xray

Epidemiology

Most common form of shoulder instability

- young males 

- M:F = 2:1

Aetiology

Indirect ER and abduction moment on arm

- disruption of anterior stabilisers

History

Initial injury

- severe pain in shoulder

Aetiology

Post-traumatic (type III clavicle fractures)

Idiopathic

4 patterns 

1. OA with osteophytes 

-  contribute to impingement

2. Osteolysis with resorption & gross osteoporosis 

Definition

Injury to ulnar collateral ligament of thumb MCPJ

Aetiology

Initial description

- chronic laxity of British gamekeeper's thumb's 

- no specific trauma

- secondary to breaking pheasant's neck

Acute trauma

- snow ski

- ball games

Valgus / forced abduction

Anatomy

UCL

Epidemiology

Male & Females > 60 years

- X-ray evidence of OA

Symptomatic 

- 25% females

- 15% males

Affected joints

Base thumb

PIPJ / Bouchard's nodes

DIPJ / Heberden's nodes

Indications

RA 

- very good results

- 97% 10 year survival Coonrad-Morrey prosthesis

Other Dx 

- OA / post-traumatic arthritis / nonunion

- tend to have worse survival than RA

Haemophilia

- elbow joint commonly involved

- 90% of haemophiliacs

Acute unreconstructable fracture > 60

DDx

Parosteal OS

- bone is not continuous with cortex in MO

Aetiology

3% incidence in elbow joint trauma to some degree

Epidemiology

Adolescents & young adults

Usually between 12 - 21 years 

Throwing athletes / gymnasts

Little Leaguer's Elbow

- combination of capitellar OCD and MCL injury

- a repetitive throwing injury / seen in pitchers

Aetiology

1.  Trauma & Overuse

Common throwing sports / gymnastics

Incidence

Lateral : Medial 9:1

Epidemiology

4th & 5th decades

- M = F

- 75% dominant arm 

50% of regular tennis players

- especially > 2 hrs / week

Aetiology

Insertion pathology / Enthesopathy

Over-extension of the elbow with supination / pronation

Anatomy

Lateral epicondyle

- anconeus from posterior face

- ECRB and EDC from anterior face (CEO)

Epidemiology

Relatively rare

Average age 50

Men 4:1 Women

Usually dominant arm

Aetiology

Primary

- associated with strenuous manual labour

Secondary

- trauma

- OCD

- synovial chondromatosis

- valgus extension overload / MCL insufficiency

Definition

A valgus knee has a tibiofemoral angle of > 10^o

Causes

Inflammatory

- RA