2.05 Trauma and Orthopaedics - The Elbow Flashcards
Give some factors that contribute towards elbow joint stability.
- humeroulnar joint
- radiocapetellar joint
- joint capsule
- medial and collateral ligaments
- common flexor and extensor origin tendons
- surrounding musculature (ie. anconeus, brachialis, triceps brachii)
What are the clinical features of elbow dislocation?
- typically present following high-energy fall
- painful and deformed joint
- swelling
- decreased function
What neurovascular findings are common OE of elbow following dislocation?
- neuropraxia of the ulnar nerve causes deficit in the territory of the ulnar nerve
- elbow has rich collateral circulation, so good capillary refill even in those with arterial injury
What investigations can be used to assess elbow dislocation?
- plain film radiographs (AP and lateral)
What X-ray findings are consistent with an elbow dislocation?
Loss of radiocapitellar and ulnotrochlea congruence.
How is elbow dislocation managed?
- closed reduction
- sufficient analgesia / sedation
- apply above elbow backslab
- plain film radiograph to confirm reduction
If the dislocation is complicated by a fracture, open type injury, or has neurovascular compromise, ORIF may be used to surgically fix the injury.
What are the common complications of elbow dislocation?
- neuropraxia of the ulnar nerve
- recurrent instability
- early stiffness
What is the terrible triad of an elbow dislocation?
An elbow dislocation associated with:
1) lateral collateral ligament injury
2) radial head fracture
3) coronoid fracture
The combination of injuries causes a very unstable elbow, and patients are likely to have recurrent problems with instability, stiffness and arthrosis.
Treatment involves ORIF and surgical reconstruction of LCL.
What is the common aetiology of olecranon bursitis?
Repetitive flexion-extension movements at the elbow causes irritation of the bursa, due to its superficial position and its vulnerability to pressure and trauma.
What are the clinical features of olecranon bursitis?
- pain and swelling
- range of motion preserved
- systemic symptoms
What are the differential diagnoses for olecranon bursitis?
- inflammatory arthropathies
- gout
- cellulitis
- septic arthritis
What investigations can be used to assess olecranon bursitis?
- bloods (FBC, CRP)
- serum urate if history is suggestive of gout
- ACPA if history suggestive of rheumatological cause
- plain film radiograph to rule out bony injury
- aspiration of fluid for microscopy and culture (GOLD STANDARD)
How is olecranon bursitis treated?
Swellings without infection can be treated with analgesia and rest.
If infection is present, IV abx and surgical drainage / washout indicated.
What are the main complications of infected olecranon bursitis?
- septic arthritis
- osteomyelitis
Most cases will resolve spontaneously
What is epicondylitis?
A chronic and symptomatic inflammation of the forearm tendons at the elbow, classified as an overuse syndrome in the elbow.
Caused by microtears in the tendons following repetitive injury.
Out of lateral and medical epicondylitis, which is more common?
Lateral epicondylitis is more common, affecting 4-7 people per 1000 per year.
What is the pathophysiology of lateral epicondylitis?
Repetitive overuse of common extensor tendon causes microtears at its origin (lateral epicondyle).
This leads to the formation of granulation tissue, fibrosis and eventually tendinosis.
What is the main risk factor for lateral epicondylitis?
Occupations and hobbies that are associated with excessive use of extensive forearm muscles.
Commonly named tennis elbow.
What are the clinical features of lateral epicondylitis?
- pain at elbow and radiating down to forearm
- worsens over weeks to months
OE localised tenderness on palpation over the lateral epicondyle and common extensor tendon.
What special tests can be used to identify lateral epicondylitis?
Cozen’s test - positive test if pain over lateral epicondyle against wrist extension.
Mill’s test
What special tests can be used to identify lateral epicondylitis?
Cozen’s and Mill’s test
https://www.youtube.com/watch?v=8K7jzDIUpLI
https://www.youtube.com/watch?v=r_A84ox9JRM
What investigations are required to diagnose lateral epicondylitis?
Diagnosis is clinical, with no further imaging needed.
Occasionally ultrasound or MRI imaging used to detect structural abnormality if suspected.
How is lateral epicondylitis managed?
- modify activities to reduce repetitive actions
- simple analgesia and topical NSAIDs
- corticosteroid injections
- physiotherapy
If conservative measures do not control symptoms, surgical intervention via open or arthroscopic debridement may be warranted.
What is the prognosis of lateral epicondylitis?
Usually self-limiting and spontaneously improves in most patients within 2 years.
