressive
dressing and posterior and/or anterior
splint are applied to immobilize the elbow
and forearm. The arm is elevated to
control peripheral edema.

MAGALONA, NAPALLATAN BSPT3

 OLECRANON BURSITIS
ELBOW INSTABILITES
- Inflamed olecranon bursa with or without
LATERAL EPICONDYLITIS, Tennis Elbow pus
- Pain in the common wrist extensor - Chronic: Student’s elbow, Draftsman’s
tendons along the lateral epicondyle and elbow, Miner’s elbow
HR joint with gripping activities - LOM: Elbow flexion
(backhand) - Mx: Compression bandage for 1hr,
- MOI: Wrist extension; pronation antibiotics, NSAIDs
- ECRB > ECD
- Special Tests: Cozen’s, Mill’s, Maudsley’s
- Tx: Neoprene sleeve, NSAID-steroid
injection

MEDIAL EPICONDYLITIS, Golfer’s Elbow,

Swimmer’s Elbow (Breaststroke)
- involves the common flexor/pronator
tendon at the tenoperiosteal junction near
the medial epicondyle
- MOI: wrist flexion; pronation
- Pronator teres > FCR
- Tx: Curvilinear brace; Cryotherapy

LITTLE LEAGUER’S ELBOW

- Overuse syndrome among young
throwers/baseball pitchers

PULLED ELBOW, Nursemaid’s Elbow

- < 5 years old
- Inferior subluxation of radial head from
annular ligament
- MOI: Pronation; extended arm

BOXER’S ELBOW, Olecranon impingement

syndrome
- MOI: Obsessive hyperextension of elbow
with valgus
- Sx:

MAGALONA, NAPALLATAN BSPT3

 - Swelling of elbow
- Locking of elbow
- (+) Bone spur

CUBITAL TUNNEL SYNDROME

- Impingement of ulnar nerve
- (+) tardy ulnar palsy (delayed nerve
symptom)
- Special Tests: Tinel Sign and Elbow
Flexion Test

References:
1. Therapeutic Exercise: Foundation and
Techniques, 7th Ed. [Kisner, Colby,
Borstad]

MAGALONA, NAPALLATAN BSPT3