Chapter 29 - The elbow Flashcards
Commonest cause of cubitus varus
Supracondylar fracture
Commonest cause of cubitus valgus
Previous lateral condyle fracture
Causes of fixed flexion deformity in the elbow
- Previous elbow fracture
- Synovitis
- Elbow arthritis
What makes up the joint margin of the elbow joint
- Lateral epicondyle
- Tip of the olecranon
- radial head
Typical history of lateral epicondylitis
- Pain sited at the lateral epicondyle and radiates down the extensor muscles
- Pain is aggravated on lifting objects such as a tea cup and with a hand shake
Examination findings of lateral epicondylitis
- Tenderness over the lateral epicondyle
- Pain on resisted extension of the wrist with elbow extended and forearm pronated
- Pain on passive flexion of the wrist
Treatment of lateral and medial epicondylitis
- Rest and NSAIDs
- Extension wrist brace in severe acute case
- Counterforce brace
- Injection with cortisone and local anaesthetic
- Physiotherapy
- Surgical release (less than 5 percent require this)
- Shock wave therapy?
- Injections of platelet derived growth factors?
Typical history of medial epicondylitis
- Pain sited over the medial epicondyle and radiates down the forearm
- may be associated ulna nerve entrapment (symptoms of ulna neuritis
Examination findings of medial epicondylitis
- Tender over the medial epicondyle
- pain on resisted flexion of the wrist with elbow extended and forearm supinated
- pain on passive extension of the wrist
Where is the pain sited in biceps tendonitis
-Over the biceps tuberosity 2 cm distal to the cubital crease over the radius and radiated up the biceps and/or down the forearm
Examination findings of biceps tendinitis
Tenderness of the biceps tuberosity
Positive yergason test
Positive Speed test
Treatment of biceps and triceps tendinitis
- Rest and NSAIDs
- Injection with cortisone and local anaesthetic
- Physiotherapy
Where is the pain sited in triceps tendinitis
Over the olecranon/ distal triceps
Examination findings of triceps tendinitis
Tenderness over the olecranon tip
Pain on resisted extension of the elbow flexed
Causes of olecranon bursitis
- Chronic irritation
- Inflammatory arthritis
- Gout
- Septic bursitis
Treatment of olecranon bursitis
- Treat underlying cause
- Anti-inflammatories
- Compression bandage with tubigrip for three weeks
- Aspiration and cortisone injection if not septic
- Septic - treat with antibiotics
- Surgical excision if does not settle
Examination findings of posterior olecranon impingement
- Slight loss of extension
- tenderness over the olecranon tip and fossa
- Pain on full extension
- No pain on resisted extension
What may be seen on Xray in posterior olecranon impingement
small fracture or osteophyte of olecranon tip
Types of arthritis in the elbow joint
- Infective: pyogenic, TB
- Inflammatory: RA, gout
- Post traumatic OA
- Degenerative OA
Investigations for arthritis of the elbow
XRay
CT scan seldom necessary
MRI in selected cases
FBC, ESR, CRP and arthritis screen where indicated
Treatment of infective arthritis of the elbow
- Washout/ debridement/ biopsy/ culture/ appropriate antibiotics
Treatment of non- infective arthritis of the elbow
- NSAIDs/ Analgesics/ Intra-articular steroid
- Synovectomy
- Debridement- open/ arthroscopic
- Arthroplasty- interposition for younger patients
- Total elbow replacement
- Arthrodesis as last resort
