Surgical Techniques for Trauma and Sports Related Injuries of the Elbow
Chronic distal biceps tendon ruptures are characterized by retraction and scarring. Direct repair... more Chronic distal biceps tendon ruptures are characterized by retraction and scarring. Direct repair requires debridement and mobilization of the tendon and muscle and may result in a flexion deformity, which resolves over 1–2 months. If the tendon cannot be repaired directly, grafting or tendon transfer can be used. Direct repair, autograft reconstruction, and brachialis transfer are described in this chapter.
Surgical Techniques for Trauma and Sports Related Injuries of the Elbow
Biceps endoscopy is a new frontier in minimally invasive elbow surgery. The technique was origina... more Biceps endoscopy is a new frontier in minimally invasive elbow surgery. The technique was originally used for diagnostic evaluation of distal biceps pathology only and has now evolved into an all-endoscopic procedure with therapeutic applications. Endoscopic techniques are useful for debridement and reinsertion of partial distal biceps tears, and complete ruptures can also be safely repaired or reconstructed. The advantages and potential pitfalls have been identified in cadaveric and clinical experience, and knowledge of the principles and technical variations of biceps endoscopy is necessary prior to the transition from open to endoscopic procedures around the distal biceps.
Surgical Techniques for Trauma and Sports Related Injuries of the Elbow
For those patients with instability of the medial and lateral sided of the elbow, there is a plac... more For those patients with instability of the medial and lateral sided of the elbow, there is a place for a circumferential graft. This has the main advantage of simplifying the bone tunnel creation and graft fixation, compared to having both medial- and lateral-sided reconstructions.
Surgical Techniques for Trauma and Sports Related Injuries of the Elbow, 2019
Synovial chondromatosis and pigmented villonodular synovitis of the elbow are both rare condition... more Synovial chondromatosis and pigmented villonodular synovitis of the elbow are both rare conditions. While the aetiology of both is unclear, there is evidence supporting genetic factors in some cases of synovial chondromatosis. Both conditions cause swelling, pain, and decreased range of motion, with synovial chondromatosis also resulting in catching and locking. Recurrence has been observed after inadequate treatment of both conditions, as has been progression of benign synovial chondromatosis to malignant chondrosarcoma. Arthroscopic treatment of both conditions has advantages in decreasing the insult to the surrounding soft tissue and improving access to the gutters. Tips on how to perform the surgery are outlined in this chapter.
Surgical Techniques for Trauma and Sports Related Injuries of the Elbow, 2019
The coronoid process of the ulna is an important bony stabilizer of the elbow forming an anterior... more The coronoid process of the ulna is an important bony stabilizer of the elbow forming an anterior buttress with the radial head to avoid posterior subluxation or dislocation of the elbow (Fig. 38.1). Specific fracture types are associated with distinct patterns of traumatic elbow instability. Coronoid fractures are classified using the O’Driscoll classification based on fragment morphology: type 1 are tip fractures associated with terrible triad elbow fracture-dislocations, type 2 are anteromedial facet fractures associated with posteromedial varus rotational-type injuries (PMVRI), and type 3 are large basal fracture associated with olecranon fracture-dislocations.
Surgical Techniques for Trauma and Sports Related Injuries of the Elbow, 2019
Triceps injuries, including triceps tendon ruptures, are relatively rare. Recently, the knowledge... more Triceps injuries, including triceps tendon ruptures, are relatively rare. Recently, the knowledge of tendon lesions has increased, and it seems to be related to more precise diagnostic and clinical assessments. The most common mechanism of injury remains a forceful eccentric contraction of the muscle. Several other risk factors have been studied, such as chronic renal failure, endocrine disorders, metabolic bone diseases, and steroid use. Olecranon bursitis and local corticosteroid injections may also play a role. The most common site of rupture is at the tendon’s insertion into the olecranon and rarely at the myotendinous junction or intramuscularly. Surgical intervention is recommended in acute complete ruptures; non-operative treatment is reserved for patients with major comorbidities, as well as for partial ruptures with little functional disability and in low demand patients. Various techniques and approaches have been proposed for the management of these challenging injuries. ...
Surgical Techniques for Trauma and Sports Related Injuries of the Elbow, 2019
Isolated radiocapitellar dislocations are rare; however our experience indicates that this is a d... more Isolated radiocapitellar dislocations are rare; however our experience indicates that this is a dramatic injury whether acute or chronic. These patients present following hyperextension injuries. We propose the mechanism to be as follows: gentle hyperextension, varus torque, and rotation from pronation to supination. This sequence followed by elbow flexion will cause the radial head to dislocate anteromedially and sit on top of the brachialis muscle-tendon junction, which will cradle the radial head and serve as a block to reduction. In some cases the radial head will buttonhole through the brachialis muscle. As a result, it will appear as though these injuries can be reduced when the elbow is flexed however; the radial head will dislocate again upon elbow extension. In the case of an irreducible anteromedial radial head dislocation with no obvious intra-articular block to reduction, patients should be evaluated with MRI or ultrasound to assess for the possibility of transbrachialis...
Surgical Techniques for Trauma and Sports Related Injuries of the Elbow, 2019
The management of complex fractures, dislocations, and fracture-dislocations of the elbow can be ... more The management of complex fractures, dislocations, and fracture-dislocations of the elbow can be challenging. External fixation of the elbow, either static or dynamic, has been used as an adjunctive treatment to stabilize the elbow while allowing the ligaments and fractures to heal. Unfortunately, the complication rate of external fixation has been high.
Painful total elbow arthroplasty is not an uncommon problem. Differentiation of infection from as... more Painful total elbow arthroplasty is not an uncommon problem. Differentiation of infection from aseptic loosening is a critical factor in directing the treatment algorithm. However, obtaining a correct microbiological and mechanical diagnosis can be difficult.
Acute distal biceps tendon reinsertion is the treatment of choice in distal biceps tendon tears. ... more Acute distal biceps tendon reinsertion is the treatment of choice in distal biceps tendon tears. We prefer to use a single 2-cm incision approach and fix the biceps tendon in a bone tunnel with a bicortical Endobutton. The original Bain technique was adapted and will be described in this chapter. The patient is placed in supine position with the arm on an arm table. A 2-cm incision is made, 3 cm distal to the elbow crease. The bicipital tuberosity is approached by blunt dissection. The tendon is usually retracted proximal to the elbow crease. The elbow is flexed, and the stump of the tendon is palpated. The tendon can be milked distally by squeezing the biceps muscle belly. The tendon is then pulled outside the skin and sutured to a cortical bone button. A leading and a trailing suture are inserted in the outer holes of the button. The elbow is extended and the forearm hypersupinated. A guide wire is then drilled centrally in the bicipital tuberosity. Care is taken not to aim this t...
Surgical Techniques for Trauma and Sports Related Injuries of the Elbow, 2019
The coracoid process is the primary stabilizer of the elbow joint. Complex fracture dislocations ... more The coracoid process is the primary stabilizer of the elbow joint. Complex fracture dislocations are difficult to manage and are a surgical challenge. Often it is the coronoid process that remains a problem, leading to persistent instability, pain, and restricted motion. This mix of the stiff, painful, and unstable elbow is a difficult challenge.
Surgical Techniques for Trauma and Sports Related Injuries of the Elbow
Osteochondritis dissecans (OCD) is a clinical condition of the capitellum which occurs most commo... more Osteochondritis dissecans (OCD) is a clinical condition of the capitellum which occurs most commonly in the adolescent athletes especially in repetitive elbow activities such as gymnasts, pitchers, and swimmers. The lesion is localized to an area of the capitellar subchondral bone plate, which is only a single trabecular layer thick (100 μm). The area involved is supplied by end vessels from the lateral condyle. The subarticular venous plexus consists of parallel veins located in the gutters of the subchondral bone plate. With repeated trauma of throwing, the fracture fails to heal. Obstruction of the venous drainage will lead to localized ischemia, edema of the intraosseous fat, and subsequently a localized compartment syndrome of the bone. Failure of healing of the fragment leads to separation, loose body formation, and finally degenerative osteoarthritis.
Surgical Techniques for Trauma and Sports Related Injuries of the Elbow
Traditional treatment of distal biceps tendinopathy and tears has been through open techniques. A... more Traditional treatment of distal biceps tendinopathy and tears has been through open techniques. Advances in endoscopic surgery have provided the opportunity to understand and treat these conditions with a new perspective. Dry endoscopy of the distal biceps without the use of fluid inflow provides detailed, clear visualization of the pathology and avoids fluid extravasation and swelling of the limb. The aim of this chapter is to introduce the technique and its diagnostic and therapeutic indications in order to help other surgeons who wish to develop their endoscopic practice.
Surgical Techniques for Trauma and Sports Related Injuries of the Elbow
This chapter will provide an overview of SPECT/CT in the management of elbow pain. SPECT/CT provi... more This chapter will provide an overview of SPECT/CT in the management of elbow pain. SPECT/CT provides a functional assessment of a nuclear scan with the superior anatomical resolution provided by CT scan. Through cases studies, we demonstrate the utility of SPECT/CT in elbow tendinopathy, impingement, and intrinsic joint pathology. We provide an algorithm to aid in the use of SPECT/CT in the evaluation of elbow pain.
reports of these tumours found in various parts of the body: abdomen, ear, tonsil, kidney and per... more reports of these tumours found in various parts of the body: abdomen, ear, tonsil, kidney and pericardium (Perez-Navarro et al., 2009). Interestingly, the initial histological diagnosis was reported as fibrolipomatous hamartoma; a very rare benign tumour that usually involve nerves in the upper extremity with a microscopic appearance very similar to that of angiofibrolipoma. Both tumours are composed of the same tissues: adipocytes, fibroblasts and vessels, but a differentiating component is the presence of residual nervous structure in fibrolipomatous hamartoma, which, however, may undergo degeneration due to compression. Other helpful differentiating features are the position of the tumour intraoperatively, namely whether it is located in tendon or nerve, and whether it moves with finger excursion. In conclusion, we report a rare case of angiolipoma of the tendon. This diagnosis can be considered as a possibility when encountering masses associated with tendons in the hand.
Surgical Techniques for Trauma and Sports Related Injuries of the Elbow
Chronic distal biceps tendon ruptures are characterized by retraction and scarring. Direct repair... more Chronic distal biceps tendon ruptures are characterized by retraction and scarring. Direct repair requires debridement and mobilization of the tendon and muscle and may result in a flexion deformity, which resolves over 1–2 months. If the tendon cannot be repaired directly, grafting or tendon transfer can be used. Direct repair, autograft reconstruction, and brachialis transfer are described in this chapter.
Surgical Techniques for Trauma and Sports Related Injuries of the Elbow
Biceps endoscopy is a new frontier in minimally invasive elbow surgery. The technique was origina... more Biceps endoscopy is a new frontier in minimally invasive elbow surgery. The technique was originally used for diagnostic evaluation of distal biceps pathology only and has now evolved into an all-endoscopic procedure with therapeutic applications. Endoscopic techniques are useful for debridement and reinsertion of partial distal biceps tears, and complete ruptures can also be safely repaired or reconstructed. The advantages and potential pitfalls have been identified in cadaveric and clinical experience, and knowledge of the principles and technical variations of biceps endoscopy is necessary prior to the transition from open to endoscopic procedures around the distal biceps.
Surgical Techniques for Trauma and Sports Related Injuries of the Elbow
For those patients with instability of the medial and lateral sided of the elbow, there is a plac... more For those patients with instability of the medial and lateral sided of the elbow, there is a place for a circumferential graft. This has the main advantage of simplifying the bone tunnel creation and graft fixation, compared to having both medial- and lateral-sided reconstructions.
Surgical Techniques for Trauma and Sports Related Injuries of the Elbow, 2019
Synovial chondromatosis and pigmented villonodular synovitis of the elbow are both rare condition... more Synovial chondromatosis and pigmented villonodular synovitis of the elbow are both rare conditions. While the aetiology of both is unclear, there is evidence supporting genetic factors in some cases of synovial chondromatosis. Both conditions cause swelling, pain, and decreased range of motion, with synovial chondromatosis also resulting in catching and locking. Recurrence has been observed after inadequate treatment of both conditions, as has been progression of benign synovial chondromatosis to malignant chondrosarcoma. Arthroscopic treatment of both conditions has advantages in decreasing the insult to the surrounding soft tissue and improving access to the gutters. Tips on how to perform the surgery are outlined in this chapter.
Surgical Techniques for Trauma and Sports Related Injuries of the Elbow, 2019
The coronoid process of the ulna is an important bony stabilizer of the elbow forming an anterior... more The coronoid process of the ulna is an important bony stabilizer of the elbow forming an anterior buttress with the radial head to avoid posterior subluxation or dislocation of the elbow (Fig. 38.1). Specific fracture types are associated with distinct patterns of traumatic elbow instability. Coronoid fractures are classified using the O’Driscoll classification based on fragment morphology: type 1 are tip fractures associated with terrible triad elbow fracture-dislocations, type 2 are anteromedial facet fractures associated with posteromedial varus rotational-type injuries (PMVRI), and type 3 are large basal fracture associated with olecranon fracture-dislocations.
Surgical Techniques for Trauma and Sports Related Injuries of the Elbow, 2019
Triceps injuries, including triceps tendon ruptures, are relatively rare. Recently, the knowledge... more Triceps injuries, including triceps tendon ruptures, are relatively rare. Recently, the knowledge of tendon lesions has increased, and it seems to be related to more precise diagnostic and clinical assessments. The most common mechanism of injury remains a forceful eccentric contraction of the muscle. Several other risk factors have been studied, such as chronic renal failure, endocrine disorders, metabolic bone diseases, and steroid use. Olecranon bursitis and local corticosteroid injections may also play a role. The most common site of rupture is at the tendon’s insertion into the olecranon and rarely at the myotendinous junction or intramuscularly. Surgical intervention is recommended in acute complete ruptures; non-operative treatment is reserved for patients with major comorbidities, as well as for partial ruptures with little functional disability and in low demand patients. Various techniques and approaches have been proposed for the management of these challenging injuries. ...
Surgical Techniques for Trauma and Sports Related Injuries of the Elbow, 2019
Isolated radiocapitellar dislocations are rare; however our experience indicates that this is a d... more Isolated radiocapitellar dislocations are rare; however our experience indicates that this is a dramatic injury whether acute or chronic. These patients present following hyperextension injuries. We propose the mechanism to be as follows: gentle hyperextension, varus torque, and rotation from pronation to supination. This sequence followed by elbow flexion will cause the radial head to dislocate anteromedially and sit on top of the brachialis muscle-tendon junction, which will cradle the radial head and serve as a block to reduction. In some cases the radial head will buttonhole through the brachialis muscle. As a result, it will appear as though these injuries can be reduced when the elbow is flexed however; the radial head will dislocate again upon elbow extension. In the case of an irreducible anteromedial radial head dislocation with no obvious intra-articular block to reduction, patients should be evaluated with MRI or ultrasound to assess for the possibility of transbrachialis...
Surgical Techniques for Trauma and Sports Related Injuries of the Elbow, 2019
The management of complex fractures, dislocations, and fracture-dislocations of the elbow can be ... more The management of complex fractures, dislocations, and fracture-dislocations of the elbow can be challenging. External fixation of the elbow, either static or dynamic, has been used as an adjunctive treatment to stabilize the elbow while allowing the ligaments and fractures to heal. Unfortunately, the complication rate of external fixation has been high.
Painful total elbow arthroplasty is not an uncommon problem. Differentiation of infection from as... more Painful total elbow arthroplasty is not an uncommon problem. Differentiation of infection from aseptic loosening is a critical factor in directing the treatment algorithm. However, obtaining a correct microbiological and mechanical diagnosis can be difficult.
Acute distal biceps tendon reinsertion is the treatment of choice in distal biceps tendon tears. ... more Acute distal biceps tendon reinsertion is the treatment of choice in distal biceps tendon tears. We prefer to use a single 2-cm incision approach and fix the biceps tendon in a bone tunnel with a bicortical Endobutton. The original Bain technique was adapted and will be described in this chapter. The patient is placed in supine position with the arm on an arm table. A 2-cm incision is made, 3 cm distal to the elbow crease. The bicipital tuberosity is approached by blunt dissection. The tendon is usually retracted proximal to the elbow crease. The elbow is flexed, and the stump of the tendon is palpated. The tendon can be milked distally by squeezing the biceps muscle belly. The tendon is then pulled outside the skin and sutured to a cortical bone button. A leading and a trailing suture are inserted in the outer holes of the button. The elbow is extended and the forearm hypersupinated. A guide wire is then drilled centrally in the bicipital tuberosity. Care is taken not to aim this t...
Surgical Techniques for Trauma and Sports Related Injuries of the Elbow, 2019
The coracoid process is the primary stabilizer of the elbow joint. Complex fracture dislocations ... more The coracoid process is the primary stabilizer of the elbow joint. Complex fracture dislocations are difficult to manage and are a surgical challenge. Often it is the coronoid process that remains a problem, leading to persistent instability, pain, and restricted motion. This mix of the stiff, painful, and unstable elbow is a difficult challenge.
Surgical Techniques for Trauma and Sports Related Injuries of the Elbow
Osteochondritis dissecans (OCD) is a clinical condition of the capitellum which occurs most commo... more Osteochondritis dissecans (OCD) is a clinical condition of the capitellum which occurs most commonly in the adolescent athletes especially in repetitive elbow activities such as gymnasts, pitchers, and swimmers. The lesion is localized to an area of the capitellar subchondral bone plate, which is only a single trabecular layer thick (100 μm). The area involved is supplied by end vessels from the lateral condyle. The subarticular venous plexus consists of parallel veins located in the gutters of the subchondral bone plate. With repeated trauma of throwing, the fracture fails to heal. Obstruction of the venous drainage will lead to localized ischemia, edema of the intraosseous fat, and subsequently a localized compartment syndrome of the bone. Failure of healing of the fragment leads to separation, loose body formation, and finally degenerative osteoarthritis.
Surgical Techniques for Trauma and Sports Related Injuries of the Elbow
Traditional treatment of distal biceps tendinopathy and tears has been through open techniques. A... more Traditional treatment of distal biceps tendinopathy and tears has been through open techniques. Advances in endoscopic surgery have provided the opportunity to understand and treat these conditions with a new perspective. Dry endoscopy of the distal biceps without the use of fluid inflow provides detailed, clear visualization of the pathology and avoids fluid extravasation and swelling of the limb. The aim of this chapter is to introduce the technique and its diagnostic and therapeutic indications in order to help other surgeons who wish to develop their endoscopic practice.
Surgical Techniques for Trauma and Sports Related Injuries of the Elbow
This chapter will provide an overview of SPECT/CT in the management of elbow pain. SPECT/CT provi... more This chapter will provide an overview of SPECT/CT in the management of elbow pain. SPECT/CT provides a functional assessment of a nuclear scan with the superior anatomical resolution provided by CT scan. Through cases studies, we demonstrate the utility of SPECT/CT in elbow tendinopathy, impingement, and intrinsic joint pathology. We provide an algorithm to aid in the use of SPECT/CT in the evaluation of elbow pain.
reports of these tumours found in various parts of the body: abdomen, ear, tonsil, kidney and per... more reports of these tumours found in various parts of the body: abdomen, ear, tonsil, kidney and pericardium (Perez-Navarro et al., 2009). Interestingly, the initial histological diagnosis was reported as fibrolipomatous hamartoma; a very rare benign tumour that usually involve nerves in the upper extremity with a microscopic appearance very similar to that of angiofibrolipoma. Both tumours are composed of the same tissues: adipocytes, fibroblasts and vessels, but a differentiating component is the presence of residual nervous structure in fibrolipomatous hamartoma, which, however, may undergo degeneration due to compression. Other helpful differentiating features are the position of the tumour intraoperatively, namely whether it is located in tendon or nerve, and whether it moves with finger excursion. In conclusion, we report a rare case of angiolipoma of the tendon. This diagnosis can be considered as a possibility when encountering masses associated with tendons in the hand.
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