Common Elbow Disorders Matthew D. Saltzman, MD Associate Professor - - PowerPoint PPT Presentation

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Common Elbow Disorders Matthew D. Saltzman, MD Associate Professor - - PowerPoint PPT Presentation

Jan 22, 2023 235 likes •603 views

Common Elbow Disorders Matthew D. Saltzman, MD Associate Professor Orthopaedic Consultant Chicago Cubs Northwestern University Feinberg School of Medicine Matthew D. Saltzman, MD Grew up in NW suburbs of Chicago University of

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Common Elbow Disorders

Matthew D. Saltzman, MD Associate Professor Orthopaedic Consultant Chicago Cubs Northwestern University Feinberg School of Medicine

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Matthew D. Saltzman, MD

Grew up in NW suburbs of Chicago University of Wisconsin-Madison Loyola University Medical School Northwestern University Orthopaedic Residency University of Washington Shoulder/Elbow Fellowship Board Certified American Board of Orthopaedic Surgery (ABOS) 2011

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Chicago Cubs

Orthopaedic Consultant

  • Game Coverage
  • Spring Training
  • Coordination of Treatment
  • Conduit to Trainers and GM

→Unique perspective to treatment

  • f orthopaedic conditions
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2016

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Athlete Manager Front Office Teammates Second

  • pinion MD

Sports Agent Treating MD

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WC Claimant Work Supervisor Attorney Treating MD IME MD Adjustor Case Manager

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Common Elbow Conditions

  • Lateral Epicondylitis (Tennis Elbow)
  • Medial Epicondylitis (Golfer’s Elbow)
  • Distal Biceps Tear
  • Elbow Fracture
  • Elbow Dislocation
  • Elbow Arthritis
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Lateral Epicondylitis

1873: “lawn tennis arm”

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Lateral Epicondylitis

Carter, JBJS 1925

Epidemiology

  • Male = Female
  • 4th or 5th decade of life
  • Dominant extremity more common
  • Manual labor, repetitive tasks
  • 80% resolve in < 1 year
  • 4-11% require surgery
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Physical Examination

  • Tenderness to Palpation just distal to lateral

epicondyle

  • Pain with resisted wrist extension
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Histologic Changes in Tendon

Normal Tendon Angiofibroblastic Hyperplasia JBJS 1999

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Non-surgical treatment

  • Rest
  • NSAIDs
  • Counter-Force Strap
  • Cock-up wrist splint
  • Physical Therapy
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Cortisone

  • Early improvement (5 days-6 weeks)
  • Late same or worse (12 wks-12 months)
  • Skin atrophy, depigmentation
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Cortisone

  • PRP ( n = 51) or corticosteroid (n = 49)
  • VAS scores: 49% improved in CSI vs. 73% in

PRP group at 1 year ( p < 0.001)

  • CSI better initially, then declined
  • PRP group progressively improved
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Surgery

  • Open or Arthroscopic
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Audience Question

What treatment is most frequently successful at resolving lateral epicondylitis?

  • 1. Cortisone injection
  • 2. PRP Injection
  • 3. Physical Therapy
  • 4. Arthroscopic surgery
  • 5. Open surgery
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Medial Epicondylitis

  • Less common
  • >90% respond to non-operative treatment
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Distal Biceps Tear

  • Lifting heavy object
  • Eccentric contraction
  • “Pop” and subsequent bruising
  • Arm “looks funny” →reverse

popeye deformity

  • Weakness (supination >flexion)
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Distal Biceps Tear

  • Hook Test (O’Driscoll)
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Distal Biceps Tear

  • MRI
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Distal Biceps Tear

  • Repair
  • Tension Slide

(Sethi)

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Distal Biceps Tear

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Audience Question

What is the most common mechanism causing distal biceps rupture?

  • 1. Muscle fatigue
  • 2. Bench press exercise
  • 3. Previous surgery
  • 4. Eccentric contraction
  • 5. Fall on outstretched hand
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Elbow Fracture

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Elbow Fracture

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Elbow Fracture

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Elbow Dislocation

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Elbow Dislocation

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Elbow Dislocation

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Elbow Arthritis

  • Not as common as other joints
  • NSAIDs, ice, heat
  • Cortisone
  • Arthroscopic debridement
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Elbow Arthritis

  • Total Elbow Arthroplasty
  • Lifetime 5 lb lifting restriction
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Audience Question

Who is the best candidate for total elbow arthroplasty?

  • 1. 70 y/o retired female with rheumatoid arthritis
  • 2. 30 y/o male soft ball coach
  • 3. 50 y/o male mechanic
  • 4. 60 y/o with displaced olecranon fracture
  • 5. 80 y/o with severe congestive heart failure

and persistent elbow clicking

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What is MMI?

  • Known natural history:
  • Elbow strain (< 3 months)
  • Elbow fracture (4-6 months)
  • Elbow tendon repair ( 3-4 months)
  • Shoulder strain (<3 months)
  • Rotator cuff tear non-op (3 months)
  • Rotator cuff tear surgery (6 months)
  • Revision rotator cuff surgery (12 months)
  • Labrum repair surgery (4 months)
  • Shoulder replacement surgery (1 year)
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Ok, let’s do an elbow exam!

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Thank You

Matthew D. Saltzman, MD Associate Professor Orthopaedic Consultant Chicago Cubs Northwestern University Feinberg School of Medicine