Common Elbow and Wrist Conditions Flashcards
How does a medial epicondyle fracture result in ulnar claw?
- Damages the ulnar nerve
- There will be a loss of sensation over the medial 1 and 1/2 fingers of the hand, on both the dorsal and palmar surfaces.
Dislocated elbow
Cause: FOOSH
Common in: Children and young adults
Symptoms: Pain, deformity and loss of function
Mostly posterior
Pulled elbow
Subluxation of radial head/ ‘Nursemaid’s elbow’
Subluxation from annular ligament
Cause: Longitudinal traction along extended arm
Common in: 2-5 yrs
Symptoms: Reduced movements/ later pain
Olecranon bursitis
Inflammation of bursa due to trauma or friction = ‘student’s elbow’
Presentation: Soft, cystic and transilluminates (shows its cystic not cellular)
Cosmetic concerns
Can become infected
Colles fracture
Fracture of distal radius +/- ulna
Dorsal displacement and angulation, shortening
Smiths fracture
Fracture of distal radius +/- ulna
Palmar displacement and angulation, shortening
Scaphoid fracture
Cause: FOOSH
Common in: Teens and 20s’
Symptoms: Tenderness in anatomical snuffbox
Hard to see on X-rays
Delayed presentation
Limited blood supply - poor healing and avascular necrosis
Where do the flexor muscles originate from?
The flexor muscles originate from the medial epicondyle.
What is the cause of Volkmann’s ischaemic contracture?
Distal fracture of humerus - Direct damage, or swelling can cause interference to the blood supply of the forearm from the brachial artery. The resulting ischaemia can cause Volkmann’s ischaemic contracture – uncontrolled flexion of the hand, as flexor muscles become fibrotic and short. There also can be damage to the median, ulnar or radial nerves.
What is the difference between tennis elbow and golfers elbow?
Typically, tennis players experience pain in the lateral epicondyle from the common extensor origin. Golfers experience pain in the medial epicondyle from the common flexor origin.
How does a supracondylar fracture occur?
A supracondylar fracture occurs by falling on a flexed elbow. It is a transverse fracture, spanning between the two epicondyles.
What are golfers/tennis elbow?
Sportspersons can develop an overuse strain of the common tendon – which results in pain and inflammation around the area of the affected epicondyle.
What is the initial management of an elbow dislocation?
- Sling or spintage
- Analgeisa
- NVT assessment (nerve, vessel, tendon distal to fracture)
- X-Ray
What is the definitive management of an elbow dislocation?
- Closed reduction under sedation to relocate joint
- Reassess NVT stability
- Immobilisation
- Re-X-ray
What is the prognosis of someone with an elbow dislocation?
Good outcome if simple
Stiffness
Recurrent instability
Supracondylar fracture of distal humerus
FOOSH
Normally age 5-7
Pain, marked swelling, bruising, no function
Neuromuscular compromise
What are the complications that may arise from a supracondylar fractures of the distal humerus?
Neurovascular injury
Late deformity (cubitus valgus/varus)
Late neuropathy
Radial head/neck fracture
FOOSH
Commonest elbow fracture
Lateral pain/ modest swelling/ loss of range
Occult fracture (not visible on imaging)
Fat pad sign
What is the treatment for a radial head/neck fracture?
- Sling and early range of motion if minimally displaced
- Open reduction and internal fixation (ORIF)
- Replacement of head
What is the treatment for subluxation of the radial head?
- Closed reduction = procedure to set a broken bone without surgery = manipulation of bone
- Sling (spontaneous resolution)
Elbow osteoarthritis
- Degenerative disease of articular cartilage
- Primary or secondary (post traumatic)
- More common in males
- Stiffness tolerated well esp. loss of extension
Supracondylar fracture of distal humerus
Cause: FOOSH
Common in: Age 5-7
Symptoms: Pain, marked swelling, bruising, no function
Complications: Neuromuscular compromise
Elbow rheumatoid arthritis
Systemic autoimmune disease
Commonest inflammatory arthropathy
Lining of the synovial membrane develops into a large mass of tissue (pannus) which leads to joint destruction.
Symptoms: Symmetrical polyarthropathy with morning stiffness
What is lateral elbow tendinopathy?
Lateral epicondylitis/ tennis elbow
- Degenerative tendinopathy - common extensor origin
Cause: repetitive activity
5th-6th decades
Radial head/neck fracture
Cause: FOOSH
Symptoms: Lateral pain/ modest swelling/ loss of range
Occult fracture (not visible on imaging)
Fat pad sign
What are rheumatoid nodules?
- Extra-articular manifestation of rheumatoid arthritis
- Cosmetic concerns
- Treatment: treat the underlying disease
What is the treatment for olecranon bursitis?
Aspiration +/- injection
Surgery
What is gouty tophi?
Disorder of nucleic acid metabolism leading to hyperuricaemia (build up of sodium urate crystals)
Fracture of distal radius +/- ulna
FOOSH
Pain/swelling/ ‘dinner fork’ deformity
What is the treatment for a scaphoid fracture?
POP cast - forearm or scaphoid
Surgery if displaced
What is ulnar nerve neuropathy?
- ‘Cubital tunnel sundrome’
- Compressive neuropathy of ulnar nerve at elbow (beware of compression at wrist or neck)
- Paraesthesiae, numbness and weakness
- Hypersensitive ‘funny bone’
How do you treat ulnar nerve neuropathy?
- Splintage
- Decompression +/- anterior transposition of nerve
When should you consider surgery for elbow conditions?
If the outcome is better than nature
Failure of non-operative treatment
