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Suggest Treatment For A Medial Epicondyle Fracture Of The Elbow
Question: I recently injured my elbow after falling while running; it took the brunt of the blow. I already have a "frozen" shoulder, and nerve damage from previous accidents in the C4 area of my spine. After the fall, I thought I had sprained it, and continued to use it in everyday activities, until while playing pool it popped and made a nasty noise and I was on the floor in pain.
After seeing my primary care dr., I was told at first that I had a chip fracture in my elbow (that x-ray is attached). I spoke with one Ortho, and he recommended surgery to fix it. I spoke with another today and he would do nothing and send me to PT, stating that the fracture had to be at least two-years old, and that he would "need more data".
Now I have a third apt at Mayo Clinic with an Ortho who has already seen the x-ray, etc.
What is going on with my elbow, in your expert opinion? Please let me know what and a treatment suggestion you'd pursue. And what you’d to gather more data on the soft tissue and nerve damage.
My profile is: 34, 160 pounds, smoker, light drinker, I work on computers all day and have for past 15 years, I work long hours and play guitar professionally.
Please help.
Confused in PHX
After seeing my primary care dr., I was told at first that I had a chip fracture in my elbow (that x-ray is attached). I spoke with one Ortho, and he recommended surgery to fix it. I spoke with another today and he would do nothing and send me to PT, stating that the fracture had to be at least two-years old, and that he would "need more data".
Now I have a third apt at Mayo Clinic with an Ortho who has already seen the x-ray, etc.
What is going on with my elbow, in your expert opinion? Please let me know what and a treatment suggestion you'd pursue. And what you’d to gather more data on the soft tissue and nerve damage.
My profile is: 34, 160 pounds, smoker, light drinker, I work on computers all day and have for past 15 years, I work long hours and play guitar professionally.
Please help.
Confused in PHX
Brief Answer:
detailed below.
Detailed Answer:
Hello,
Welcome to Healthcare Magic.
I read carefully your query and examined closely the X-ray you provided.
From the X-ray it is clear that you have a medial epicondyle fracture ,when the epicondyle seem to be avulsed.
Other X-rays with a lateral view of the elbow would be really helpful to determine better the localization of the fractured part.
The treatment of this type of fracture can be conservative or surgical.If the avulsed medial epicondyle is not displaced or the fracture has between 5-15 mm displacement , it can be treated with 1-2 weeks cast or splint.
If the amount of dislocation of the fractured part is greater ,surgical fixation is necessary to bring the medial epicondyle in place.
To determine clearly the exact location of the fractured part and the amount of dislocation ,further investigation are necessary including : lateral X-ray of the elbow and probably MRI.
From the X-ray I would say that there is no significant soft tissue damage.
Hope this helps.
Let me know if you have any other question.I will try my best to answer thoroughly and clear your doubts.
Kind regards,
Dr.Rovena Murati
detailed below.
Detailed Answer:
Hello,
Welcome to Healthcare Magic.
I read carefully your query and examined closely the X-ray you provided.
From the X-ray it is clear that you have a medial epicondyle fracture ,when the epicondyle seem to be avulsed.
Other X-rays with a lateral view of the elbow would be really helpful to determine better the localization of the fractured part.
The treatment of this type of fracture can be conservative or surgical.If the avulsed medial epicondyle is not displaced or the fracture has between 5-15 mm displacement , it can be treated with 1-2 weeks cast or splint.
If the amount of dislocation of the fractured part is greater ,surgical fixation is necessary to bring the medial epicondyle in place.
To determine clearly the exact location of the fractured part and the amount of dislocation ,further investigation are necessary including : lateral X-ray of the elbow and probably MRI.
From the X-ray I would say that there is no significant soft tissue damage.
Hope this helps.
Let me know if you have any other question.I will try my best to answer thoroughly and clear your doubts.
Kind regards,
Dr.Rovena Murati
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
OK -- thank you for your answers. I have gathered the full X-rays, which include the lateral view of the arm.
Symptoms:
-Redness
-Swelling (controlled with heat and ice)
-90% reduction in mobility.
The arm, when laid flat, dips upwards about 15 degrees, whereas the adjacent, healthy arm lays prone.
The arm, when bent up as far as possible, does not even reach 30%, and is unable to be bent further up.
The arm throbs persistently, and is unable to pull open doors, support weight, etc.
The elbow and upper arm, shoulder are all very tender, and the shoulder cracks when stretched, has limited range of motion and likely muscle and tendon damage (which an MRI will confirm).
My thoughts are:
Fractured elbow
Torn tendons
Torn Ulnar Collateral Ligament of the Elbow
medial epicondyle fracture, possibly avulsed
Your thoughts, I have uploaded these new reports.
I have a pre-surgery consultation at Mayo Clinic on March 16th. They will be doing an MRI on my left and right shoulder and the arm and elbow.
Symptoms:
-Redness
-Swelling (controlled with heat and ice)
-90% reduction in mobility.
The arm, when laid flat, dips upwards about 15 degrees, whereas the adjacent, healthy arm lays prone.
The arm, when bent up as far as possible, does not even reach 30%, and is unable to be bent further up.
The arm throbs persistently, and is unable to pull open doors, support weight, etc.
The elbow and upper arm, shoulder are all very tender, and the shoulder cracks when stretched, has limited range of motion and likely muscle and tendon damage (which an MRI will confirm).
My thoughts are:
Fractured elbow
Torn tendons
Torn Ulnar Collateral Ligament of the Elbow
medial epicondyle fracture, possibly avulsed
Your thoughts, I have uploaded these new reports.
I have a pre-surgery consultation at Mayo Clinic on March 16th. They will be doing an MRI on my left and right shoulder and the arm and elbow.
Brief Answer:
detailed below.
Detailed Answer:
Hello again.
I saw carefully the new X-rays you provided.
The lateral view of the arm seems quite normal .The fracture of medial epicondyle is not visible on this view.The localization of the avulsed part of medial epicondyle is not clear.
A MRI is necessary to evaluate every possible soft tissue injury (tendons and ligaments) and to determine the location of the avulsed part.
In this avulsed part is localized inside the joint ,it can cause considerable swelling and reduction of joint mobility.
From the X-rays is not very clear the localization of this part.
From the X-rays it doesn't seems to have major soft tissue injury or swelling.
It is normal to experience redness , swelling and reduced mobility of the joint considering the fact that you have medial epicondyle fracture.
Injuries in tendons and ligaments are difficult to assess in X-rays.They are suspected from patients complain and physical examination and are confirmed with MRI.
A torn Ulnar Collateral Ligament of the Elbow would cause pain along the inside of the elbow with swelling,reduced mobility of joint.In this case closing the hand and clenching the fist reproduces the painful symptoms.There is test used to evaluate the integrity of this ligament called Valgus stress test and if the ligament is inured the test will show increased laxity compared with the other side.
Injuries of biceps tendons would cause apart considerate swelling,bruising and a deformed view of the arm but also would cause difficulties rotating your arm from a "palm up" to a "palm down" position.
Despite the clinic and the physical findings ,only MRI can exclude possible tendons and ligaments injuries.
So considering all your symptoms it is possible that the fracture is also associated with tendon or ligament injuries but this requires a careful physical examination of the arm and doing specific tests to confirm it.
Hope this helps.
Please let me know if you have any other question.
Kind regards,
Dr.Rovena
detailed below.
Detailed Answer:
Hello again.
I saw carefully the new X-rays you provided.
The lateral view of the arm seems quite normal .The fracture of medial epicondyle is not visible on this view.The localization of the avulsed part of medial epicondyle is not clear.
A MRI is necessary to evaluate every possible soft tissue injury (tendons and ligaments) and to determine the location of the avulsed part.
In this avulsed part is localized inside the joint ,it can cause considerable swelling and reduction of joint mobility.
From the X-rays is not very clear the localization of this part.
From the X-rays it doesn't seems to have major soft tissue injury or swelling.
It is normal to experience redness , swelling and reduced mobility of the joint considering the fact that you have medial epicondyle fracture.
Injuries in tendons and ligaments are difficult to assess in X-rays.They are suspected from patients complain and physical examination and are confirmed with MRI.
A torn Ulnar Collateral Ligament of the Elbow would cause pain along the inside of the elbow with swelling,reduced mobility of joint.In this case closing the hand and clenching the fist reproduces the painful symptoms.There is test used to evaluate the integrity of this ligament called Valgus stress test and if the ligament is inured the test will show increased laxity compared with the other side.
Injuries of biceps tendons would cause apart considerate swelling,bruising and a deformed view of the arm but also would cause difficulties rotating your arm from a "palm up" to a "palm down" position.
Despite the clinic and the physical findings ,only MRI can exclude possible tendons and ligaments injuries.
So considering all your symptoms it is possible that the fracture is also associated with tendon or ligament injuries but this requires a careful physical examination of the arm and doing specific tests to confirm it.
Hope this helps.
Please let me know if you have any other question.
Kind regards,
Dr.Rovena
Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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