Ligaments of the Elbow Stability Of The Elbow - Everything You Need To Know - Dr. Nabil Ebraheim
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- čas přidán 31. 05. 2018
- Dr. Ebraheim’s educational animated video describes ligaments of the elbow and stability of the elbow.
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The primary stabilizer of the elbow is the ulnohumeral joint. The coronoid process is the anterior buttress of the olecranon. The coronoid process prevents posterior dislocation of the elbow. Fractures of the coronoid more than 50% of the height will lead to elbow instability. With fracture of the coronoid process, it is important to recognize the anteromedial fracture. LCL tear and impaction fracture of the anteromedial coronoid facet will lead to posteromedial instability of the elbow joint. Sometimes this fracture is not easily seen on the x-rays and it can be missed. Delayed treatment of this fracture may result in varus and posteromedial instability, and early onset of osteoarthritis. Surgical fixation should be done and usually done through a medial approach. Posteromedial instability results from a varus deforming force. The coronoid process is also the attachment site for the important ligament, the anterior bundle of the medial collateral ligament of the elbow. Fracture of the coronoid process can also be a part of the terrible elbow triad. The MCL is composed of three bands, the anterior, posterior, and transverse bundles. The anterior band of the MCL is the strongest primary stabilizer to valgus stress in 90 degrees of flexion. In extension, it provides about 30% of the restraint. The osseous and articular components of the elbow joint, as well as the anterior joint capsule, resist the valgus forces in extension. The MCL originates from the posterior medial epicondyle of the distal humerus. It inserts into the sublime tubercle of the medial coronoid process. Late cooking and early acceleration will give the highest valgus torque to the medial collateral ligament. The deficiency of this ligament is diagnosed with the moving valgus stress test or the valgus stress test. With the arm fully supinated, find the MCL and take the forearm, placing a valgus stress on the medial collateral ligament. The elbow valgus stress test is used to assess the integrity of the medial collateral ligament. Clinical exam is not as good as the MRI. MRI is the best study to diagnose complete tears of the MCL of the elbow. CT scan arthrogram is more sensitive than MRI for partial lesions. In case of complete tear, reconstruction of the medial collateral ligament (ulnar) deficiency is the best procedure. Indication for surgery would be a complete tear in high level throwing athletes. 90% return to pre-injury level of activity. The posterior portion of the MCL forms the floor of the cubital tunnel. The posterior bundle of the MCL is tight in elbow flexion. If you want to get more flexion of the stiff elbow, release the contracted posterior band of the medial collateral ligament. The third part of the MCL is called the transverse bundle. The LCL complex consists of four parts: lateral ulnar collateral ligament (LUCL), lateral radial collateral ligament (RCL), accessory lateral collateral ligament (ALCL), and annular ligament (AL). The lateral ulnar collateral ligament (LUCL) is the key anatomic structure which prevents posterolateral instability. The radial collateral ligament (RCL) and the accessory collateral ligament (ALCL) has some contribution to lateral elbow stability. All of this is debated and controversial, but there is consensus that the lateral collateral ligament complex and not an individual ligament is important in preventing posterolateral rotary instability of the elbow. The lateral ulnar collateral ligament (LUCL) acts like a sling for the radial head. The LUCL traverses the posterolateral aspect of the radial head. The LUCL originates from the lateral humeral epicondyle. The LUCL inserts into the crista supinatoris of the proximal ulna. Posterolateral rotary instability of the elbow occurs with LUCL deficiency. It is diagnosed with a lateral pivot shift test. The LUCL is deep and slightly distal to the common extensor tendon. Surgical approaches and arthrotomy to the lateral elbow may damage the ligament and may result in posterolateral instability of the elbow. Posterolateral rotary instability can also occur from iatrogenic injury to the LCL during treatment of tennis elbow. This can be a complication of surgery or can be part of the pathology that involves the extensor carpi radialis brevis muscle. It may also occur from injection of steroids into this area. This ligament that is close to the tendon can be injured due to excessive release of the origin of the ECRB tendon. The patient will have a painful click and difficulty achieving a full elbow extension after surgery. To avoid this condition, keep the detachment of the tendon anterior to the equator of the radial head. The annular ligament stabilizes the radioulnar joint. The radial head is important and provides approximately 30% of valgus stability.
You make the pathology and the problem so clear. Thank you so much for posting this material.
thank you so much Dr. Ebraheim!
Fantastic video Dr. very helpful and easy to understand
Excellent video, Doctor.
Felt like a 700 year old dracula was teaching me Anatomy.
Maybe you can teach us?
@@bandit12nut didn't say it was bad.
Awesome video!
Great as always!!!
Your videos are so good!😊
That's very informative and simple to study from , thank you so much 5/8/2018 😊
Great video thank you so much!
Great doc just want know you have any info about c8 problems please
Thank you sir. Very helpful video for students
Well explained prof
Very helpful, thank you:)
great video. thanks a lot
Thank you Dr very helpful for my FRCS
Thank you
Thank you so much doc
thank you Prof
Very good
Thanks alot
thank you for the video
Great film, very useful for doctors. Greetings from Poland, Szczecin.
Greetings
Thank you
very informative
Very helpful
Thx alot for this video , very great
Can you explain the part of biomechanics
Very nice !
Thank you for the video. Very informative. I have a baseball pitching background- would you please explain better what you mean by "late cocking" and "early acceleration"? 3:39
Thanks
Windblown…! Thank you so much!
I had a terrible triad injury had a great surgeon UW Madison,wi got most of my extention and use back of my elbow.
Nice presentation as you usual dr. Ebrahim .. I have one question about the last sentence from this nice video ..
Radius head has a valgus stability about 30% only if the MCL is intact.. but if there is a Deficiency of the MCL the radius head will provide up to 75% stability
Wow there is a lot involved in the elbow lot of ligaments and muscle
Dear doctor. Could you make some videos of basic radiology for non orthopedic physicians? Thank you. I watch all your videos.
I have a “High grade partial tear in the UCL” any ideas how to specifically rehab this? I’ve had it for 2 years and have been playing tennis and arm wreslting as a pro…. So I’ve stopped all activities for now that I got my MRI… any ideas?
Hola, he visto este video, para intentar entender, porque los doctores me dicen que no podré quedar igual, ya que me disloque el codo derecho, y yo hacia mucho ejercicio. No se dan cuenta que con ese comentario, me dejan hundida en la desesperanza?. Ojala y pueda ayudarme. Gracias.
also include more about terrible triad treatment sir.other wise nice presentation
Great explanation. Thank you for the video! I did cheat and speed it up 1.75x... 😄
When I extend my arm out in front of me and rotate my wrist I feel popping in my elbow. The same ligaments you say are stabilizers for the elbow feel so tight on me that I can extend my arm out hard and rotate my wrist and get a LOUD POP. It sounds terrible but I have desire to pop it bc it feels tight. My elbows both feel like they lack stability. Doing preachers with my left arm is very painful. My wrists also don’t want to be straight they almost want to be limp and they also pop often. Strange thing is I work out all the time and I’m actually very strong relative to 95% of the population. And I can do most things with minimum pain. I just don’t know what’s going on with my elbows. They’ve been a problem for years now
Great video sir ....
I have suffering from this issue since nov 2017 due to road accident...my elbow radial head is broken and after that doctor suggested to operation need to do than after operation my elbow joint by surgical wire and post two weeks plaster removed & advice to do elbow extension or closed but still i do as per advice but except little more extension my hand is not open complete and consultant to doctor but he again advice same things.....sir please suggest what should i do.....is he correct or not ? & What is the solution?
V super posterior &elbow
Hi doc.I Injured my elbow.the doctor said that the bone is blocking the passage . How can I get it straight again?
Yeah, i can't straight elbow too
This is serious shit foamy! I cant do my fringe 😩😤😩