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MSK 2023 > Clinical elbow conditions > Flashcards

Clinical elbow conditions Flashcards

1
Q

Most common elbow injury

A

Supracondylar fracture (extraarticular, joint not involved)

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2
Q

How do supracondylar fractures occur?

A

FOOSH, elbow hyperextended

eg monkey bars

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3
Q

Age for supracondylar fractures

A

<10

Peak 5-7 years - more active

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4
Q

Presentation supracondylar fracture

A

Pain
Deformity
Loss of function

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5
Q

Less common supracondylar fracture

A

Elderly

Falling on flexed elbow (5%)

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6
Q

Displacement supracondylar fractures

A

Posterior displacement `

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7
Q

Main complications supracondylar fractures

A 
Cubitus varus (gunstock deformity)
Median nerve damage
Ischaemic contracture (brachial artery)
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8
Q

Ischaemic contracture explained

A

Ischaemia –> infarction
Scar tissue (fibrosis)
Fibrous tissue contracts (myofibroblasts)
Volkmann’s ischaemic contracture

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9
Q

Volkmanns ischaemic contracture position

A

Flexed wrist and elbow
Pronated
Extended fingers at metocarpophalangeal joint
Flexed fingers at interphalangeal joint

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10
Q

Dislocated elbow, how does it occur?

A

FOOSH, elbow PARTIALLY flexed (strongest in full extension and flexion)

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11
Q

Elbow fracture X-ray

A

Posterior displaced
Ulna posteriorly displaced

(Humerus –> anterior)

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12
Q

Associated injuries dislocated elbow

A

Ulna ligament tear
Associated fracture?
Ulnar nerve damage

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13
Q

How do anterior elbow dislocations occur?

A

Force to posterior aspect of flexed elbow

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14
Q

What is pulled elbow?

A

Subluxation of radial head (partial disruption)

Due to tear of distal attachment to radius

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15
Q

Pulled elbow who and why?

A

Children 2-5 years old

Annular ligament weaker

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16
Q

What position is pulled elbow likely to occur in?

A

Pronated

Longitudinal traction on arm (pulling extended arm)

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17
Q

Why does subluxation occur more in pronated position?

A

Annular ligament is looser in pronation

Radial head more likely to ‘slip through’

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18
Q

Radial head and neck fracture cause

A

FOOSH

Radial head impacts on capitulum of humerus

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19
Q

Pulled elbow presentation

A

Reduced movement
Pain lateral proximal forearm (radial side)
Not using arm

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20
Q

Radial head and neck fracture presentation

A

Pain lateral proximal forearm
Loss of range of movement
Small swelling

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21
Q

X-ray sign radial head/neck fracture

A

Fat pad/Sail sign (dark grey patch around joint)
Effusion present
Blood into joint - haemarthrosis

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22
Q

What causes fat pad/sail sign?

A

Displacement of fat pads from fossas (olecranon)

Fat is less dense - dark black/grey

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23
Q

OA of elbow common people

A

Men > women
Manual workers
Athletes involving throwing (javelin)

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24
Q

Patient description OA elbow

A

Grating (crepitus)
Locking (loose cartilage)
Swelling = late
Paraesthesia (ulnar nerve impinged by osteophyte)

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25
Q

Rheumatoid arthiritis?

A

Autoimmune

Autoantibodies - rheumatoid factor attach synovial membrane

26
Q

What happens in RA?

A

Inflammed synovial cells form pannus

Penetrates through cartilage to bone causing erosion and deformity

27
Q

Where does RA mostly occur?

A

Metacarpophalangeal joints
Proximal interphalangeal joints
Hands, feet, cervical spine

28
Q

Other damage RA

A

Anaemia of chronic disease

Damage to other organs (pericarditis, atherosclerosis, peripheral neuropathy)

29
Q

RA vs OA

A

RA: OA:
20-40 Older
Rapid onset (remission/worse) Gradual
Symmetrical Unilateral begins
Pain improves with usage Pain worse with use
Fatigue, malaise No systemic effects

30
Q

Radiological features RA

A

LESS
Loss of joint space
Erosions of bone (marginal/juxta-articular)
Soft tissue swelling
See through bones (periarticular osteopenia)

Can have subluxation/gross deformity of joints

31
Q

What is tennis elbow?

A

Lateral elbow tendinopathy - Lateral epicondylitis

32
Q

Lateral elbow tendinopathy presentation

A

Pain at common extensor origin (lateral epicondyle)

33
Q

Why does lateral elbow tendinopathy occur?

A

Extensor carpi radialis brevis usually stabilises wrist when elbow extended
ECRB weakened due to overuse - microscopic tears in origin area
= inflammation and pain

34
Q

When does pain occur LET?

A

Extension of wrist = lateral epicondylar pain

35
Q

People likely to get LET

A

Tennis players
Painters
Plumbers
Carpenters

(repetitive extension of wrist)

36
Q

What is golfers elbow?

A

Medial elbow tendinopathy - medial epicondylitis

37
Q

What does MET affect?

A

Common flexor origin - medial epicondyle

38
Q

Common site of MET

A

Between pronator teres and flexor carpis radialis origins

39
Q

Patient presentation MET

A

Medial elbow ache
Pain on resisted pronation/flexion of wrist
Ulnar nerve symptoms (little finger +1/2 ring finger parathesia)

40
Q

Causes of swellings of elbow

A

Olecranon bursitis
Rheumatoid nodules
Gouty Tophi

41
Q

Assessing radial nerve function

A

Thumbs up -motor

Sensory - thumb and base of 2 first fingers (dorsum)

42
Q

Assessing median nerve

A

Ok sign - motor

Sensory - tips of first two fingers, most palm of hand

43
Q

Assessing ulnar nerve

A

Little finger + half ring finger

44
Q

What is students elbow?

A

Olecranon bursitis

Due to repeated minor trauma (leaning on desk)

45
Q

What occurs during olecranon bursitis?

A

Fills with serous fluid - transilluminates when light shines through it

46
Q

Treatment olecranon bursitis

A 
Cosmetic 
If infected (eg septic bursitis) need antibiotics and aspiration
47
Q

Rheumatoid nodules

A

Have RA
Usually smoker and more aggressive RA
More prone to other extra-articular complications (eg vasculitis and lung disease)

48
Q

where do RA nodules occur usually?

A

Over-exposed regions with repeated microtrauma

Elbow
Fingers
Forearms
Back of heel

49
Q

What is gout?

A

Defective purine metabolism
Increased production of URIC ACID
Monosodium urate crystals deposited in synovial cavity
= acute inflammation

50
Q

Gout treatment

A

NSAID’s

Xanthine oxidase inhibitors (reduce production of uric acid)

51
Q

What are gout tophi?

A

Nodular masses of monosodium urate crystals in soft tissue

Caused by hyperuricaemia (untreated gout)

52
Q

Complications gout tophi

A 
Usually painless but:
Pain
Soft tissue damage
Deformity
Joint destruction
Nerve compression
53
Q

Common sites gout tophi

A

Fingers
Ears
Olecranon bursa
Elbow subcutaneous tissue (resemble RA nodules here)

54
Q

What happens to gout tophi as enlarge?

A

Work way towards skin to drain via forming sinus tract or draining ulcer

55
Q

Ulnar nerve journey

A

Posterior to medial epicondyle of humerus

Through cubital tunnel –> forearm

56
Q

Where is cubital tunnel?

A

Posterolateral to medial epicondyle

57
Q

Where does ulnar nerve often get compressed?

A

Flexor carpi ulnaris = two heads (medial epicondyle and medial olecranon origin)
Tendon arch joins them
Ulnar passes under this arch and can get compressed

58
Q

How ulnar nerve injured?

A

Banging elbow on desk

59
Q

Pain ulnar nerve trauma

A

Sharp pain radiating from elbow to cutaneous ulnar territory

60
Q

Effects of ulnar nerve compression

A

Flexor carpi ulnaris affected
Median half of flexor digitorum profundus

Little finger + 1/2 ring finger parathesia

61
Q

Treatment ulnar nerve compression

A

Surgically release and move anterior to medial epicondyle

MSK 2023 (55 decks)

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