Common Conditions of the Elbow Flashcards
Other Name for Lateral Epicondylitis
Tennis Elbow
Lateral Epicondylitis
- Patho
- Sxs
- PE
- Radiology
- Treatment
Patho
- inflammation of the extensor tendons at their insertion onto the lateral epicondyle
- more commonly a degenerative disease (tendonosis) in older adults as the blood supply diminishes to the tendon, reducing its ability to heal itself
Sxs
- dull ache on the outer aspect of the elbow that increases with grasping, twisting and resisted extension of the wrist and fingers
- pain can cause guarded motion perceived as weakness
PE
- tenderness over insertion of the extensor tendon on the lateral elbow
increasing pain with resisted extension/supination of the wrist
Rad
- normal
- use to r/o radiocapitellar arthritis
Tx
- RICE, especially when acute
- ->be aware of tennis elbow bands; can cause radial tunnel syndrome
- PT: iontophoresis/friction massage
- NSAIDs +/- injection
- last resort –> surgery
Other Names for Medial Epicondylitis (3)
Pitcher’s Elbow
Golfer’s Elbow
Bowler’s Elbow
Medical Epicondylitis
- Patho
- Sxs
- PE
- Radiology
- Treatment
Patho
- microtrauma to flexor carpi radialis tendon insertion on the medical epicondyle (same mechanism as lateral epicondylitis)
- degenerative tenodosis
Sxs
- dull ache on medial elbow that is worse with flexion and pronation
PE
- tender on medial epicondyle
- increased pain with resisted flexion and pronation
Rad
- normal
Treatment
- Rest +/- ice
- NSAIDs +/- injections (be very careful injecting because may damage ulnar nerve - refer)
- PT: iontophoresis, friction massage
- referral for resistant cases
Olecranon Bursitis
- Patho
- Causes
- Risk factors
- Dx
- Treatment
Patho
- Inflammation, swelling +/- pain over olecranon process
Causes:
- MC trauma
- Infection: puncture wounds; microscopic wounds
- Inflammation: gout, psuedo gout, RA, uremia in renal failure
Risk Factors: DM, chronic ETOH, occupation/hobbies, gout
Dx
- xray if trauma or suspicion of FB +/- gout
- CBC if suspicious of infx
- ESR/CRP if suspicious of gout
- aspiration for gram stain and culture should only be performed by specialist (s. aureus MC)
Tx
- NOTHING. Resolves in 2-4 weeks
- Rest, protect from further trauma
- NSAIDs for analgesia
- only use injection if certain no infx is present
Types of Ulnar Nerve Entrapment Syndromes and generally their causes
Cubital Tunnel Syndrome
- aka Truck Driver’s Elbow
- chronic pressure on the ulnar nerve where it passes b/w bone, tendons, and ligaments at the elbow
- can also be entrapment of the nerve from hypertrophy of the triceps or the flexor/pronator musculature
Tardy Ulnar Palsy
- Ulnar neuropathy remotely after an injury at the condylar groove
Ulnar Nerve Entrapment Syndromes
- Causes
- Symptoms
- PE
- Dx
- Tx
Causes
- May be from acute trauma like fx or dislocation
- If from dislocation address this first–prompt reduction with neurovascular status evaluation
Sxs
- paresthesias in ring and small fingers
- weakness of intrinsic muscles
- weakness of abduction of 5th digit
PE
- Pope blessing’s sign with chronic entrapment
- Positive Froment’s sign
- atrophy of intrinsic muscles on inspection
Dx
- Clinical +/- EMG
Tx
- splinting - night time extension splint
- NSAIDs
- surgery - ulnar nerve transposition
Radial Nerve Entrapment Syndromes (2)
Radial nerve palsy
Radial tunnel syndrome
Radial nerve palsy
- Other name for (1)
- Signs
- Tx
“Saturday Night Palsy”
Signs - wrist drop - loss of sensation in dorsal web space b/w thumb and index finger - Tx - cock-up splint for wrist - ortho f/u - OT - Claw hand may result in non-resolving cases
Radial Tunnel Syndrome
- nerve this actually involves
- common cause of
Actually posterior interosseus nerve in forearm
Use caution with tennis elbow straps
Subluxation of Radial Head
- Patho
- Common age group
- MOI
- Signs
- Rad
- Reduction technique
- F/u
Patho
- non-calcified radial head is pulled out from under annular ligament
Common age group
- peak age 1-4 y.o.
MOI
- sudden longitudinal pull on arm with forearm pronated
Signs
- arm held in slight flexion and pronation
- child will not use arm, but usually not distressed
- x-ray if any question of fx
Reduction
- supinate forearm and flex the elbow
F/u
- re-examine and get post reduction films
- sling prn for pain, but try to avoid
- NSAIDs for pain
- generally child will begin to use arm immediately but will be sore for 3-5 days
- educate parents to avoid MOI to b/c joint now more unstable
Elbow Dislocation
- MOI
- Evaluation
- Reduction
MOI
- fall on a nearly extended elbow; high energy
- MC posterior
- commonly associated with radial head fx
- also check wrist
Eval
- x-rays
- PE: good neurovascular exam
Reduction
- IV conscious sedation
- stabilize upper arm
- in line traction (longitudinal pull) on lower arm
- flexion of elbow
- push toward hand on olecranon
F/u
- long arm posterior splint
- post-reduction films
- CMS in hand
- specialist referral
Fx of the Radial Head
- MOI
- Sxs
- PE
- Dx
- Tx
MOI
- FOOSH
- radial head driven into capitellum
Sxs
- elbow pain +/- swelling
PE
- tenderness over radial head
- limitation of motion, esp with extension and pronation/supination
Dx
- AP, lateral, and oblique series
- postive fat pad sign
Tx
- generally OK for primary care if <50% of joint
- sling for comfort
- ice for swelling, pain
- analgesics, avoid NSAIDs in fxs
- encourage early AROM
- f/u films at wk 1, 3, 6
Radial Neck Fxs
- long arm posterior splint
- refer to specialist
Supracondylar fx
- MOI
- Management
- Complications
- Rehab
MOI
- fall backward on partly extended elbow
- generally pediatric fx
Management
- REFER AND MD CONSULT ALWAYS
- high risk for vascular compromise (brachial art) and nerve injury (median, ulnar, or radial)
Complications
- loss of ROM
- post-traumatic arthritis
- non-union
- NERVE OR VASCULAR INJURY
Rehab
- very important to avoid loss of ROM
