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DISORDERS OF LASHES
Trichiasis
Trichiasis is a very common acquired condition characterised by inturning of las
hes arising from normal sites of origin.It may be idiopathic or secondary to chr
onic lid margin disease. It should not be confused with pseudotrichiasisassociat
ed with entropion.
CHAPTER 1
EYELIDS

Fig. 1.1
Idiopathic trichiasis.

Fig. 1.2
Severe long-standing trichiasis causing inferior cornealscarring.

Fig. 1.3
Trichiasis and misdirection of lashes due to severechronic anterior blepharitis
.

Fig. 1.4
Trichiasis of the upper lid and corneal scarring due toherpes zoster ophthalmic
us.
Acquired distichiasis (metaplastic lashes)
Acquired distichiasis is caused by metaplasia and dedifferentiation of the meib
omian glands to become hair follicles inpatients with cicatrising conjunctivitis
.
Congenital distichiasis
Congenital distichiasis is a rare condition that may be sporadic or dominantly i
nherited. A minority of patientsalso manifest chronic lymphoedema, spinal arachn
oid cysts and congenital heart defects (lymphoedema trichiasis syndrome).
2
Chapter 1
EYELIDS

Fig. 1.5
A partial or complete second row of lashes emerging at orslightly behind the me
ibomian gland orifices. The aberrant lashes tendto be thinner, shorter and less
pigmented than normal cilia and areoften directed posteriorly. (Courtesy of D. M
. Albert and F. A. Jakobiec.)

Fig. 1.6
A variable number of lashes that originate from meibomiangland orifices.
3
Disorders of lashes

Lash ptosis
Lash ptosis may be idiopathic or associated with the floppy eyelid syndrome, der
matochalasis or long-standing facialpalsy.

Fig. 1.7
Downward displacement of normal lashes.
Ectopic lash

Fig. 1.8
Subcutaneous lash.

Fig. 1.9
Subconjunctival lash.
Madarosis
Madarosis is a decrease in number or complete loss of lashes.
Local causes
4
Chapter 1
EYELIDS

Fig. 1.10
Lash in a punctum may cause irritation on blinking.

Fig. 1.11
Lash introduced into the anterior chamber duringsurgery. (Courtesy of L. Merin.)

Fig. 1.12
Severe long-standing anterior blepharitis.

Fig. 1.13
Destruction of lashes by infiltrating lid tumours.

Fig. 1.14
Thermal burns.

Fig. 1.15
Trichotillomania habitual hair removal. (Courtesy of L. Merin.)
5
Disorders of lashes
Associated systemic conditions

Fig. 1.16
Generalised alopecia.

Fig. 1.17
Alopeciaareata.

Fig. 1.18
Atopic dermatitis, characterised by itchy erythema,scaling and lichenification.

Fig. 1.19
Myxoedema, which may also cause loss of eyebrowsand puffiness of periorbital ski
n.

Fig. 1.20
Systemic lupus erythematosus, which may beassociated with a characteristic butter

fly facial skin rash.

Fig. 1.21
Ichthyosis, characterised by itchy, dry and scaly skin.(Courtesy of A. Pearson.)
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7238661 Atlas de Oftalmologia[1]

Stoleri George
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Greene: Netter's Orthopaedics, 1st ed.
Copyright 2006 Saunders, An Imprint of Elsevier
MISCELLANEOUS CONDITIONS Acute Sprains
The medial collateral ligament (MCL) complex includes the anterior bundle, the p
osterior bundle, and thetransverse ligament (
Figure 15-13
). The anterior bundle of the MCL originates at the midportion of themedial epi
condyle and inserts onto the coronoid tubercle of the ulna. The anterior bundle
is the primaryrestraint to valgus stress. Its eccentric location provides valgus
restraint throughout the full arc of flexion-extension. With the elbow in full
extension, stability to valgus stress is conferred equally by the MCL,anterior c
apsule, and bony articulation. With the elbow in 90of flexion, the MCL provides 5
5% of valgusstability. The contribution of the radiocapitellar articulation to v
algus stability is secondary and significantonly when the anterior bundle is dis
rupted.
Figure 15-13
Ligaments of Right Elbow Joint
The lateral collateral ligament (LCL) complex includes the radial collateral lig
ament, the annular ligament,the accessory lateral collateral ligament, and the l
ateral ulnar collateral ligament. The

lateral ulnar collateral ligament

originates from the anteroinferior portion of the lateral epicondyle, inserts o
n thesupinator crest of the proximal ulna, and is the primary lateral stabilizer
. The
annular ligament
serves as acheckrein for the radial head.Patients with acute sprains report a h
istory of acute pain after a fall or forceful throwing injury. Valgusdistraction
injuries transmit loads primarily to the MCL complex and the medial flexor-pron
ator muscular origin. Injuries to the LCL typically occur with a varus stress to
the elbow joint when it is in extension andthe forearm is in pronation. In acut
e injuries, the global swelling and tenderness, as well as theunreliability of s
tress maneuvers, make it virtually impossible for the clinician to determine pre
cisely whichligament components are injured. Avulsion fractures may be seen on r
adiographs. Short-termimmobilization and gradual resumption of activities are su
ccessful in treating most acute elbow sprains.
Copyright 2008 Elsevier Inc. All rights reserved. - www.mdconsult.com
Greene: Netter's Orthopaedics, 1st ed.
Copyright 2006 Saunders, An Imprint of Elsevier
Chronic Medial Elbow Pain and Instability
Medial elbow pain and MCL instability typically develop in athletes involved in
repetitive throwing activities.Pain is usually gradual in onset, localized to th
e medial aspect of the elbow, and most severe during theacceleration phase of pi
tching (ie, the phase of pitching in which maximum valgus stress is transmitted
tothe elbow). MCL disruption or attenuation is most often noted at the midsubsta
nce of the anterior bundle.Concomitant symptoms of lateral elbow pain may occur
secondary to the valgus overload, causingcompression, shear injury, and osteocho
ndral fragments and/or osteochondritis dissecans of thecapitellum.Examination re
veals tenderness on the medial aspect of the elbow. Valgus instability is assess
ed with theelbow in 25of flexion to relax the ulnohumeral articulation. The patie
nt should be evaluated for thepresence of a concomitant ulnar entrapment neuropa
thy. Radiographs should be inspected for signs of osteochondral loose bodies, me
dial osteophytes, and osteochondritis dissecans. Magnetic resonanceimaging (MRI)
can be helpful in preoperative planning.Nonoperative treatment includes activit
y modification followed by a gradual rehabilitation program. For persistent symp
tomatic instability, operative treatment includes reconstruction of the MCL with
a tendongraft, removal of any associated osteophytes or loose bodies, and decom
pression of ulnar neuritis.
Copyright 2008 Elsevier Inc. All rights reserved. - www.mdconsult.com
Greene: Netter's Orthopaedics, 1st ed.
Copyright 2006 Saunders, An Imprint of Elsevier
Posterolateral Rotatory Elbow Instability
Posterolateral rotatory instability develops after injury to the ulnar collatera
l component of the LCL. With alax or attenuated ligament, patients report latera
l elbow pain and catching or giving way of the elbow. Thelateral pivot test may
be difficult to perform except when the patient is completely relaxed under anes
thesia. MRI studies often identify the ligament disruption. Reconstruction of th
e lateral ulnar collateralligament with a tendon graft is required for treatment
of persistent and disabling symptoms.
Copyright 2008 Elsevier Inc. All rights reserved. - www.mdconsult.com
Greene: Netter's Orthopaedics, 1st ed.
Copyright 2006 Saunders, An Imprint of Elsevier
Rupture of the Distal Biceps Tendon

Rupture of the distal biceps brachii tendon is uncommon; however, timely diagnos
is of these injuries isimportant because failure to recognize and repair the les
ion before the onset of irreversible musclecontraction decreases the strength of
elbow flexion and forearm supination by 30% to 50%. Predisposingfactors include
a male older than 40 years and the presence of preexisting degenerative changes
in thetendon. Rupture typically occurs at the insertion of the biceps tendon in
to the radial tuberosity (see
Figure15-13
).Injury results from an extension force on a partially flexed and contracting
biceps muscle. Patientsfrequently report the acute onset of sharp pain in the an
terior aspect of the elbow, followed by a chronic,dull ache that is exacerbated
by lifting activities. Examination shows tenderness and a defect in theantecubit
al fossa resulting from absence of the normally prominent bicipital tendon. If t
he aponeurosisremains intact, the defect is not as obvious. If the tendon ruptur
e is incomplete, no defect is obvious, butthe patient experiences pain and weakn
ess on flexion of the elbow against resistance. Radiographs areusually normal. M
RI may be helpful in evaluation of equivocal cases.Partial ruptures can be manag
ed with splinting and activity modifications. Complete ruptures are treatedmore
successfully with operative repair. Injury to the radial nerve is a possible com
plication of surgicalrepair.
Copyright 2008 Elsevier Inc. All rights reserved. - www.mdconsult.com
Greene: Netter's Orthopaedics, 1st ed.
Copyright 2006 Saunders, An Imprint of Elsevier
Olecranon Bursitis
The olecranon bursa is easily irritated because of its superficial location (see
Figure 15-13
) and thetendency for people to lean on their elbows. Precipitating factors inc
lude falls or direct blows, aninflammatory arthritis such as rheumatoid arthriti
s or gout, and occupations and avocations that causeprolonged irritation. Olecra
non bursitis also may develop in patients with chronic lung disease who lean ont
heir elbows to aid breathing. Septic bursitis (infection) may occur primarily, b
ut it is more likely to developas a secondary complication of aseptic olecranon
bursitis.The onset of pain and swelling is relatively rapid when caused by traum
a or infection but is indolent whencaused by other conditions. Pain is variable,
exacerbated by elbow flexion, and more intense withinfection. Examination revea
ls a boggy swelling over the olecranon process. Erythema and increasedwarmth are
common in patients with acute bursitis and universal in individuals with septic
bursitis.Tenderness is less marked in chronic, recurrent aseptic bursitis.If th
e olecranon bursitis is small and only mildly symptomatic, treatment should incl
ude observation,avoidance of direct pressure, and, occasionally, short-term spli
nting with the elbow extended. Patientswith more symptomatic bursitis should hav
e the bursa aspirated for Gram stain and culture. Patientswithout infection shou
ld have the elbow protected and immobilized in relative extension with a foam or
compressive dressing. Patients with septic bursitis require limited surgical dr
ainage or daily aspirationand antibiotic administration that covers penicillin-r
esistant
Staphylococcus aureus
. Excision of achronically inflamed olecranon bursa should be avoided if at all
possible because recurrence is commonand operative treatment may lead to chronic
infection.
Copyright 2008 Elsevier Inc. All rights reserved. - www.mdconsult.com
Similar to Netter's Orthopaedics
Netter Sports Medicine
Photografic manual of regional orthopaedic and neurological .pdf

Adam's Outline of Orthopaedics 14th Edition

netter-ortho
Office Orthopaedics
Operative Orthopaedics Stanmore Guide 2010
The Orthopaedic Clinical Examination - b. Reider 2nd Ed . 2005
Surgical Exposures in Orthopaedics the Anatomic Approach, 4th 2009 Pg
Postgraduate Orthopaedics - MCQs and EMQs for the FRCS (Tr & Orth), 1E (2012) [P
DF] [UnitedVRG]
SOAP for Orthopedics [PDF][Tahir99] VRG
Key Topics in Orthopaedic Trauma Surgury
Apley s System of Orthopaedics and Fractures
[D.zuckerman] Handbook of Fractures (3rd Ed.)
Master Techniques in Orthopaedic Surgery - Relevant Surgical Exposures
Master Techniques in Orthopaedic Surgery Soft Tissue Surgery
!Emergeortho procedures
Rockwood and Green's Fractures in Adults, 7th Edition 2010 Azmy2000
First Aid for the Orthopaedic Boards_2C Second Edition (FIRST AID Specialty Boar
ds)
Practical Procedures in Orthopaedic Trauma Surgery
Case Files Orthopaedic Surgery
FRCS Trauma and Orthopaedics Viva (2012).pdf
Miller's Review of Orthopedics
Lecture Notes on Orthopaedics and Fractures 4th Edition 2010
Atlas of Orthopedic Examination of the Peripheral Joints
Master Techniques in Orthopaedic Surgery Knee11
100 Cases in Orthopaedics and Rheumatology
atlas of orthopaedic surgery.pdf
fileshare.ro_netter.pdf
Master Techniques in Orthopaedic Surgery
Musculoskeletal Assessment - Joint Motion and Muscle Testing
More From This User

Upustvo Za Pripremu Strunog Rada

Ancient Hebrew Dictionary
Masa Klasyczny Leszek Magiera
PATOLOGIJA - FZS - Sarajevo
Tadeusz Mika Fizykoterapia
Learn to Read Biblical Hebrew Vl. 2
How to make your own kippah
HOW TO MAKE YOUR OWN KIPAH
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Kineziterapija Osoba s Neurolo kim Poremeajima 1 Dio
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konverzija
Zutm
Articulacion Del Hombro
KARDIJOLOGIJA PITANJA
CervikalniSindrom
gowa i szyja
Atlas Anatomii Czowieka
Netter's Orthopaedics
Nov 20, 2014 by ??? ???????
(0 ratings)
2.1K views
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Netter Sports Medicine

by Fran Redondo
Photografic manual of regional orthopaedic and neurological .pdf
by alex4andra
Adam's Outline of Orthopaedics 14th Edition
by Szcs Orsolya
netter-ortho
by Syafiq Bin Abdullah
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479
of 722

Greene: Netter's Orthopaedics, 1st ed.

Copyright 2006 Saunders, An Imprint of Elsevier
MISCELLANEOUS CONDITIONS Acute Sprains
The medial collateral ligament (MCL) complex includes the anterior bundle, the p
osterior bundle, and thetransverse ligament (
Figure 15-13
). The anterior bundle of the MCL originates at the midportion of themedial epi
condyle and inserts onto the coronoid tubercle of the ulna. The anterior bundle
is the primaryrestraint to valgus stress. Its eccentric location provides valgus
restraint throughout the full arc of flexion-extension. With the elbow in full
extension, stability to valgus stress is conferred equally by the MCL,anterior c
apsule, and bony articulation. With the elbow in 90of flexion, the MCL provides 5
5% of valgusstability. The contribution of the radiocapitellar articulation to v
algus stability is secondary and significantonly when the anterior bundle is dis
rupted.
Figure 15-13
Ligaments of Right Elbow Joint
The lateral collateral ligament (LCL) complex includes the radial collateral lig
ament, the annular ligament,the accessory lateral collateral ligament, and the l
ateral ulnar collateral ligament. The
lateral ulnar collateral ligament
originates from the anteroinferior portion of the lateral epicondyle, inserts o
n thesupinator crest of the proximal ulna, and is the primary lateral stabilizer
. The
annular ligament
serves as acheckrein for the radial head.Patients with acute sprains report a h
istory of acute pain after a fall or forceful throwing injury. Valgusdistraction
injuries transmit loads primarily to the MCL complex and the medial flexor-pron
ator muscular origin. Injuries to the LCL typically occur with a varus stress to
the elbow joint when it is in extension andthe forearm is in pronation. In acut
e injuries, the global swelling and tenderness, as well as theunreliability of s
tress maneuvers, make it virtually impossible for the clinician to determine pre
cisely whichligament components are injured. Avulsion fractures may be seen on r
adiographs. Short-termimmobilization and gradual resumption of activities are su
ccessful in treating most acute elbow sprains.
Copyright 2008 Elsevier Inc. All rights reserved. - www.mdconsult.com
Greene: Netter's Orthopaedics, 1st ed.
Copyright 2006 Saunders, An Imprint of Elsevier
Chronic Medial Elbow Pain and Instability
Medial elbow pain and MCL instability typically develop in athletes involved in
repetitive throwing activities.Pain is usually gradual in onset, localized to th
e medial aspect of the elbow, and most severe during theacceleration phase of pi
tching (ie, the phase of pitching in which maximum valgus stress is transmitted
tothe elbow). MCL disruption or attenuation is most often noted at the midsubsta
nce of the anterior bundle.Concomitant symptoms of lateral elbow pain may occur
secondary to the valgus overload, causingcompression, shear injury, and osteocho
ndral fragments and/or osteochondritis dissecans of thecapitellum.Examination re
veals tenderness on the medial aspect of the elbow. Valgus instability is assess
ed with theelbow in 25of flexion to relax the ulnohumeral articulation. The patie
nt should be evaluated for thepresence of a concomitant ulnar entrapment neuropa
thy. Radiographs should be inspected for signs of osteochondral loose bodies, me
dial osteophytes, and osteochondritis dissecans. Magnetic resonanceimaging (MRI)
can be helpful in preoperative planning.Nonoperative treatment includes activit
y modification followed by a gradual rehabilitation program. For persistent symp
tomatic instability, operative treatment includes reconstruction of the MCL with
a tendongraft, removal of any associated osteophytes or loose bodies, and decom

pression of ulnar neuritis.

Copyright 2008 Elsevier Inc. All rights reserved. - www.mdconsult.com
Greene: Netter's Orthopaedics, 1st ed.
Copyright 2006 Saunders, An Imprint of Elsevier
Posterolateral Rotatory Elbow Instability
Posterolateral rotatory instability develops after injury to the ulnar collatera
l component of the LCL. With alax or attenuated ligament, patients report latera
l elbow pain and catching or giving way of the elbow. Thelateral pivot test may
be difficult to perform except when the patient is completely relaxed under anes
thesia. MRI studies often identify the ligament disruption. Reconstruction of th
e lateral ulnar collateralligament with a tendon graft is required for treatment
of persistent and disabling symptoms.
Copyright 2008 Elsevier Inc. All rights reserved. - www.mdconsult.com
Greene: Netter's Orthopaedics, 1st ed.
Copyright 2006 Saunders, An Imprint of Elsevier
Rupture of the Distal Biceps Tendon
Rupture of the distal biceps brachii tendon is uncommon; however, timely diagnos
is of these injuries isimportant because failure to recognize and repair the les
ion before the onset of irreversible musclecontraction decreases the strength of
elbow flexion and forearm supination by 30% to 50%. Predisposingfactors include
a male older than 40 years and the presence of preexisting degenerative changes
in thetendon. Rupture typically occurs at the insertion of the biceps tendon in
to the radial tuberosity (see
Figure15-13
).Injury results from an extension force on a partially flexed and contracting
biceps muscle. Patientsfrequently report the acute onset of sharp pain in the an
terior aspect of the elbow, followed by a chronic,dull ache that is exacerbated
by lifting activities. Examination shows tenderness and a defect in theantecubit
al fossa resulting from absence of the normally prominent bicipital tendon. If t
he aponeurosisremains intact, the defect is not as obvious. If the tendon ruptur
e is incomplete, no defect is obvious, butthe patient experiences pain and weakn
ess on flexion of the elbow against resistance. Radiographs areusually normal. M
RI may be helpful in evaluation of equivocal cases.Partial ruptures can be manag
ed with splinting and activity modifications. Complete ruptures are treatedmore
successfully with operative repair. Injury to the radial nerve is a possible com
plication of surgicalrepair.
Copyright 2008 Elsevier Inc. All rights reserved. - www.mdconsult.com
Greene: Netter's Orthopaedics, 1st ed.
Copyright 2006 Saunders, An Imprint of Elsevier
Olecranon Bursitis
The olecranon bursa is easily irritated because of its superficial location (see
Figure 15-13
) and thetendency for people to lean on their elbows. Precipitating factors inc
lude falls or direct blows, aninflammatory arthritis such as rheumatoid arthriti
s or gout, and occupations and avocations that causeprolonged irritation. Olecra
non bursitis also may develop in patients with chronic lung disease who lean ont
heir elbows to aid breathing. Septic bursitis (infection) may occur primarily, b
ut it is more likely to developas a secondary complication of aseptic olecranon
bursitis.The onset of pain and swelling is relatively rapid when caused by traum
a or infection but is indolent whencaused by other conditions. Pain is variable,
exacerbated by elbow flexion, and more intense withinfection. Examination revea
ls a boggy swelling over the olecranon process. Erythema and increasedwarmth are
common in patients with acute bursitis and universal in individuals with septic
bursitis.Tenderness is less marked in chronic, recurrent aseptic bursitis.If th

e olecranon bursitis is small and only mildly symptomatic, treatment should incl
ude observation,avoidance of direct pressure, and, occasionally, short-term spli
nting with the elbow extended. Patientswith more symptomatic bursitis should hav
e the bursa aspirated for Gram stain and culture. Patientswithout infection shou
ld have the elbow protected and immobilized in relative extension with a foam or
compressive dressing. Patients with septic bursitis require limited surgical dr
ainage or daily aspirationand antibiotic administration that covers penicillin-r
esistant
Staphylococcus aureus
. Excision of achronically inflamed olecranon bursa should be avoided if at all
possible because recurrence is commonand operative treatment may lead to chronic
infection.
Copyright 2008 Elsevier Inc. All rights reserved. - www.mdconsult.com
Similar to Netter's Orthopaedics
Netter Sports Medicine
Photografic manual of regional orthopaedic and neurological .pdf
Adam's Outline of Orthopaedics 14th Edition
netter-ortho
Office Orthopaedics
Operative Orthopaedics Stanmore Guide 2010
The Orthopaedic Clinical Examination - b. Reider 2nd Ed . 2005
Surgical Exposures in Orthopaedics the Anatomic Approach, 4th 2009 Pg
Postgraduate Orthopaedics - MCQs and EMQs for the FRCS (Tr & Orth), 1E (2012) [P
DF] [UnitedVRG]
SOAP for Orthopedics [PDF][Tahir99] VRG
Key Topics in Orthopaedic Trauma Surgury
Apley s System of Orthopaedics and Fractures
[D.zuckerman] Handbook of Fractures (3rd Ed.)
Master Techniques in Orthopaedic Surgery - Relevant Surgical Exposures
Master Techniques in Orthopaedic Surgery Soft Tissue Surgery
!Emergeortho procedures
Rockwood and Green's Fractures in Adults, 7th Edition 2010 Azmy2000
First Aid for the Orthopaedic Boards_2C Second Edition (FIRST AID Specialty Boar
ds)
Practical Procedures in Orthopaedic Trauma Surgery
Case Files Orthopaedic Surgery
FRCS Trauma and Orthopaedics Viva (2012).pdf

Miller's Review of Orthopedics

Lecture Notes on Orthopaedics and Fractures 4th Edition 2010
Atlas of Orthopedic Examination of the Peripheral Joints
Master Techniques in Orthopaedic Surgery Knee11
100 Cases in Orthopaedics and Rheumatology
atlas of orthopaedic surgery.pdf
fileshare.ro_netter.pdf
Master Techniques in Orthopaedic Surgery
Musculoskeletal Assessment - Joint Motion and Muscle Testing
More From This User
Upustvo Za Pripremu Strunog Rada
Ancient Hebrew Dictionary
Masa Klasyczny Leszek Magiera
PATOLOGIJA - FZS - Sarajevo
Tadeusz Mika Fizykoterapia
Learn to Read Biblical Hebrew Vl. 2
How to make your own kippah
HOW TO MAKE YOUR OWN KIPAH
Kinezimetrija u TZO
(Masaje) - Dolor Muscular Tecnicas Manuales en Tejidos Blandos
A Manual and Grammar of the Yiddish Language J. Mazin
RECNIK ONKOLOSKIH POJMOVA
Patologija Skripta Po Ispitnim Pitanjima
Kineziterapija Osoba s Neurolo kim Poremeajima 1 Dio
Digitalna Fotografija - Prakticni Vodic
tuzlansko post card templet
CervikalniSindrom
konverzija
Zutm
Articulacion Del Hombro

KARDIJOLOGIJA PITANJA
CervikalniSindrom
gowa i szyja
Atlas Anatomii Czowieka
Netter's Orthopaedics
Nov 20, 2014 by ??? ???????
(0 ratings)
2.1K views
EMBED
DOWNLOAD
ADD TO LIBRARY
DESCRIPTION
Netter's Orthopaedics ATLAS PDF
Show more
RELATED
Netter Sports Medicine
by Fran Redondo
Photografic manual of regional orthopaedic and neurological .pdf
by alex4andra
Adam's Outline of Orthopaedics 14th Edition
by Szcs Orsolya
netter-ortho
by Syafiq Bin Abdullah
PreviousNext
Page 1 of 7
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Join our team!
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Scribd on AppstoreScribd on Google Play

Copyright 2016 Scribd Inc.
Terms of service
Accessibility
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Site Language:
English
Search
UPLOADLIBRARY
BooksAudiobooksComicsSheet Music
Search document
479
of 722
Greene: Netter's Orthopaedics, 1st ed.
Copyright 2006 Saunders, An Imprint of Elsevier
MISCELLANEOUS CONDITIONS Acute Sprains
The medial collateral ligament (MCL) complex includes the anterior bundle, the p
osterior bundle, and thetransverse ligament (
Figure 15-13
). The anterior bundle of the MCL originates at the midportion of themedial epi
condyle and inserts onto the coronoid tubercle of the ulna. The anterior bundle
is the primaryrestraint to valgus stress. Its eccentric location provides valgus
restraint throughout the full arc of flexion-extension. With the elbow in full
extension, stability to valgus stress is conferred equally by the MCL,anterior c
apsule, and bony articulation. With the elbow in 90of flexion, the MCL provides 5
5% of valgusstability. The contribution of the radiocapitellar articulation to v
algus stability is secondary and significantonly when the anterior bundle is dis
rupted.
Figure 15-13
Ligaments of Right Elbow Joint
The lateral collateral ligament (LCL) complex includes the radial collateral lig
ament, the annular ligament,the accessory lateral collateral ligament, and the l
ateral ulnar collateral ligament. The
lateral ulnar collateral ligament
originates from the anteroinferior portion of the lateral epicondyle, inserts o
n thesupinator crest of the proximal ulna, and is the primary lateral stabilizer
. The
annular ligament
serves as acheckrein for the radial head.Patients with acute sprains report a h
istory of acute pain after a fall or forceful throwing injury. Valgusdistraction
injuries transmit loads primarily to the MCL complex and the medial flexor-pron
ator muscular origin. Injuries to the LCL typically occur with a varus stress to
the elbow joint when it is in extension andthe forearm is in pronation. In acut
e injuries, the global swelling and tenderness, as well as theunreliability of s
tress maneuvers, make it virtually impossible for the clinician to determine pre
cisely whichligament components are injured. Avulsion fractures may be seen on r
adiographs. Short-termimmobilization and gradual resumption of activities are su
ccessful in treating most acute elbow sprains.
Copyright 2008 Elsevier Inc. All rights reserved. - www.mdconsult.com

Greene: Netter's Orthopaedics, 1st ed.

Copyright 2006 Saunders, An Imprint of Elsevier
Chronic Medial Elbow Pain and Instability
Medial elbow pain and MCL instability typically develop in athletes involved in
repetitive throwing activities.Pain is usually gradual in onset, localized to th
e medial aspect of the elbow, and most severe during theacceleration phase of pi
tching (ie, the phase of pitching in which maximum valgus stress is transmitted
tothe elbow). MCL disruption or attenuation is most often noted at the midsubsta
nce of the anterior bundle.Concomitant symptoms of lateral elbow pain may occur
secondary to the valgus overload, causingcompression, shear injury, and osteocho
ndral fragments and/or osteochondritis dissecans of thecapitellum.Examination re
veals tenderness on the medial aspect of the elbow. Valgus instability is assess
ed with theelbow in 25of flexion to relax the ulnohumeral articulation. The patie
nt should be evaluated for thepresence of a concomitant ulnar entrapment neuropa
thy. Radiographs should be inspected for signs of osteochondral loose bodies, me
dial osteophytes, and osteochondritis dissecans. Magnetic resonanceimaging (MRI)
can be helpful in preoperative planning.Nonoperative treatment includes activit
y modification followed by a gradual rehabilitation program. For persistent symp
tomatic instability, operative treatment includes reconstruction of the MCL with
a tendongraft, removal of any associated osteophytes or loose bodies, and decom
pression of ulnar neuritis.
Copyright 2008 Elsevier Inc. All rights reserved. - www.mdconsult.com
Greene: Netter's Orthopaedics, 1st ed.
Copyright 2006 Saunders, An Imprint of Elsevier
Posterolateral Rotatory Elbow Instability
Posterolateral rotatory instability develops after injury to the ulnar collatera
l component of the LCL. With alax or attenuated ligament, patients report latera
l elbow pain and catching or giving way of the elbow. Thelateral pivot test may
be difficult to perform except when the patient is completely relaxed under anes
thesia. MRI studies often identify the ligament disruption. Reconstruction of th
e lateral ulnar collateralligament with a tendon graft is required for treatment
of persistent and disabling symptoms.
Copyright 2008 Elsevier Inc. All rights reserved. - www.mdconsult.com
Greene: Netter's Orthopaedics, 1st ed.
Copyright 2006 Saunders, An Imprint of Elsevier
Rupture of the Distal Biceps Tendon
Rupture of the distal biceps brachii tendon is uncommon; however, timely diagnos
is of these injuries isimportant because failure to recognize and repair the les
ion before the onset of irreversible musclecontraction decreases the strength of
elbow flexion and forearm supination by 30% to 50%. Predisposingfactors include
a male older than 40 years and the presence of preexisting degenerative changes
in thetendon. Rupture typically occurs at the insertion of the biceps tendon in
to the radial tuberosity (see
Figure15-13
).Injury results from an extension force on a partially flexed and contracting
biceps muscle. Patientsfrequently report the acute onset of sharp pain in the an
terior aspect of the elbow, followed by a chronic,dull ache that is exacerbated
by lifting activities. Examination shows tenderness and a defect in theantecubit
al fossa resulting from absence of the normally prominent bicipital tendon. If t
he aponeurosisremains intact, the defect is not as obvious. If the tendon ruptur
e is incomplete, no defect is obvious, butthe patient experiences pain and weakn
ess on flexion of the elbow against resistance. Radiographs areusually normal. M
RI may be helpful in evaluation of equivocal cases.Partial ruptures can be manag
ed with splinting and activity modifications. Complete ruptures are treatedmore
successfully with operative repair. Injury to the radial nerve is a possible com
plication of surgicalrepair.

Copyright 2008 Elsevier Inc. All rights reserved. - www.mdconsult.com

Greene: Netter's Orthopaedics, 1st ed.
Copyright 2006 Saunders, An Imprint of Elsevier
Olecranon Bursitis
The olecranon bursa is easily irritated because of its superficial location (see
Figure 15-13
) and thetendency for people to lean on their elbows. Precipitating factors inc
lude falls or direct blows, aninflammatory arthritis such as rheumatoid arthriti
s or gout, and occupations and avocations that causeprolonged irritation. Olecra
non bursitis also may develop in patients with chronic lung disease who lean ont
heir elbows to aid breathing. Septic bursitis (infection) may occur primarily, b
ut it is more likely to developas a secondary complication of aseptic olecranon
bursitis.The onset of pain and swelling is relatively rapid when caused by traum
a or infection but is indolent whencaused by other conditions. Pain is variable,
exacerbated by elbow flexion, and more intense withinfection. Examination revea
ls a boggy swelling over the olecranon process. Erythema and increasedwarmth are
common in patients with acute bursitis and universal in individuals with septic
bursitis.Tenderness is less marked in chronic, recurrent aseptic bursitis.If th
e olecranon bursitis is small and only mildly symptomatic, treatment should incl
ude observation,avoidance of direct pressure, and, occasionally, short-term spli
nting with the elbow extended. Patientswith more symptomatic bursitis should hav
e the bursa aspirated for Gram stain and culture. Patientswithout infection shou
ld have the elbow protected and immobilized in relative extension with a foam or
compressive dressing. Patients with septic bursitis require limited surgical dr
ainage or daily aspirationand antibiotic administration that covers penicillin-r
esistant
Staphylococcus aureus
. Excision of achronically inflamed olecranon bursa should be avoided if at all
possible because recurrence is commonand operative treatment may lead to chronic
infection.
Copyright 2008 Elsevier Inc. All rights reserved. - www.mdconsult.com
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Branduri de top
PopulareIT, Electronice & ElectrocasniceJucarii, Copii & BebeCasa, Gradina & Aut
oFashion & Ingrijire personalaTimp liber
Samsung
Philips
Chicco
BOSCH
ASUS
Pampers
Sony
Apple
LEGO
Lenovo
LG
Whirlpool

Humanitas
Lacoste
Guess
Descarca aplicatia eMAG
Lasa-ne numarul tau de telefon si iti vom trimite link-ul de download.
07xxxxxxxx
Trimite SMS
Servicii pentru clienti
Deschiderea coletului la livrare
30 de zile drept de retur
Garantii si service
Suport 24/7
Plata cu cardul in rate fara dobanda
Finantare in rate prin eCREDIT
Comenzi si livrare
Contul meu la eMAG
Cum comand online
Livrarea comenzilor
Cele mai noi produse
Vanzari corporate
Suport clienti
Suport 24/7
Formular reparatie produs
Formular returnare produs
Formular reclamatii si sesizari
Intrebari frecvente
Contact
eMAG.ro
eMAG Marketplace
Termeni si conditii
Prelucrarea datelor cu caracter personal
Politica de utilizare Cookie-uri
ANPC
Solutionarea litigiilor
Afla Despre
eMAG Cariere
Showroom-uri
Fundatia eMAG
Blog
Program afiliere
Copyright 2001-2016 Dante International, CUI: 14399840, Reg. Com. J40/372/2002 e
mag.bg emag.hu
intra in cont
Nu ai cont? Click aici
Ce vrei sa cauti azi?
Contul meu Favorite Cosul meu
Oferta Produse
Tehnologii SMART
Laptop, Tablete & Telefoane
PC, Periferice & Software
TV, Audio, Foto & Gaming
Electrocasnice & Climatizare
Fashion
Ingrijire personala & Cosmetice
Carti, Birotica & Cadouri
Casa, Bricolaj & Petshop
Sport & Activitati in aer liber

Auto, Moto, RCA & Roviniete

Jucarii, Copii & Bebe
Supermarket
Toate departamentele
Promotiile saptamanii Resigilate Lichidari Carduri cadou Aboneaza-te la newslet
ter! eMAG Help
Cea mai variata gama de produse
Livrare rapida
Deschiderea coletului la livrare
Suport 24/7
Retur simplu in 30 de zile
Ce se cumpara acum
actualizare la 30 de secunde Live
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Bucura-ti simturile!
TV, Electronice & Foto
Tehnologii de ultima ora Extinderea garantiei 30 zile drept de retur eCREDIT
Televizoare & accesorii
Audio HI-FI & Profesionale
Home Cinema & Audio
Videoproiectoare & accesorii
Playere, Boxe portabile & Casti audio
Aparate foto & accesorii
Camere video & sport
eBook Readere si Accesorii
Telescoape & Optica
Promotii televizoare
Promotii console gaming
Promotii soundbar
Promotii casti audio
Promotii foto D-SLR
La promotie
Aparat foto digital Canon PowerShot G9x, 20.2MP, Silver
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Aparat foto digital Canon SX530 HS, 16MP, Black, Premium KIT (include Geanta Pol
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eMAG - Aplicatie mobile
Fii conectat la lumea ta!
Laptop, Tablete & Telefoane
Extinderea garantiei 30 de zile drept de retur eCREDIT
Laptopuri & accesorii
Laptop / Notebook
Genti laptop
Telefoane mobile & accesorii
Tablete & accesorii
Telefoane fixe & Sisteme de teleconferinta
Promotii laptopuri
Promotii telefoane mobile
Promotii tablete
Promotii iPad
Promotii casti PC
La promotie
Laptop Dell Inspiron 15 (5559) 5000 Series, 15.6-inch HD (1366x768), Intel Core
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i5-6200U, 8GB (2x4GB) DDR3L 1600MHz, 1TB SATA (5400rpm
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000 Lei
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Laptop HP ProBook 470 G3 cu procesor Intel Core i5-6200U 2.30GHz, Skylake , 17.3", 8
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Telefon mobil Samsung Galaxy E5, Dual Sim, 16GB, Black
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Branduri de top
PopulareIT, Electronice & ElectrocasniceJucarii, Copii & BebeCasa, Gradina & Aut
oFashion & Ingrijire personalaTimp liber
Samsung
Philips
Chicco
BOSCH
ASUS
Pampers
Sony
Apple
LEGO
Lenovo
LG
Whirlpool
Humanitas
Lacoste
Guess
Descarca aplicatia eMAG
Lasa-ne numarul tau de telefon si iti vom trimite link-ul de download.
07xxxxxxxx
Trimite SMS
Servicii pentru clienti
Deschiderea coletului la livrare
30 de zile drept de retur
Garantii si service
Suport 24/7
Plata cu cardul in rate fara dobanda
Finantare in rate prin eCREDIT
Comenzi si livrare
Contul meu la eMAG
Cum comand online
Livrarea comenzilor
Cele mai noi produse
Vanzari corporate
Suport clienti
Suport 24/7
Formular reparatie produs
Formular returnare produs
Formular reclamatii si sesizari
Intrebari frecvente
Contact
eMAG.ro
eMAG Marketplace
Termeni si conditii
Prelucrarea datelor cu caracter personal
Politica de utilizare Cookie-uri
ANPC
Solutionarea litigiilor
Afla Despre
eMAG Cariere
Showroom-uri
Fundatia eMAG

Blog
Program afiliere
Copyright 2001-2016 Dante International, CUI: 14399840, Reg. Com. J40/372/2002 e
mag.bg emag.hu
intra in cont
Nu ai cont? Click aici
Ce vrei sa cauti azi?
Contul meu Favorite Cosul meu
Oferta Produse
Tehnologii SMART
Laptop, Tablete & Telefoane
PC, Periferice & Software
TV, Audio, Foto & Gaming
Electrocasnice & Climatizare
Fashion
Ingrijire personala & Cosmetice
Carti, Birotica & Cadouri
Casa, Bricolaj & Petshop
Sport & Activitati in aer liber
Auto, Moto, RCA & Roviniete
Jucarii, Copii & Bebe
Supermarket
Toate departamentele
Promotiile saptamanii Resigilate Lichidari Carduri cadou Aboneaza-te la newslet
ter! eMAG Help
Cea mai variata gama de produse
Livrare rapida
Deschiderea coletului la livrare
Suport 24/7
Retur simplu in 30 de zile
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actualizare la 30 de secunde Live
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Camere video & sport
eBook Readere si Accesorii
Telescoape & Optica

Promotii
Promotii
Promotii
Promotii
Promotii

televizoare
console gaming
soundbar
casti audio
foto D-SLR

La promotie
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Fii conectat la lumea ta!
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Extinderea garantiei 30 de zile drept de retur eCREDIT
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Laptop / Notebook
Genti laptop
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Tablete & accesorii

Telefoane
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fixe & Sisteme de teleconferinta

laptopuri
telefoane mobile
tablete
iPad
casti PC

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Branduri de top
PopulareIT, Electronice & ElectrocasniceJucarii, Copii & BebeCasa, Gradina & Aut
oFashion & Ingrijire personalaTimp liber
Samsung
Philips
Chicco
BOSCH
ASUS
Pampers
Sony
Apple
LEGO

Lenovo
LG
Whirlpool
Humanitas
Lacoste
Guess
Descarca aplicatia eMAG
Lasa-ne numarul tau de telefon si iti vom trimite link-ul de download.
07xxxxxxxx
Trimite SMS
Servicii pentru clienti
Deschiderea coletului la livrare
30 de zile drept de retur
Garantii si service
Suport 24/7
Plata cu cardul in rate fara dobanda
Finantare in rate prin eCREDIT
Comenzi si livrare
Contul meu la eMAG
Cum comand online
Livrarea comenzilor
Cele mai noi produse
Vanzari corporate
Suport clienti
Suport 24/7
Formular reparatie produs
Formular returnare produs
Formular reclamatii si sesizari
Intrebari frecvente
Contact
eMAG.ro
eMAG Marketplace
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Afla Despre
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Fundatia eMAG
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Program afiliere
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mag.bg emag.hu
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