683 01 Elbow - Why does my Arm Hurt: From Little Leaguers to Golden Sneakers Case-Based скачать в хорошем качестве

683 01 Elbow - Why does my Arm Hurt: From Little Leaguers to Golden Sneakers Case-Based

Mary Lloyd Ireland, M.D. Professor - University of Kentucky Dept. of Orthopaedic Surgery and Sports Medicine www.marylloydireland.com 0:00 Why does my Arm Hurt: From Little Leaguers to Golden Sneakers 0:22 Menu -Elbow, Introduction, Dislocation, Medial Elbow Pain, STOP 0:41 Appearance and fusion of secondary ossification centers of the elbow in females and males. from Andrews JA, et. al., Injuries in Baseball, Lippincott-Raven, 1998. 1:42 ELBOW Differential Diagnosis - MEDIAL Acute • Avulsion Fracture Medial Humeral Epicondyle • Ulnar Collateral Ligament Sprain (rare) • Ulnar Nerve Subluxation (rare) • Fracture Chronic • Medial Humeral Epicondyle Overgrowth • Stress Reaction • Nerve Instability UCL Tear and Instability Previously rare, now common in younger pitchers 3:22 ELBOW Differential Diagnosis LATERAL Acute • Osteochondritis Dissecans Capitellum • Osteochondral Fracture Capitellum • Avulsion Fracture Lateral Humeral Epicondyle • Anterior Subluxation Radial Head • Fracture Capitellum Radial Head Chronic • Lateral Humeral Epicondylitis • Radial Head hypertrophy/ overdevelopment • Loose Bodies • Osteochondritis dissecans Capitellum • Ostechondritis Radial Head OCD incidence appears to be decreasing, but no good epidemiologic studies in Little League 4:19 ELBOW Differential Diagnosis POSTERIOR Acute • Olecranon Fracture • Olecranon Apophysitis • Olecranon Bursal Contusion Chronic • Olecranon Traction Apophysitis • Olecranon Spurs • Loose Bodies • Posteromedial Spurs Olecranon apophysitis = Osgood Schlatter's disease of the elbow 5:11 ELBOW - Differential Diagnosis ANTERIOR Acute • Distal Physeal Humerus Fracture • Capsular Sprain • Hyperextended Elbow Chronic • Loose Bodies 5:28 Supracondylar Fractures -Catastrophic Results -Neurovascular injury 6:02 Displaced supracondylar humerus fracture 6:35 What you never want to see, but if you see it you'll never forget it: Volkmann's Ischemic Contracture 6:59 Supracondylar Fractures - Complications Cubitus Varus • Malunuion • Cosmetic not functional • Corrective osteotomies = loss of fixation 7:37 Elbow Dislocation • Older Child and adolescent • Think transphyseal, if young • Medial epicondyle fracture? 8:16 14 YO Football Athlete • Back of arm hit during practice • Elbow posterior dislocation 9:15 UCL Attachment not on Medial Epicondyle 11:18 Medial Humeral Epicondyle Origin of flexor pronator group (FCR, FCU, FDS, PL, PT Part) UCL attaches -Anterior oblique band -Medial epicondyle/coronoid ant inf 11:39 from Andrews JA, et. al., Injuries in Baseball, Lippincott-Raven, 12:09 Lateral Forces = Compression - Medial Forces = Tension 12:39 Elbow -Salvo JP et. al, “Avulsion Fracture of the Ulnar Sublime Tubercle in Overhead Throwing Athletes,” Am J Sports Med 30(3), 2002, 426-431. 13:12 Medial elbow pain diagnoses in throwers •Medial epicondyle stress fracture •UCL tear •Ulnar neuritis/hypermobility •Flexor-pronator strain much less common •Subluxating medial triceps •Valgus extension overload •Sublime tubercle fracture proximal ulna 13:53 Medial epicondyle fracture Controversial -Displaced extra-articular fractures To Fix, or Not to Fix? 14:58 12 year old medial elbow pain for Pitcher and Quarterback 16:01 12 year, 11-mo. Old RHD Pitcher •3 week history, medial elbow pain •Kept throwing •Little League, now in All-Stars •PE: 16:32 Elbow initial xrays Medial epicondyle displaced fracture UCL tear complete vs. partial 17:15 Follow up 17:41 BB Bullet Appearance to medial epicondyle fracture • May heal if you don’t allow pitching too early • May take long time to heal, but UCL is intact 18::03 BB Gun - Don't allow to fire too soon 18:24 14 YO Pitcher, medial elbow pain for a year, open medial humeral epiphysis torn UCL UCL reconstruction performed, baseball 19:00 Risk Factors •Overuse •Fatigue •High Pitch Velocity •Showcase Participation •Age Groups – Age Matched Case Control Study Olsen II SJ, Fleisig GS, Dun S, Loftice J, Andrews JR, “Risk Factors for Shoulder and Elbow Injuries in Adolescent Baseball Pitchers,” Am J Sports Med 34(6); 2006,905-912. 20:07 UCL Reconstruction •27 Patients, with avg. 35 month followup •Risk fctors (6) •Patient results: •50% increase in UCL reconstructions in high school players Petty DH, Andrews JR, Fleisig GS, Cain EL, "Ulnar Collateral Ligament Reconstruction in High School Baseball Players: Clinical Results and Injury Risk Factors," Am J Sports Med 32(5), 2004;1158-1164. 20:40 STOP Elbow Injuries in Youth Baseball: Youth Sports Injury Prevention - www.stopsportsinjuries.org 21:32 Any Given Monday - Dr. James R. Andrews 22:12 Prevention is Key •Pitchers are at high risk 22:27 - Conclusion: 13 YO "Big Pitcher" Syndrome Protect our young athletes • Reduce rate of Rotator Cuff and UCL tears in young pitchers 22:52 Little League pitchers do NOT become Big League pitchers 23:27 Nolan Ryan didn't start pitching until he was in high school