Common Elbow Conditions Flashcards
What does the capitulum articulate with?
Radius
What does the trochlea articulate with?
Ulna
Which bone moves in pronation and supination?
Radius rotates around the fixed ulna
In a normal elbow joint, if you draw a line down the anterior surface of the humerus and the middle of the radius where should the lines cross?
The capitulum
What type of membrane surrounds the joint capsule of the elbow?
Synovial membrane
What are the 3 ligaments of the elbow joint?
Radial collateral ligament
Ulnar collateral ligament
Annular ligament
What is the function of the Radial collateral ligament?
Resists force applied from the medial side
What is the function of the ulnar collateral ligament?
Resists force applied from the lateral side
What is the function of the Annular ligament?
Holds head of the radius in place
What are the general presentations of an elbow condition?
Pain
Swelling
Restriction of movement
Deformity
Where does the fracture usually take place in a supracondylar fracture?
Fracture line extra articular so doesn’t involve the joint
Above the condyles
In a supracondylar fracture, what direction is the distal fragment usually displaced?
Posteriorly
What sort of trauma leads to a supracondylar fracture?
Fall onto an outstretched hand (FOOSH) with arm normally EXTENDED
What nerves and blood vessels are at risk of damage from a supracondylar fracture?
Median nerve
Radial nerve
Brachial artery
What can happen as a result of a supracondylar fracture damaging the brachial artery?
Oedema (Compartment syndrome)
Ischaemia
Muscle infarction leading to Volkmann’s Ischaemic contracture
How does muscle infarction lead to Volkmann’s Ischaemic contracture?
Dead muscle tissue undergoes repair
Scar tissue replaces dead tissue via fibrosis
Myofibroblasts in fibrotic tissue contract
What branch of the median nerve is most at risk with a supracondylar fracture?
Anterior interosseous branch
How can injury to the brachial artery be assessed?
Detect capillary re-fill time, press on the nails and see how long it takes for them to go from white back to pink
What nerve is likely damaged if the patient cant make an OK sign with their fingers properly?
Anterior interosseous branch of median nerve
What the possible ways a supracondylar fracture can be managed?
Closed reduction and held in position with a plaster
Closed reduction and percutaneous pinning
What is a pulled elbow?
Subluxation of the radial head from the annular ligament
What is subluxation?
Partial dislocation of a joint with some abnormal apposition of the articulating surfaces
Why is subluxation of the radial head/pulled elbow common in children?
Annular ligament is weaker in children
How is subluxation of the radial head/pulled elbow normally caused?
Longitudinal traction with arm extended and forearm pronated
(Swinging a child around in circles)
How is a pulled elbow/subluxation of the radial head treated?
Flex the elbow and supinate (REVERSE THE FORCES THAT CAUSED)
How are elbow dislocations usually caused?
Fall Onto Outs Stretched Hand (FOOSH) So arm in extension
What way is the elbow normally dislocated in a fall onto an outstretched hand?
Posterior and Lateral (Posterolateral)
Why are elbow dislocations more common when the joint is partially flexed?
Here elbow stability relies more on the ligaments
When fully extended or flexed the bone configurations contribute to stability the most
What may be damaged as a result of an elbow dislocation?
Ulnar nerve
Ulnar collateral ligament
How are dislocations described in terms of direction?
Depends on the displacement of the distal fragment
So in an elbow dislocation the ulna and radius normally have moved posterior and laterally
How do you treat an elbow dislocation when theres no associated neurovascular damage?
Analgesics then reduce back into place
How do patients with radial head or neck fractures usually present?
Previous trauma
Lateral elbow pain
Restricted Range of Motion (especially on pronation/supination)
How may you detect a radial head or neck fracture on an X-ray?
Presence of fat pad/sail sign
What is a fat pad sign indicating a radial head fracture?
Darker denser region surrounding the elbow
As a result of Haemarthosis, this pushes the fat out from the coracoid and olecranon fossa producing the darker region
What is haemarthrosis?
When blood is in the joint
How is a radial head or neck fracture treated if it minimally displaced?
Conservative management and early Range Of Motion exercises
Compare Osteoarthritis to Rheumatoid arthritis:
When are they the worst and when do they get better?
Rheumatoid = Early morning joint stiffness improves with movement
Osteoarthritis = Gets more painful as day goes on/ prolonged activities
Compare Osteoarthritis to Rheumatoid arthritis:
What joints are affected?
RA = Symmetrical and poly articular
OA = Starts Uniaterally and limited to one set of joints (fingers)
Compare Osteoarthritis to Rheumatoid arthritis:
What joints are affected?
RA = Symmetrical and poly articular
OA = Starts Uniaterally and limited to one set of joints (fingers)
Compare Osteoarthritis to Rheumatoid arthritis:
Do you get systemic symptoms?
RA = Yes fatigue and malaise
OA = None
What is Osteoarthrits?
Degenerative disease of articular cartilage, the progressive loss of cartilage leads to Bone on bone rubbing and pain with use
What is the Pneumonic for remembering how Osteroarthritis appears on an X-ray?
What are the features of an osteoarthritic x-ray?
LOSS
Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts
How is an osteoarthritic elbow treated?
Analgesia
Intra-articular injections (only 2 or 3 times effective)
Replacement of joint
What is Rheumatoid arthritis?
A systemic inflammatory diseases which can affect joints
What happens in Rheumatoid arthritis?
Autoimmune antibodies attack synovial membrane
Inflamed synovial cells proliferate and form a pannus
Pannus erodes and penetrates the cartilage and bone leading to joint deformity
What will be raised in the blood in an individual with Rheumatoid arthritis?
cRP
Platelet potentially
Who are at an increased risk of RA?
Female
40-50yrs
What are some systemic features of elbow RA?
Malaise
Fatigue
Weight loss
Low grade fever
What is the pneumonic used to remember the features of a Rheumatoidal arthritic x-ray?
LESS
What does the LESS mnemonic for Rheumatoid arthritis stand for?
Loss of joint space
Erosions of bone
Soft tissue swelling
See through bones (osteopenia) near the joint space
With severe RA what may happen to the joints particularly at the fingers?
Subluxation of joints
Metacarpophalangeal and proximal interphalangeal joints particularly affected so fingers start too deviate to ulnar side
What is Lateral Epicondylitis/tennis elbow?
Tendonopathy of the common extensor origin (particularly extensor carpi radialis brevis
What movement leads to the tendonopthy of the common extensor origin leading to lateral epicondylitis/tennis elbow?
Repetitive wrist extension and forearm pronation (BACKHAND IN TENNIS)
What can be examined in a patient with lateral epicondylitis /tennis elbow?
Pain in extensor origin on resisted wrist/finger extension when the elbow is fully extended
What 4 muscles originate on the common extensor origin (Lateral epicondyle)?
Extensor carpi radialis brevis
Extensor carpi ulnaris
Extensor digitorum
Extensor digiti minimi
What is Medial Epicondylitis/golfers elbow?
Tendonopathy of the common flexor origin
What can cause medial epicondylitis/golfers elbow?
Micro trauma to the medial epicondyle caused by repetitive activities like wrist Flexion and forearm pronation
Forceful grip
Exposures to constant vibration at elbow
How do patients with medial epicondylitis/golfers elbow present?
Pain over medial epicondyle
Pain with resisted forearm pronation and wrist Flexion
How is lateral epicondylitis/tennis elbow and medial epicondylitis/golfers elbow treated?
Physiotherapy
Activity modification
What muscles originate at the common flexor origin?
Pronator Teres
Flexor carpi radialis
Palmaris longus
Flexor carpi ulnaris
Flexor digitorum superficialis
How can you remember the 4 superificial anterior forearm muscles?
Pass, Fail, Pass, Fail
Thumb under medial epicondyle then palm with 4 fingers going across the top of the forearm
Index = Pronator Teres
Middle = Flexor carpi radialis
Ring = Palmaris longus
Little = Flexor carpi ulnaris
Compare Osteoarthritis to Rheumatoid arthritis:
How fast is the onset?
RA = Rapid (weeks - months)
OA = Many years
What drugs are used to treat Rheumatoid Arthritis?
DMARDs (Disease Modifying Anti-Rheumatic Drugs)
What is Olecranon Bursitis?
Inflammation of the bursa overlying the olecranon normally caused by friction
What is the alternate name to Olecranon Bursitis?
Students elbow
What is it called if a bursa has become infected?
Septic bursitis
What should happen if a light is shone onto a sterile olecranon bursitis?
What about septic bursitis?
Light should shine through due to fluid just being serous fluid
Not going to transluminate in septic bursitis
How is a sterile olecranon bursitis normally treated?
Normally sorts itself
Very rarely drainage
How is a septic olecranon bursitis treated?
ANTIBIOTICS
What are rheumatoid nodules?
Hard nodules that are a common manifestation of extra-articular Rheumatoid Arthritis
How do rheumatoid nodules appear with a light shone on them?
How are rheumatoid nodules treated?
Treat the Rheumatoid Arthritis (DMARDs)
Possibly surgery (mainly a cosmetic problem)
What is gout?
Inflammatory condition caused by hyperuricaemia leads to deposition of mono sodium Urate crystals in the synovial cavity of joints
Triggers innate immune response leading to acute inflammation of the joints
How is gout normally treated?
NSAIDs (Non steroidal anti inflammatory drugs)
What are gouty tophi?
When monosodium Urate (MSU) crystals are deposited into soft tissues like the skin and tendons
White looking crystals
Once the high initial levels of uric acid in the blood have been treated, what prophylactic drug can be given to reduce production of uric acid and reduce the risk of gouty tophi?
Allopurinol or febuxostat
What is cubital tunnel syndrome?
When the ulna nerve in the cubital tunnel of the elbow gets compressed
How do you treat cubital tunnel syndrome?
Decompress the ulnar nerve in the cubital tunnel
Splinting at 45º at night
Analgesia
Surgery
What does the overlying tendon of the roof of the cubital tunnel run between?
The 2 heads of flexor carpi ulnaris
What may a patient with Cubital tunnel syndrome present with?
Parasthesia (numbness and tingling) in the cutaneous territory of the ulnar nerve and maybe muscle weakness in muscles supplied by ulnar
