Osteoarthritis
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
Male & Females > 60 years
- X-ray evidence of OA
Symptomatic
- 25% females
- 15% males
Base thumb
PIPJ / Bouchard's nodes
DIPJ / Heberden's nodes
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
Parosteal OS
- bone is not continuous with cortex in MO
3% incidence in elbow joint trauma to some degree
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
1. Trauma & Overuse
Common throwing sports / gymnastics
Lateral : Medial 9:1
4th & 5th decades
- M = F
- 75% dominant arm
50% of regular tennis players
- especially > 2 hrs / week
Insertion pathology / Enthesopathy
Over-extension of the elbow with supination / pronation
Lateral epicondyle
- anconeus from posterior face
- ECRB and EDC from anterior face (CEO)
Relatively rare
Average age 50
Men 4:1 Women
Usually dominant arm
Primary
- associated with strenuous manual labour
Secondary
- trauma
- OCD
- synovial chondromatosis
- valgus extension overload / MCL insufficiency
A valgus knee has a tibiofemoral angle of > 10o
Inflammatory
- RA
Usually occurs in young people
- often previous history of tendonitis ± steroid injections
Usually at level of inferior pole of patella
- less common at tibial tubercle
- mid-substance ruptures rare
Severe pain
Palpable defect
Extensor deficit / unable to SLR
Patella alta / high riding patella
Osteochondritis Dissecans
- separation of avascular fragment of bone & cartilage
M : F = 2:1
Mean age 18 years
- can present as young as 9
4:1000
Developmental Anatomy
Knee joint first appears as a mesenchymal cleft at 8 weeks gestation
- ACL and PCL separate entities by week 10