Elbow axis deviations - cubitus varus & cubitus valgus
Elbow axis deviations - cubitus varus & cubitus valgus
The axial deviation of the elbow
Changes of position (axial deviation) in the elbow joint are relatively common. It is usually a condition following injuries in childhood. The most common deviation of the joint axis is inward, in the varus, which means a change towards the center of the body in the frontal plane. Among other things, this can lead to severe movement restrictions.
The axis of the upper limb is expressed by the angle defined by the longitudinal axis of the arm and the longitudinal axis of the forearm when the elbow is extended. The physiological value of this angle is between 5 and 15 degrees outwards (from the body), whereby the angle is slightly greater in women than in men. This angle gradually decreases as the elbow is flexed. In pathological axial deviation, in which the lower end of the humerus points inwards (cubitus varus), the angle of the elbow is negative (the hand points inwards relative to the arm). With flexion, the hand then moves outwards atypically in relation to the arm. In most cases, however, it is not a deformity in just one plane, but a spatial problem, i.e. a deformity in all three planes.
Forms of malalignment - cubitus varus & cubitus valgus
The physiological shape of the elbow can be affected by varus or valgus deviations. The axis deviation can be recognized by a side comparison.
1. Cubitus varus:
This is a deviation of the elbow axis inwards. The forearm is shifted towards the center of the body in relation to the upper arm. This can often be caused by fractures of the distal humerus (upper arm bone), particularly in the area of the so-called medial epicondyle.
2. cubitus valgus:
In contrast, cubitus valgus is an outward deviation of the elbow axis. The forearm deviates away from the center of the body in relation to the upper arm. Cubitus valgus can also be caused by fractures, particularly in the area of the lateral epicondyle.
Misalignments can lead to severe pain
Axial deviations in the elbow area are not always just a cosmetic problem. This leads to overloading of the joint on the inside, causing pain and the gradual development of osteoarthritis (joint wear and tear). This leads to a restriction in the range of motion and thus also to a deterioration in the function of the entire upper limb. On the outside of the joint, there may be a gradual stretching of the outer collateral ligament, which can lead to instability of the joint. Paralysis of the ulnar nerve can also gradually develop.
Treatment options for axis deviations
Treatment options for axis deviations
How cubitus valgus and cubitus varus are treated depends on various factors:
- Severity of the deformity
- Age of the patient
- any existing symptoms
An accurate diagnosis is necessary to identify the correct medical indications for the treatment of elbow problems. Contact me for an appointment!
Therapy and exercises
In mild forms, physiotherapy exercises and targeted stretching exercises can help to improve the mobility of the elbow. Physiotherapy can also help to strengthen the muscles and support the function of the elbow.
Surgical correction for deviations of the elbow
If the pain is very severe or the axial deviation leads to restrictions, the only solution for such a poorly healed fracture is surgery. Corrective osteotomy is a surgical procedure to realign bones in order to correct the deformity in the elbow.
Correction during childhood or after growth arrest is possible. Corrections on children are generally easier for the surgeon than an operation on an adult patient. The average age of the injury is 5-6 years, the average age of correction in childhood is 10 years.
There are a number of options for surgically correcting this deformity. These are completely different in children and adults. The main difference is not only the speed of healing (faster in children), but children also have a firmer periosteum. This makes it easier to restore the range of motion of the fixed elbow joint after the operation. The surgical approach is smaller and therefore less invasive in children. Internal fixation of the bone after correction is also much less demanding in children.
During surgery, I always try to correct not only the obvious axial deviation of the forearm inwards, but also the deviation in the remaining two planes (deviation backwards and rotational deviation). This requires not only the necessary imaging examinations, but also subsequent very careful planning of the operation. The operation itself is not easy and should be performed by an experienced specialist.
experienced specialist
. After a correctly performed operation, the patient begins active rehabilitation exercises from the second postoperative day so as not to restrict the range of movement. I have operated on dozens of patients and they are generally very satisfied.
