epidemiology

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

Epidemiology

2 groups

- young patient with high velocity injury

- older patient with comminuted, osteoporotic fracture

In the second group fixation can be very difficult

Anatomy

Hinged Joint

- trochlea axis is centre of rotation

- 40^o anterior angulation in sagittal plane

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

50% rheumatoid patients have elbow pathology

- 80% also have shoulder pathology

- 90% hand and wrist

Always consider entire upper limb

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

Osteochondritis Dissecans

- separation of avascular fragment of bone & cartilage

Epidemiology

M : F = 2:1

Mean age 18 years

- can present as young as 9

4:1000

Definition

Round or "D" shaped rather than crescenteric meniscus

- occupies > 70% of tibial surface

- 90% occur on lateral side

Epidemiology

Uncommon

- 1:100

- usually presents in children & adolescents

Epidemiology

Average age 6 years

20% distal humeral fracture

- second most common elbow fracture after supracondylar

Mechanism

Pull Off 

- more common 

- fracture begins posterolateral metaphysis

- LCL, ECRL & ECRB attached to fragment

Push off

- varus force to extended EJ

Classification

Definition

Any act or failure to act that

- results in or potentially results in harm / death / physical / emotional / sexual abuse

- by a parent or caretaker who is responsible for the child

4 types

Neglect 

Physical (punch / kick / bite / burn / shake)

Sexual 

Emotional

Risk factors