2: Joint Disorders Of The Elbow Flashcards
What is the most common cause of medial epicondyle pain
Medial epicondylitis
What is medial epicondylitis also known as
Golfer’s Elbow
What age is the peak incidence of medial epicondylitis
30-40y
What causes medial epicondylitis
Repetitive use of the fore-arm flexors
How will medial epicondylitis present clinically
- Pain on flexion of the fore-arm
- Tenderness over the medial epicondyle
- Potentially parasthesia of 4+5th finger (ulna.N)
What muscles originate at the medial epicondyle
Pronator teres and fore-arm flexors
Explain the pathophysiology of medial epicondylitis
Repetitive use of fore-arm flexors leads to micro-trauma and subsequent inflammation.
How is medial epicondylitis managed
Conservatively:
- Brace/Strap
- NSAIDs
- Ice
- Rest
When is surgery for medial epicondylitis indicated
Refractory to medial treatment for 6-12m and severely impacting QOL
What surgery can be offered for medial epicondylitis
Open debridement and excision of under surface of pronator mass
What is lateral epicondylitis also referred to as
tennis elbow
What is a good mnemonic to remember lateral epicondylitis
LET
Lateral epicondylitis
Extensors
Tennis elbow
What causes lateral epicondylitis
Repetitive use of fore-arm extensors
What is a risk factor for lateral epicondylitis
tennis
How will lateral epicondylitis present
- pain on gripping
- reduced grip strength
- pain on forearm extension
Which muscle in particular often leads to tennis elbow
extensor carpi radialis brevis
How is tennis elbow diagnosed
clinically
What is first-line management for lateral epicondylitis
Conservative:
- NSAIDs
- Rest
- Ice
- Strap/Brace
What is second line for lateral epicondylitis
Open debridement of extensor carpi radialis brevis (ERCB)
When is surgical debridement of extensor carpi radialis brevis indicated
If symptoms persist 6-12m following and impact QOL
What is olecranon bursitis also referred to as
Student’s elbow
What is olecranon bursitis
Inflammation of bursa surrounding the elbow
What is the typical demographic of olecranon bursitis
Middle-aged male patients
What causes olecranon bursitis
Continual pressure on the elbow. Eg. due to occupation or trauma
What are two risk factors for olecranon bursitis
- Gout
- Rheumatoid arthritis
How will olecranon bursitis present
- Swelling over posterior aspect of the elbow
- Pain
- Warmth and erythema
What investigations are performed for olecranon bursitis
Clinical diagnosis.
If septic arthritis is suspected, take an aspirate
What is first-line management of olecranon bursitis
Conservative:
- Rest
- Ice
- Compression bandaging
- Analgesia
If olecranon bursitis is large and painful, what may be performed
Aspiration
What should be prescribed if septic bursitis is suspected
Flucloxacillin
What is a complication of olecranon bursitis
Abscess formation (septic bursitis)
What is cubital tunnel syndrome
entrapment of the ulna nerve at the elbow
If the ulna nerve is trapped at the following what is it termed
a. wrist
b. elbow
a. Guyon’s canal syndrome
b. Cubital tunnel syndrome
What can cause cubital tunnel syndrome
- Prolonged elbow flexion
- Medial epicondyle fracture
- Non-union of medial epicondyle
- Diabetes
What are 3 situations may there be prolonged elbow flexion
- Leaning on a desk
- Post-surgical operation
- Athletes
Where will individual with cubital tunnel syndrome feel pain
Referred pain to the forearm
What are the 3 motor signs of ulna nerve damage
- Claw hand
- Wartenberg sign
- Froment sign
What is ulna claw hand
There is loss of flexion at the MCP and extension at the PIPs
What is wartenberg sign
Persistent abduction of the little finger caused by weak third interoessi muscle
What is froment sign
Thumb flexes when pinching a piece of paper to compensate for a weak abductor polices muscle
How is sensation affected in cubital tunnel syndrome
parasthesia or loss of sensation over 5th and half of 4th finger
How can sensory deficits in cubital tunnel syndrome be tested for
parasthesia when tapping over the medial epicondyle
Which cord of the brachial plexus is the ulna nerve derived from
Medial cord (C8-T1)
Explain the passage of the ulna nerve into the wrist
- Ulna.N arises from the medial cord
- It passes the medial epicondyle between the heads of the flexor carpi ulnaris
- It passes into the wrist via Guyon’s canal
What 5 muscles does the ulna nerve innervate
- 3rd and 4th Interoessi
- Lumbricals
- Flexor carpi ulnaris
- Adductor polices
- Abductor digiti minimi
What is the action of the third and 4th lumbricals
- Flex at the MCP
- Extend at the PIPs
What is the function of adductor policies
Adducts the thumb
What is the function of abductor policies
Abducts the thumb
What is the function of abductor digiti minimi
Abducts the little finger
What is the action of interoessi muscle
Finger abduction and adduction
Explain the ulna paradox
- Ulna nerve innervates half of the flexor digitorum profundus
- If the Ulna is injured more proximal (cubital tunnel.s) it looses it’s innervation
- Loss of FDP weakens flexion at the PIP. Meaning patient only presents with extension at the MCP joints
- The hand therefore presents less claw-like (and therefore less severe) despite being a more severe injury
What is first-line investigation for suspected cubital tunnel syndrome
Electromyography (EMG)
What is first-line management for cubital tunnel syndrome
Conservative:
- NSAIDs
- Behaviour modification
- Night bracing
What is second-line management for cubital tunnel syndrome
Surgery
What surgeries can be performed for cubital tunnel syndrome
- Surgical decompression
2. Medial epicondylectomy
