Sports Injuries of the Elbow

123 Pages·2021·6.684 MB·English

by  Adam C. Watts, Lennard Funk, Michael Hayton, Chye Yew Ng, Mike Walton

Matthew P. Lungren
Michael R.B. Evans
Editors
Clinical Medicine
Sports Injuries
Covertemplate
of the Elbow
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LCelinnnicaarld M Feudnikcine Covers T3_HB
Michael Hayton
Second Edition
Chye Yew Ng
Mike Walton
Editors
112323
Sports Injuries of the Elbow
Adam C. Watts • Lennard Funk
Michael Hayton • Chye Yew Ng
Mike Walton
Editors
Sports Injuries of the
Elbow
Editors
Adam C. Watts Lennard Funk
Wrightington Hospital Wrightington Hospital
Wigan Wigan
UK UK
Michael Hayton Chye Yew Ng
Wrightington Hospital Wrightington Hospital
Wigan Wigan
UK UK
Mike Walton
Wrightington Hospital
Wigan
UK
ISBN 978-3-030-52378-7 ISBN 978-3-030-52379-4 (eBook)
https://doi.org/10.1007/978-3-030-52379-4
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature
Switzerland AG 2021
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher,
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Contents
1 Clinical Anatomy of the Elbow . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
James R. A. Smith and Rouin Amirfeyz
2 Imaging of the Elbow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
James R. A. Smith and Rouin Amirfeyz
3 Biomechanics of the Elbow Joint . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Jeppe Vejlgaard Rasmussen and Bo Sanderhoff Olsen
4 Elbow Injuries in the Throwing Athlete . . . . . . . . . . . . . . . . . . . . 37
Ann-Maria Byrne and Roger van Riet
5 Posterolateral Rotatory Instability of the Elbow . . . . . . . . . . . . . 51
Joideep Phadnis and Gregory I. Bain
6 Osteochondritis Dissecans of the Elbow . . . . . . . . . . . . . . . . . . . . 63
Christiaan J. A. van Bergen, Kimberly I. M. van den Ende,
and Denise Eygendaal
7 The Stiff Painful Elbow in the Athlete . . . . . . . . . . . . . . . . . . . . . 73
Abbas Rashid
8 Tendon Injuries Around the Elbow . . . . . . . . . . . . . . . . . . . . . . . . 83
Jeremy Granville-Chapman and Adam C. Watts
9 Myofascial Syndromes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
Philip Holland and Adam C. Watts
10 Rehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
Jill L. Thomas and Val Jones
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121
v
1
Clinical Anatomy of the Elbow
James R. A. Smith and Rouin Amirfeyz
Contents
1.1 Introduction 2
1.2 Osteoarticular Anatomy 2
1.2.1 The Humerus 2
1.2.2 The Ulna 2
1.2.3 The Radius 3
1.3 Capsuloligamentous Anatomy 4
1.3.1 Joint Capsule 4
1.3.2 Ligaments 5
1.3.2.1 Medial Collateral Ligament Complex 5
1.3.2.2 Lateral Collateral Ligament Complex 6
1.4 Muscular Anatomy 6
1.5 Neurovascular Anatomy 8
1.5.1 Radial Nerve 8
1.5.2 Median Nerve 9
1.5.3 Ulnar Nerve 9
1.5.4 Medial Cutaneous Nerves of the Arm and Forearm 10
1.5.5 Lateral Cutaneous Nerves of the Arm and Forearm 10
1.5.6 Arteries 11
1.5.7 Veins 12
References 13
J. R. A. Smith
Severn Deanery, Bristol, UK
R. Amirfeyz (*)
Bristol Royal Infirmary, Bristol, UK
e-mail: [email protected]
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature 1
Switzerland AG 2021
A. C. Watts et al. (eds.), Sports Injuries of the Elbow, https://doi.org/10.1007/978-3-030-52379-4_1
2 J. R. A. Smith and R. Amirfeyz
Key Learning Points the greater sigmoid notch of the olecranon. Its
medial aspect projects further distally. The capi-
1. The elbow joint is comprised of three articula- tellum is hemispherical in shape and articulates
tions; the humeroulnar, radiocapitellar and with the concave surfaced radial head. The troch-
proximal radioulnar joints. lear groove separates the two articular surfaces
2. The articulations are surrounded buy a joint (Fig. 1.1).
capsule with condensations that form the lat- The trochlear-capitellar articular surface is
eral ligament complex and medial collateral internally rotated approximately 5–7° in relation
ligament. to the epicondylar axis [1]. Additionally, this sur-
3. Three important nerves cross the elbow joint; face has a valgus angle of between 6 and 8° when
the ulnar nerve, median nerve and radial compared to the long axis of the humerus [2].
nerve. This is an important issue when the joint axis of
4. The elbow is supplied by the brachial, radial rotation is to be surgically reproduced (fixation of
and ulnar arteries and their recurrent branches. fracture or application of a dynamic external fix-
The radial head is intracapsular and relies on ator). In the sagittal plane the articular surface of
retrograde blood flow. the humerus protrudes approximately 30° ante-
rior to the long axis of the humerus.
On the anterior surface of the humerus, proxi-
1.1 Introduction mal to the articular surface, lie the coronoid and
radial fossae. These accommodate the coronoid
A thorough understanding of the anatomical process and radial head when the elbow is in
structures is fundamental to correct diagnosis full flexion. Similarly, on the posterior aspect of
and safe treatment of disorders of the elbow. the humerus, the olecranon fossa accommodates
This chapter provides an overview of the surgical the olecranon process of the ulna, permitting
anatomy, and is divided into four anatomical sec- full extension of the elbow. The normal range
tions: osteoarticular, capsuloligamentous, mus- of elbow flexion/extension is approximately
cular and neurovascular. 0–150°, with 30–130° necessary to maintain
a functional arc [3]. A sulcus, posterior to the
medial epicondyle, accommodates the passage of
1.2 Osteoarticular Anatomy the ulna nerve (Fig. 1.2).
The elbow joint is comprised of three articula-
tions: the humeroulnar, radiocapitellar and proxi- 1.2.2 The Ulna
mal radioulnar joints (although located within the
capsule of the elbow joint this is really a part of The main articulating portion of the proximal
the forearm joint). ulna is the greater sigmoid (or trochlear) notch. It
is formed predominantly by the olecranon, with
the coronoid process extending the joint surface
1.2.1 The Humerus anteriorly (Fig. 1.3). It is elliptical in shape, with
a longitudinal ridge conveying a stable and con-
The humerus terminates distally as a medial and gruent articulation with the trochlea, forming the
lateral column, each forming a condyle and an humeroulnar joint. It is oriented approximately
epicondyle. These two columns hold the trochlea 30° posterior to the long axis of the ulna to match
and the capitellum. The trochlea is an asymmet- the anterior angulation of the distal humerus. The
rical spool-shaped surface that articulates with coronoid process is comprised of a large antero-
1 Clinical Anatomy of the Elbow 3
Fig. 1.1 Anterior view
of right distal humerus
Lateral
supracondylar Medial
ridge supracondylar
ridge
Radial fossa
Coronoid fossa
Lateral
epicondyle
Medial epicondyle
Capitellum
Trochlea
Trochlear ridge
medial facet and smaller anterolateral facet that (AMCL), and is fundamental to both the valgus
articulate with the medial trochlea and lateral stability of the elbow (see capsuloligamentous
trochlea respectively. anatomy section) and maintaining the trochlea
The articular cartilage surface of the trochlear within the greater sigmoid notch.
notch is interrupted by a variable transverse ‘bare
area’ of bone, located midway between the tip of
the olecranon and the coronoid process (Fig. 1.4). 1.2.3 The Radius
Distal to the trochlear notch, on the lateral
aspect of the coronoid process, lies the lesser The surface of the radial head is concave in
sigmoid (or radial) notch. This accommodates shape. Both the proximal end and approxi-
the radial head, forming the proximal radioulnar mately its circumference are covered with
joint. The supinator crest originates at the distal articular cartilage, allowing a smooth articu-
part of the lesser sigmoid notch, and provides the lation with both the capitellum, and the lesser
origin of the supinator muscle and on the most sigmoid notch. The radial neck constitutes the
proximal part of it, the insertion for the lateral most distal intra-articular portion of the proxi-
ulnar collateral ligament (LUCL). mal radius.
On the medial coronoid, lies an important On the anteromedial surface of the radius, just
bony prominence—the sublime tubercle. This distal to the neck, lays the bicipital tuberosity.
provides the insertion site for the anterior bun- This is the point of insertion for the biceps bra-
dle of the anterior medial collateral ligament chii tendon.
4 J. R. A. Smith and R. Amirfeyz
Fig. 1.2 Posterior view
of right distal humerus
Spiral groove
Olecranon
fossa
Lateral
epicondyle
Median
epicondyle
Trochlea
Sulcus for
ulnar nerve
1.3 Capsuloligamentous medially (sparing the tip, which remains intra-
Anatomy articular) and the annular ligament laterally.
Posteriorly it attaches above the olecranon fossa
1.3.1 Joint Capsule and around the medial and lateral margins of the
sigmoid notch.
The three elbow articulations are surrounded by The maximum capacity of the capsule is
a joint capsule and form a synovial joint. The 25–30 mL at approximately 80° of flexion [4].
anterior capsule inserts proximally above the The capsule is innervated by the nerves that cross
radial and coronoid fossae of the humerus, and it; namely the musculocutaneous, radial, median
attaches to the anterior surface of the coronoid and ulnar nerves.
1 Clinical Anatomy of the Elbow 5
Fig. 1.3 Lateral view of
Coronoid process
right proximal ulna
Greater sigmoid
notch
Olecranon
Supinator crest Lesser sigmoid
notch
Fig. 1.4 Right proximal Olecranon
radioulnar joint
Longitudinal ridge
Lesser
sigmoid notch
Bare area of
greater sigmoid
Radial head notch
Annular
ligament
Supinator crest
Bicipital
tuberosity
Radius
Ulna
1.3.2 Ligaments The anterior bundle originates from the
anteroinferior aspect of the medial epicondyle
1.3.2.1 Medial Collateral [5], and inserts on the sublime tubercle of the
Ligament Complex ulna, on average 18 mm posterior from the tip
The medial collateral ligament comprises an of the coronoid [6]. The centre of the anterior
anterior and posterior bundle, and a supporting bundle origin lies at the axis of rotation of the
transverse ligament; the function of which is not elbow [7, 8], however, it is comprised of an ante-
well understood (Fig. 1.5). rior and posterior band, which are maximally