Elbow protrusion

Elbow protrusion is medically known as cubitus valgus, which is also common in young children and is directly related to fracture of the medial and lateral condyles of the humerus, premature closure, necrosis that cannot be reduced, or poor reduction. Elbow protrusion usually has no obvious symptoms and appears deformed. Some serious elbow protrusions can easily cause delayed ulnar neuritis, osteoarthritis and other diseases, and treatment needs to be carried out according to the condition.

When the normal elbow joint is fully extended, there is a slight valgus, about 10° in men and about 15° in women. This eversion angle is called the carry angle. If this angle increases, the forearm is too abducted, which is called cubitus valgus deformity.

Causes

Failure to timely reduce or poor reduction of lateral and medial humeral condyle fractures in children, premature closure or ischemic necrosis of the lateral humeral condyle epiphysis, and unreduced or poorly reduced elbow dislocation can all lead to elbow valgus. Cubital valgus caused by medial humeral condyle fracture is due to overgrowth of the medial humeral condyle. Unreduced or poorly reduced elbow dislocation can also cause elbow valgus. The reason why elbow valgus occurs after radial head resection is that the important mechanical blocking function of the proximal radius disappears after the radial head resection, causing abnormal biomechanics of the elbow joint and forearm.

Clinical manifestations

The elbow is deformed in appearance, often asymptomatic, and the elbow valgus angle increases when the elbow is in extended position, reaching more than 30°. There is generally no obvious obstacle to elbow joint movement, but damage to the articular surface of the elbow in the late stage may cause pain. For patients with severe hallux valgus, because the ulnar nerve is in a state of high tension or is frequently rubbed due to adhesions after trauma, delayed ulnar neuritis may occur, with symptoms of ulnar nerve injury, that is, tingling and sensory disturbances in the ulnar nerve-controlled area of ​​the hand (the little finger and half of the ring finger), weakness and atrophy of the intrinsic muscles of the hand, etc. People who engage in heavy physical labor may develop osteoarthritis of the elbow joint.

treat

Generally, elbow valgus without elbow dysfunction and pain symptoms does not need to be treated.

1. Conservative treatment

It is suitable for patients with early-stage elbow osteoarthritis with mild clinical symptoms and no obvious elbow dysfunction. Pain is the most common symptom, which can be treated with physical therapy such as physical therapy and massage, or by taking medications such as aspirin, and can also be supplemented with neurotrophic drugs.

2. Surgery

(1) Surgical method: supracondylar osteotomy and ulnar nerve advancement.

(2) Indications for surgery include: ① Severe cubital valgus deformity that has been stable for more than several years. ② Those with obvious joint pain and weakness symptoms that affect elbow joint function. ③Those with traumatic arthritis. ④Those with delayed ulnar neuritis.

The main purpose of surgery is to correct deformity, stabilize joints, relieve pain, change uneven force on joints, and prevent worsening of joint degeneration.

Elbow valgus is mainly the result of elbow trauma and lesions. Therefore, when the elbow is traumatic and lesions occur, the possibility of elbow valgus or valgus deformity should be considered, especially when there is a supracondylar fracture of the humerus or elbow dislocation. It is important to correct the lateral displacement first, and then make other readjustments, and try to achieve anatomical readjustment as much as possible. If the deformity is mild and asymptomatic, no treatment is necessary. If the deformity is obvious or delayed ulnar nerve injury occurs, surgery should be performed as soon as possible to avoid irreversible changes such as osteoarthritis or ulnar nerve injury.