Common Bony and/or Articular Conditions

Osteoarthritis and rheumatoid arthritis, dislocation and history of fracture are factors which may lead to progressive loss of function and/or surgical intervention

Myositis Ossificans (MO) & Heterotopic Ossification (HO)

  • Bone spontaneously lays down into muscle (MO) or in surrounding areas or joint space (HO) following blunt trauma or fracture
  • Idiopathic onset associated with traumatic brain injury
  • Presents as red, hot, swollen, marked painful motion
  • Active and passive ROM is encouraged and may require spinting.
  • MASSAGE, PASSIVE STRETCHING AND RESISTIVE EXERCISES ARE CONTRAINDICATED

Internal Derangement

  • periodic locking of joint due to loose bodies in joint
  • results in loss of end-range flexion and extension which gradually resolve; repeat occurrences and predispose OA changes
  • in adolescents: associated with trauma (chip fracture) or osteochondrosis
  • in adults: cartilage fractures due to trauma and becomes a loose body (treated with joint manipulation); may need arthroscopic removal
  • in mid-age to elder: fragments are more numerous: may result in longer periods of limted motion

Subluxation of the Radial Head

  • "Nursemaid's Elbow" or "Pulled Elbow": sudden traction injurynursemaids elbow.jpg
  • Child is lifted up suddenly by the arm while it is held over their head in a pronated and extended position
  • Presents with painful inability to use arm and avoidance of supination
  • Generally resolves with short term immobilization

Trauma

  • sprain/strain to joint capsule (likelihood increases with RA)
  • traumatic ulnar dislocation
  • fracture (radial fracture is most common elbow fracture)
  • may result in post-immobilization capsular tightness and loss of motion, especially with closed reduction of a fracture
  • may result in progressive osteoarthritis or joint replacement
  • displaced fractures may require surgery with hardware and/or removal of bone
  • should be taken with stretching if there is a bony block to ROM; overstretching can lead to hypermobility

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Elbow Dislocation

Elbow subluxation and dislocation can have long-standing secondary effects associated with nerve trauma and heterotopic ossification. Uncontrolled swelling can result in disability that includes the wrist and hand.

Patients are typically placed in a posterior splint for up to 2 weeks and then begin gradual ROM and strengthening of surrounding structures to progressively add stability while ROM is progressively increased.